It has been my honor to serve as the 69th president of the Congress of Neurological Surgeons. I was humbled and excited by this opportunity to make a difference. In this address, I hope to stimulate a discussion about how we can and should practice, educate, and influence with reason. How as active voices for science and truth we can cultivate an age of reason for neurosurgery, and medicine as a whole. âA long habit of not thinking a thing wrong gives it a superficial appearance of being right.â These words, written by Thomas Paine, in the pamphlet âCommon Senseâ, which spurred the United States to fight for its independence, underscore the theme of this year's meeting. Paine would go on to pen The Age of Reason and the Rights of Man, which were some of the first examples of free rational inquiry and critical thinking in the United States. Today, we are living in a time of major upheaval with respect to trust in institutions, acceptance of fact, and recognition of expertise. Twenty-four hour news cycles, constant reminders to engage in social media, and a culture that rewards fame for fame's sake have all contributed to our current state of mistaking skepticism and critical thinking with denialism. Equal time is given to spurious viewpoints, which are touted as equivalent to verifiable truths. To be clear, skepticism is no vice. Suspicion of dogma is not, by itself, a crime. However, what has happened worldwide over the past several years has eroded trust in institutions and neurosurgery is no exception. Much of the loss of trust in the rigor of scientific inquiry can be traced to the deluge of information to which we are exposed. The amount of information being generated across the globe is staggering. Some 500 million tweets are sent daily for a total of 200 billion tweets per year. By the year 2020, the entire digital universe is expected to reach 44 zettabytes (that's a 1 followed by 21 zeroes). That is 40 times more bytes than there are stars in the observable universe. The ability to distinguish reputable information from misinformation is a nearly impossible task when information comes at us so quickly. One can appreciate how easily information can be manipulated. Simple things like reviews on websites can no longer be trusted. In fact, research recently published in the journal Science, has shown that on social media, false stories spread 70% faster than true ones. This phenomenon is not due to bots but rather posts by humans. Conspiracies can be easily concocted by unsubstantiated claims. Correlation is often confused with causation. Myth is reported as fact. Celebrity can now overcome a need for proof. The deluge of scientific misinformation parallels the increase in digital content. Medical journals, once a respected repository of rigorous scientific inquiry have become the source of significant misinformation and dubious peer review. InCites Journal Citation Reports now indexes more than 12 500 journals. Not all journals are equal. Even a journal with a good reputation can sometimes get it wrong. Predatory journals, a term coined only a decade ago, are now commonplace and difficult to differentiate from well-respected titles. These journals often charge a significant article processing fee, lack rigorous, if any, peer review, and take advantage of the âpublish or perishâ paranoia that pervades academic medicine. One might think that the accessibility of data would allow individuals to make rational choices about the information that they consume. However, there is virtually no regulation of this information. Our patients have more access than ever to the medical literature. However, the democratization of information may have actually undermined scientific trust and understanding. As neurosurgeons, we can differentiate high quality journals from low-quality ones but the public probably cannot tell the difference. Patients now arrive to our clinics armed with misinformation in the form of alternative therapies including potentially harmful supplements or ineffective treatments. This is all creating a situation we would never have imagined 20 yr agoâbefore the rise of the internet. And it is a sensitive issueâat a time when we are encouraged, and appropriately so, to engage more with our patients and to listen and involve them, this admirable goal has gone awry. Now our first burden is to teach them how to trust the experts, trust us, again. We must be prepared to help our patients differentiate the truth from hype. To reassure them that the treatments we use are based on the best available medical evidence, and why evidence is essential. âI have always strenuously supported the right of every man to his own opinion, however different that opinion might be to mine. He who denies to another this right, makes a slave of himself to his present opinion, because he precludes himself the right of changing it.â Paine wrote that we are entitled to our own opinions, no matter how different yours may be to mine, but we should all retain the right to change it. And we should, if persuaded by solid evidence. As physicians, we are not immune to the pitfall of holding rigidly to our biases. As science changes our practices we are often slow to adapt. Physicians in general continue to practice medicine that is contrary to the evidence. Each year JAMA publishes an update on medical overuse. How many times do you see gabapentin and its derivatives prescribed for sciatica? How about those 2 million-dollar robots your hospital is buying for kidney surgery? It turns out the evidence for their efficacy is very thin. Although neurosurgery is not immune to these hazards, to our credit, we have taken on trials of procedures that have eventually narrowed their scope of use. When a treatment shows promise, we have done the studies to verify their worth. But there may always be grey areas particularly when it comes to certain procedures. âBut it is necessary to the happiness of man that he be mentally faithful to himself.â Has our judgment been clouded on occasion by economic incentives? Perhaps but we also get some things right including adopting technology knowing that the benefit will be there for our patients. Above all, when the challenge is adopting new ways of helping patients, it is incumbent on us to perform the appropriate studies when results look promising. No one else can validate or rejectâthat is a critical part of our responsibility as surgeons. An example from the neuro-oncology world is the EGFR variant 3 vaccine for the treatment of glioblastoma. Compared to historical controls, the vaccine showed tremendous promise but in a randomized controlled trial, it did not hold up. Neither did bevacizumab which also showed promise in Phase II trials but failed in phase III. What if we hadnât conducted these important randomized trials? How many patients would have been exposed to harmful and useless treatments? Without firm evidence for their use, procedures and treatments can be sold and promoted to an unsuspecting public who can be swindled, or worse, harmed. When this happens, even procedures that may benefit our patients can get caught up in the fray. We need only look to the lay press to see how our profession can be sullied in ways that may seem unfair to us. Poorly investigated procedures and technology can harm our entire profession. What do we do when this misinformation reaches our patients? And they believe it because they read it somewhere? Or someone told them about it? And they come to us with their belief hardened? As Paine tells us, it is an almost impossible task to undo what has been done. To be clear, no one person, political leaning, or socioeconomic class has a monopoly on misinformation. Today we have an example that is compelling, taking place in real time, literally as we sit here today. In perhaps what is the defining misinformation campaign of our times, the link between vaccines and autism. Measles was declared eradicated in the US in 2000 by the CDC and the Americas in 2016 by the Pan American and World Health Organizations thanks to widespread vaccinations. But just a few years later, the disease is making a resurgence due to a decline in vaccinations. Not because of some new untreatable strain or forces beyond our control, or a vaccine so expensive that no one can afford it. No, the resurgence is due to a decline in vaccinations. Parents simply choosing to not vaccinate. In Europe, the numbers are even worse with the continent experiencing nearly 100 000 reported cases. Measles is a terrible disease with a death rate as high as 30% prior to the vaccine. Even today, it has a case fatality rate of 3 in 1000. Nonmedical exemptions are becoming more common and are clearly causing a spike in measles outbreaks. These exemptions are occurring across the political spectrum in communities all over the United States. In my home state of Texas, the number of nonmedical exemptions has been rising dramatically, from just about 2000 in 2002 to over 64 000 in 2019. What has not been going down commensurate with this 30-fold increase in exemptions is the rate of autism. How did we get here? The link between measles, mumps, rubella and autism, stems from an article by Andrew Wakefield in 1998. This study of just 12 children concluded that the vaccine resulted in âdevelopmental regression in a group of previously normal childrenâ. The cause was taken up by celebrities and others resulting in a sustained attack against the safety of vaccines. We have watched the CDC and WHO and pediatric and infectious disease experts speak out with truth and science and reasonâand yet too many parents listen to celebrities and anecdotes. The scientists promoting the safety and efficacy of these vaccines get demonized. We have watched truth and reason be trumped by hype, no matter how well intended it is. The effects of this paper linger even today, all over the world, with high rates of belief that vaccines cause autism. Twelve years later, The Lancet published a retraction indicating that âseveral elementsâ of the paper were âincorrectâ. By then, the damage had been largely done. Now we are experiencing outbreaks all over the country with dangerous, even intentional, exposures of our children to diseases with not insignificant consequences, including death. Change is possible though. After a measles outbreak in Disneyland in 2015, the California legislature passed Senate Bill 227 which banned non-medical exemptions in 2016. This resulted in a record high vaccination rate of over 95% of kindergartners. Medical misinformation is making its way into our hospitals and clinics like never before. We need to push back. We are the experts, and we can make a difference. When we hear something absurd, we should not be afraid to call it out. We must use our expertise to inform patients and the public. Our voices can change minds. There is no risk-free proposition. We do have data on harm from vaccines. The National Vaccine Injury Compensation Program pays out adjudicated claims and collects data from individuals harmed by vaccines. Between 2006 and 2017, 3.4 billion doses of vaccines were distributed in the US. One individual was compensated for every 1 million doses distributed. By comparison, the likelihood of being struck by lightning is 1 in 700 000. This information is rarely, if ever, mentioned in the so-called vaccine debate. Perhaps the most famous example of the harm medical misinformation can cause is the choice Apple co-founder Steve Jobs made regarding his own cancer diagnosis. Jobs was diagnosed with a pancreatic neuroendocrine tumor at age 48. He was advised to undergo potentially curative surgery, but for 9 mo he sought out alternative treatments including vegan diets, acupuncture, cleansings, and even consulted a psychic. He eventually had the surgery but according to many experts this delay almost certainly cost him his life. My wife Lorelei was diagnosed with a similar tumor not so long ago. In 2010, after years of intermittent abdominal pain attributed to reflux, while suffering with severe pain, from what we now know was acute pancreatitis, she went, on her own, to a local emergency room and insisted on getting a computed tomography. It was a shock; she was too healthy to be that sick. We discovered her tumor when our twin boys were barely a year old. We were fortunate to have the best information on how to treat her tumor and after her distal pancreatectomy and splenectomy, she has made a remarkable recovery. I would not be standing here, not as president of the CNS, not as a neurosurgeon, but as the person I am today had it not been for the love and support of my wife. Her journey reminds me that medical science has made a remarkable difference in the lives of countless human beings. What would have happened to someone with a pancreatic tumor 100 yr ago, or even 50 yr ago without the advances that we now take for granted. We are celebrating cures of stage IV cancers even in patients with brain metastases thanks to the diligence and hard work of unsung heroes in laboratories and patients willing to enroll in clinical trials. We wait to hear results of prospective randomized controlled trials because they provide us the best evidence that a treatment is going to work. And the payoff is that our patients survive to live another day, spend time with their families, and enjoy life. We are in a unique position to advocate for our patients by advancing truth, confronting misinformation, and recommending the best treatments, but also by avoiding those that do not work or have not demonstrated efficacy in a rigorous way. We should not be afraid to advise a patient that an âalternative treatmentâ may expose them to real harm. Choosing âalternativeâ medicine over standard of care therapies can lead to a significant decrease in survival for patients with cancer. Now I askâwhat can we do, each of us? I want you to leave here ready to help our patients by doing something, and each of us will choose our own way. Doing something can take many forms. It is an uphill battle for sure. You will be facing the so-called Dunning-Kruger Effect in which overconfidence and a knowledge deficit go hand in hand. I had the opportunity to meet with Dr Peter Hotez, Dean for the National School of Tropical Medicine at Baylor College of Medicine, and a champion of vaccinations, he told me we need a curriculum that specifically teaches health and science verbal communication in our medical schools. We need to teach the tools to defend science and expertise. We need to speak in declarative sentences and avoid talking down to our patients. He titled his book âVaccines Did Not Cause Rachel's Autismâ in order to simplify the message. I encourage you to read this book, but do not look at the book reviews; theyâve been corrupted by the anti-vaccination movement. âThe mind once enlightened cannot again become darkâ To conclude, I want to encourage you to counter misinformation and dangerous recommendations in the following ways: We must all stay abreast of the latest and best studies in our field. Familiarize yourselves with ways to differentiate good studies from bad. When patients ask you about a treatment you know to be ineffective or dangerous, it is your opportunity to help that patient Check your arrogance though, our patients deserve honesty, as well as humility and respect Participate in honest and open Morbidity and mortality conferences, Review practice changing peer-reviewed literature with colleagues If misinformation is being spreadâsay something. We have to be actively engaged. We are the experts. Be critical, be skeptical, but remain open to changing your mind if the evidence convinces you to do so. This is what I am asking. That we are even more forceful in being the guardians of medical truth with our patients and with our communities. To quote Paine one last time: âThe mind once enlightened cannot again become darkâ Disclosures The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
The following reminiscence by Cedric Raine is the 10th autobiography in a series published in the Journal of Neuropathology and Experimental Neurology. These have been solicited from senior members of the neuropathology community who have been noted leaders and contributors to neuroscience and to the American Association of Neuropathologists (AANP) and have a historical perspective of the importance of neuropathology in diagnosis, education, and research. His is the first autobiography by a distinguished PhD member (as well as former president) of the AANP, highlighting the contributions and integral roles of basic neuroscientists in our Association. It is hoped that this series will entertain, enlighten, and present members of the AANP with a better sense of the legacy that we have inherited, as well as reintroduce our respected members as humans having interesting lives filled with adventures, joys, and sorrows, and allow them to present their lives in their own words. MNH, RAS âA man is the product of his thoughts. What he thinks he becomes.â Mahatma Gandhi Lacking a more original arresting opening, let me begin by saying that to be invited to join the list of esteemed neuropathologists featured in the Journal's Autobiography Series, following icons like Asao Hirano, Robert Terry, and Nicholas Gonatas, is both a privilege and a challenge. Never known for being conventional and sporting a background completely at odds with the standard training of most members of the American Association of Neuropathologists (AANP), I would like to take off on a different foot by thanking my colleagues in the Association for welcoming and accepting me, among the first PhDs, into the fold as an Active Member. When Mike Hart rang me a few months ago asking me to prepare a piece for the Series, my knee-jerk reaction was to decline on the grounds of juvenility and inappropriateness. Recognizing that autobiographies usually represent one's own self-chosen, self- redacted reminiscences, I was in no hurry to wax solipsistic to the readership and my colleagues. As we spoke, however, I rationalized the issue by recalling how many years had flown by since I became involved with the AANP (actually, 44) and how my own development as an investigator had paralleled and benefited from my affiliation with the Association and its mouthpiece, the Journal of Neuropathology and Experimental Neurology (JNEN). Setting feelings of uncertainty aside and with Mike still on the line, I thought, âthis is the academic body that gave me the legs to stand on in neuropathology; of course, I'm qualified; I'll do it.â So, for an autobiography garnished more with anecdotes than achievements, read on. I was born in May 1940 in Eastbourne, England, to a single mother; the vivid description of WWII events from her provided me with images difficult to distinguish from actual memories. She used to talk about the Dunkirk evacuation and the dogfights overhead between Spitfires, Hurricanes, and ME 109s, with their contrails slicing the summer sky, all occurring while I was in my push-chair. Moreover, this coastline was also the planned landing site for the German invasion barges waiting to depart Belgium, but thanks to the Royal Air Force and the Valiant Few, it never came to pass. Not surprisingly, Eastbourne residents were advised to evacuate to safer havens, particularly as German bombers driven from the London Blitz fled our airspace and jettisoned unspent bombs along the coast. My mother decided to return to her parents' home in Carlisle, Cumberland, 400 miles north, 8 miles south of the Scottish border. We arrived in Carlisle in 1942, unannounced and definitely not welcome. Apparently, she had left Carlisle about 10 years earlier under a cloud and had not been heard of since. However, her odyssey had ended; her funds had run dry and she had come home. Aunt Maureen, who is 7 years older than me, answered the doorbell and found her sister who she had never seen, standing on the doorstep with âa beautiful little boy in a green woolen suit with small pink flowers across the front.â We were admitted into the house by my grandmother; my grandfather was summoned from his victory garden and there followed an unpleasant confrontation ending with my grandmother (my life's best friend and savior), taking me by the hand out of the fray saying âT am going to put this young man through university, â and she did. Shortly thereafter, real memories began to form. There were 4 sisters in the house; 3 of them rather like the ugly sisters of Cinderella constantly battled with my mother and abused me at their convenience. I was terrified; I used to hide a lot and developed a bad stutter, which stayed with me until I came to the States in the late 1960s. My mother kept my hair long and in a pageboy style (remember Cedric of âLittle Lord Fauntleroy?) and had me attend dancing classes at the age of 3 (Fig. 1). About 12 months later, the hair came off, my mother took a war-related job, and I was released to the Carlisle streets to become a grubby member of the populace. The dance class of Florence Wilkinson (rear center), Carlisle, 1943. That's me, fifth from left, front row, hands on knees. Note pageboy hairstyle. My aunt Maureen (extreme right, in front of man) delivered me to the class. It was wartime and, like many cities in the United Kingdom, Carlisle was in the thick of it. The United States had by now entered the war (thank heavens!), and being a center for about 6 railroad companies and situated on the only road south from Glasgow (the main port for traffic from North America), everything had to come through Carlisle, much to the delight of the local kids. The roadside and railway embankments became our playgrounds as convoys and trains of US and Canadian troops, lines of gray-painted trucks with long trailers carrying airplanes with folded wings, and tanks (oh, the tanks!) trundled through the cobbled streets of Carlisle. Near our street was a long lay-by where tanks would stop as crews took a break. I can still smell the hot oily fumes. We would race like mad to them and climb aboard shouting, âAny gum, chum?â Our reward was usually sticks of Wrigley's gum and/or a Hershey barâwhat a delight to kids from families on severe rationing! On 1 occasion, an American soldier, noticing my dirty face, gave me a bar of perfumed soap with which I ran home to give my mother who had not seen its like for some years. The war had a toughening effect on kids: fathers were not around, we lived in a matriarchal society, and we grew up fast. My grandmother, anxious to get me out of the house, walked me down to Brook Street School just after I turned 4 and enrolled me as a 5-year-old in the infants' class. That worked fine until I was to take the 11-plus examination, a to the at the age of and the to a education, at which were My age was and I was to to take the the following I the 11-plus some and a and a on the I and began by saying that I had to the to a a I thought, but was by a about in I still from I of from Brook Street the to 8 but years at Carlisle an in the It was of a at the were and (Fig. the age of well on the of and to to become an My mother no worked and I was by my age from the My grandmother put her foot down and to her she going to I to the following to join the to be for the which I me a to I was by a in by local who I had while (as I summer from the age of to a while to a few taking off for the of the I that I had been by of to become the of What a I thought, as I my for the long home. The following I at to for a my Carlisle School was I mad for about years (Fig. but to down in my to on the which I with a my at I had a with a Maureen (my who I had in in the of where I many at the home of an aunt and with Maureen was after she left and I entered the but after I entered my her and, a gave her my much of my at I had my Maureen to me on the as I and she through to become a at in in were and with a in and a to the and in the United Kingdom, I entered the I the and of on my to be for as a out to with no but 3 I gave up and took a as a in the a house in a of Carlisle. well for me until the I and the local a man who had the many of he would be the to get as and I was with I was in the of a of with a by a he at me the I released the it and the under the On on the he and to climb His hands and he more his on the more he it but I to the is I the Carlisle arrived and took his a had been for earlier the he had the down the road from the many thereafter, would come into the asking to who up and I would them the that it. was to months in and I gave up my as a About a after I left I a who me of a for an at the in The was to and its was I had read of American that featured and on by and in the of and I was with through an who was a of the I to and an was I arrived at the and was up to the of a house, through which where I was to my (Fig. The was to with me about my and my where I had about and I with I the and was a As I left his me to my of some with at a in long after I left the I turned a into a My and training me in I was to the and of the from in and in and became in and The was for basic and was by which many members to and were his His was on and on were and members were to like in their and would stop at to his on my a to the of a of from the community to a by that a he had had for The in the of a for a while he up a series of a of of and from and was to be by my and the left for the to return the following to the the entered my the some of the and the to The the were the was and thereafter, being with the left the by to the were and the became members became of had not of a who would have the was home to a of and among was and only the for to were the I 6 years in the I grew to my on and, I a PhD to he me the to a not to a of to a of and with many my own was not and many young as a of and bad like and we the to the to be the on. it would be to most of the was a and that his was the in the the however, he a he would a for my and me the me to the and and prepare the for When began to and was I was from he be However, as I became more in and and more his me as his unpleasant its ugly he who I to and with me that I would this for my it I never his to get me but it put a on many a after 4 years of Maureen 1 that she had a as a for me to get down to my PhD It worked and I the in 3 but its was a that it be of and that I was not to from the As would have decided to take a to from in and I took the as the to the for my with my own after he I the product to the and for to a as my that I had my and the as a When entered the I to the for me to the to the for at the to and walked became a an with out the I would home and Maureen, no On the 10th I and I of his His he his and later, the was with the the that the for PhD in the United a that the me, and an my to 3 the decided for no to from my much and around, I to the of to into the more but it The the as I was the came in and me with a that I was as of that I my was a and home. Not I came in and was about to attend the a in with its and The and I was a PhD in there was more to had me on a my would to about a in On of the the after my he out different from were and at the of a I to the and was a of was on the that 1 would the of the following The effect was that my PhD me to and a few later, he my a friend with a PhD in at a of and I was to in I decided to there was a of for in the United Kingdom, which was in the of a to the and the United I at 1 to on of the of my but the academic in the and were Maureen and I decided to the United and, I an of a with Robert Terry, an known at the of in the I it. had also heard about me from my friend a who had left for 1 in my as a in the had become a of and had about the to his he was advised to Maureen and I to come to the United I for the of with for the and took them to for in the with a my with and to the for and to to We had no but to put our house on the of it for the small from the going and funds in and for our in England, we in with miles later, in after I the for at the AANP in the to It was a from who had been about to to take up a in became of Neurology at the of me, the in the and me he would take in the of the to he the following to the United Our in were particularly I was from training my and the me advised me not to up and to that was to while on the with the down to and the as I the he entered the I was and that I stop and the to I to until I was began to I to and to with and I and, from that was an of and that a of it was on the I into had the with his the of the and I have vivid memories of I took the and some of the at his much and into the and more was and began for I kept and and he kept and I and to me to I was me and out as he the get for I heard more about this but he never me years later, I this to an of young as of a talk a were I a better than for the On my in the I delivered the to for and would the at the up and into to for our to the to the and to As I left the with my I to he to the of the which he me my training in in the United was of his as of the by an on from and with members and never a in On a arrived at with a Maureen and a to in research. My in was I only We were by who delivered to his in where we his and their 3 and where we stayed for while I in at and Maureen the to an The me into to who was in to took me to the of the I have little more than with into small at I still it how much neuropathology had from that small (the foot in product have been waiting for me, was the (Fig. with in at an in Our was no more than off to attend to while his for I would run the until a the was in I would to a I would my on and would a between the and that of a on of a on which I had also worked and published in been my he left, gave me a of where I the and friend and and a who would become my for in the My first was an to out for there was an of in and out of that small Mike and of them were about to and were to their on These were for the most in the with a of to and were well and with the best the was this from Carlisle in a still the with a an and little from to get a foot on the and not to I the found an a some on and after a little more than 1 at and much the left had a for and, my first I with and of of which would The with and, my I would the just to read and more and more and many for What a from and the into my just as and I (Fig. were a series of on and the AANP in walked into the and me an for an from the of me to prepare the and Experimental and he would the a and the to that The was and 3 (my own an and to the in our the was and and, the to me to at the me up to with a in of a senior to an to a young was my as an investigator at The in thanks to and my colleagues at my was and after into the I was to and an training for and funds for 3 a and and a My was to a home with and that would be to and who would be to on their rather than and of more than years in my was that my from and I was at the on the (Fig. and background with my of with I an for a training and a to which my of will the with and of my in the Raine Note the I was most to a with and that in on and left the 3 of much to our own his of he was there was and we never I also an with and our many contributions to the of the of on as became more this would into the of the and the of in a PhD was for into my at a as were in My into was more by my up with and our on in the much a and of the and most I have known in (Fig. late the the of also in my of which was with of my of the at from its in until his in (Fig. was a and and an the of and our we a of for the first of in the and the of from Moreover, we worked and many of in the and as began to take center I up with and members of his at my own and to and into and our into the of with and was with and which in the first of to in in and the of a of to to and in As we entered the the began to for neuropathology in as of the and as and as began to and as became and more as for our and the at AANP Neuropathology at was also about to a with to in a by the of the decided to but only would with both left, a was was no our was and members became and began to to our Neuropathology became a of a the for a while but and to join the in left for and the was to who the for a few but of the and the he to in the and to run a a of its former (Fig. my own on had been to the it me to my colleagues on. I to (Fig. I a with the of and had the of a who me my from the of the to in in I was to the of with a of from for and and a of by the of we entered the with a of which to Neuropathology and and The were also in my and were in and at of the best I with in the my and with and the of to a of and the most of my years at came through my to and an of and into the of by a and with and were to between to of became a of my the the of an of through my 1 present them in list will me for the German (the 4 with (the 4 with and in a with the following also training with Mike and all the I my thanks for the and into my I their was and I from them at As for some of my I he with from his to his and in (Fig. As for Terry, in 3 of and to to up with a with some by (Fig. was in fine and I was to his the many the at were as as in on a from The of Terry, and we have my and I am left with my to my who my my and my and for years. was my first and as I a for from through the a was with me from the late until ran the of the Journal of which I in from to and it and my (Fig. to I be my and in from to the present My would I be my training a of and the standard for me were to have in About 12 months into my at and I our first on the of in to and I was it was On the I the of was a for a to which I was I and with and I at the I my to the up front and my me into an a in a I with the much to their was I with and my first in The AANP been the for my academic and (Fig. and its was usually the of my of the at I was into from the at a were for Active The was into the most being the the Association to and by I was to the for the and after about 3 years of and we in the AANP that be admitted as Active many years thereafter, was and the basic by who would have on the of I a AANP and on and/or delivered and for 1 was to be being the of and the and the for to Neuropathology I on the of from to academic I have I more to the AANP than to the of a few lines on Maureen and I were never with of our but in while as a in a for Maureen was to a young boy with who had been abused and by his She became of and, he was for she decided we a home. So, in at the age of he entered our lives our and, a of we entered to read and had and a a home and developed a beautiful he worked as an in a a at which he that for began he Maureen, and he never let his get in the of his was with for 12 years and became a and member of our however, the on in his years and his many years on up with and he in thereafter, in Maureen was as having and, as a my at became I began to my to and in until Maureen her like a but after a she in 7 months we had from to Maureen to as a grandmother in the young of and having to in a and her an Maureen lived long to but was never well to from the would have I Maureen much in to the years we were it was of her that I was to it along the road to Neuropathology (Fig. I have just the first is in the center with Mike Hart Maureen, my and Maureen in as a me to my which I and a with I am in There on my for colleagues me and images for of still and I am more to attend So, me on the do and
In 1936, 200 of the world's top medical scientists met in Brussels to address an emerging epidemic. Since the turn of the century, cancer had been steadily growing as a major cause of death. Naturally, researchers looked first to environmental factors, particularly agents of the Industrial Age, such as asbestos, road tar, ionizing radiation, and synthetic dyes. Since then, however, attention has been diverted away from such important environmental causes of cancer, especially where economic interests are at stake, according to Dr. Devra Davis in The Secret History of the War on Cancer (1). This expansive, ambitious book spans nearly a century and dozens of controversies, anecdotes, and personal stories. Davis devotes a chapter to describing the growth of the eugenics movement and Nazi medicine. Another chapter details the evolution of the nation's leading voluntary anticancer organization, from the grassroots anticancer advocacy of the American Society for the Control of Cancer's Women's Field Army to the corporate Lasker-era American Cancer Society. She describes how professional turf battles delayed the introduction of the Papanicolaou smear for over a decade. In subsequent chapters, she warns of the possible hazards to physician-researchers in working with novel compounds, the overselling of routine mammography, the role of paid experts in environmental tort litigation, the politics of establishing regulatory standards for environmental and occupational exposures, and the potential as-yet-unproven hazards of cell phones. A key theme running throughout the book is how financial interests, professional allegiances, and political ideology can manipulate the scientific process. Archives and court documents reveal how well-meaning scientists have at times become complicit in defending industrial interests at the expense of public health. There is no âsecret historyâ here, however, as these histories are largely drawn from the work of other scholars. One exception is Davis's own study of the papers of Robert Kehoe, a key figure in the development of the occupational health field who conducted a wide range of toxicology research under contract for various industries. These documents provide a unique case study of how one academic laboratory functioned and interacted with its industry sponsors, and one wishes they were more fully explored here. Unsurprisingly, tobacco figures big in Davis's story. She touts German physician Franz H. MĂŒller's 1939 case-control study of lung cancer and smoking (previously described in Robert Proctor's The Nazi War on Cancer (2)) as âthe first irrefutable modern proof that smoking causes lung cancer in humansâ (1, p. 61). This work was largely ignored by American and British researchers conducting their own case-control studies 10 years later. Davis faults these latecomers with failing to immediately denounce cigarettes, whereas MĂŒller had definitively declared tobacco to be âthe single most important cause of the rising incidence of lung cancerâ (1, p. 53). Davis's argument here and repeated throughout the book is that, when the bar for medical proof is set too high, life-saving public health action is delayed. By the time of the 1964 Surgeon General's report (3), an unprecedented wealth of evidence had been amassed, including seven cohort studies and over 30 case-control studies implicating cigarettes as a cause of cancer. However, public health interventions often have to be taken on lesser evidence. Davis criticizes reliance on epidemiology as the âgold standard,â demanding an alternative to âwaiting for enough bodies to drop or sicken before we decide we've got a problemâ (1, pp. 399â400). Yet how much and what kind of evidence should be required to act? Unfortunately, Davis stops short of proposing any concrete answers to this question. There are a number of factual and historical errors in the book that detract from its force. For example, Davis devotes a page to describing Clarence C. Little's tenure as âthe first Director of the fledgling National Cancer Instituteâ (1, pp. 120â121). In fact, he never held this post, although he did serve as one of six original members of the National Advisory Cancer Council. She claims that the Council for Tobacco Research gave money âdirectlyâ to Wilhelm Hueper and Tom Mancuso to study the environmental and occupational causes of cancer. However, the document she cites for this makes it clear that funds were given to Mancuso but not to Hueper (1, p. 153). She has both R. A. Fisher and Nathan Mantel working âdirectlyâ for the tobacco industry in 1967; this is unlikely as Fisher died in 1962 and Mantel was still at the National Cancer Institute (1, p. 189). Davis is at her strongest when telling her own story. She provides engaging, first-hand accounts of her early career in the 1980s as a junior epidemiologist tackling big issues, such as assessing the disease burden for victims of exposure to hazardous wastes and studying whether cancer rates were increasing. Davis began working on the latter question under the guidance of Abe Lilienfeld at The John Hopkins University. She found that the incidence of multiple myeloma and brain cancer in men over 45 years of age had grown by more than a third in less than two decades, and a resulting paper in the Lancet (4) drew major headlines. Davis describes an encounter with Richard Doll, in which he told her that she had made a âcolossal errorâ and that her findings would be explained by improved diagnosis and record keeping for these particular cancers (1, p. 257). She held to her story and gathered the evidence to prove Doll's hypothesis wrong. She also incorporates personal stories and encounters with cancer, including her own brush with a suspicious mammography reading, her family's exposure to the legacy of environmental pollution in Pennsylvania, and the experiences of friends and colleagues facing difficult decisions and questions about treatment options. Throughout, she also raises questions about what might have been done differently to prevent these cancers. In the end, however, the book is frustrating for its lack of explicit conclusions or recommendations about how things should be done differently. After 480 pages describing many twists and turns in the politics of cancer research, there are no substantive conclusions to tie it all together. Davis offers broad statementsââwe need to open a new frontâ in the war against cancer (1, p. xviii)âbut she fails to offer concrete proposals. In the book's closing pages, she briefly suggests the need for an independent commission for the assessment of toxic hazards and medical monitoring programs for exposed populations, but these suggestions are not developed. âI am not smart enough,â she claims, âto know what kind of system will best identify and address the preventable causes of cancer in our environmentâ (1, p. 430). On this point, she is clearly wrong. As her own autobiographic accounts illustrate, there are few people privileged with the range of scientific and real-world policy experience Davis has to be in a better position to offer some potential solutions. Indeed, this is what makes her failure to do so, so disappointing. Conflict of interest: none declared.
At first thought, there would appear to be little or no obvious connection between Landmarks in Hepatology and the essay recently published in the New England Journal of Medicine by 1986 Nobel Peace Prize Laureate Elie Wiesel.1 In 40 articles published over the past 4 years, the Landmarks series has not only documented the background of numerous discoveries in hepatology that have resulted from observation and experimentation, but it has also celebrated the physicians and investigators who brought us these new hepatological insights, investigations, and therapies. The Landmarks essays have been embellished with play on words and other attempts at humor, biography, history, politics, and the arts, and have presented for the readership abstruse facts and historical trivia to enhance the appreciation and enjoyment of the science and clinical innovation of hepatology. In contrast, Professor Wiesel's essay reminded us of one of the saddest eras in medical experimentation that serves as an archetype for inhumanity perpetrated by physicians, often but not always in the name of science, on hapless human subjects who had no choice but to participate in the most cruel and brutal experiments. It goes without saying that there was no semblance of informed consent. Wiesel refers, of course, to the medical experiments carried out by Nazi physicians and their henchmen and lackeys during the Dark Age known as the Third Reich. Out of this sordid experience, portrayed in the accounts of survivors and eyewitnesses, historical documents, and in the testimonies of those physicians who faced the Nuremberg Tribunal, ethical rules for experimentation on patients and volunteers were codified2 (Fig. 1). Surely, however, there is no connection between the celebration of hepatological discovery and the perversion of Nazi medical brutalityâbut there is. And because there is we have the opportunity, justification, and, in fact, the duty to confront the memory of these events so as to reinforce our vigilance and determination to uphold the highest ethical standards in hepatology and, indeed, in all of medicine, be it experimental science or routine clinical practice. This connection between discovery in hepatology and cruel experimentation was personified by one of the most prestigious and prodigious investigators in liver disease in the 1920s and 1930s; namely, Hans Eppinger. Observant and perceptive readers of Landmarks in Hepatology will surely have noticed that until now there has been no mention of Hans Eppinger nor any reference to his many contributions in the field. This purposeful exclusion came about, rightly or wrongly, because I felt unable to honor this physician-scientist for his early discoveries, knowing full well about his later utterly ethically unacceptable activities as a medical leader, physician-scientist, and human being. This month's article will therefore redress the balance with respect to both components of that man's extraordinary career, which ended ignominiously in self-destruction. My decision to revisit those tragic events was not taken lightly; it is also in full keeping with the commitment expressed in the first paragraph of the very first article in this series,3 which promised enlightenment in order to avoid repetition of past mistakes. Whereas it is hard to believe that anything as terrible as occurred under the auspices of Nazi medicine could happen now or in the future, we can never be reminded too often of the needs for obtaining true informed consent, for full disclosure in explaining the likely outcome of our actions as physicians, and of partnering with rather than patronizing our patients and study volunteers. Physicians have an abiding responsibility toward their patients and experimental subjects, whose rights must be protected and championed even when the good of the community, of the state, and of humankind appears to be at stake. It is timely to address this issue now in the closing days of the year that simultaneously commemorated the 60th anniversary of the liberation of the Nazi extermination camps at the end of the Second World War and saw the wide distribution and acclaim of the movie Hotel Rwanda, which poignantly and painfully chronicled a recent modern genocide so graphically. We have yet to learn the full extent of physician participation and complicity in the abuse and torture of detainees at Abu Ghraib.4, 5 To paraphrase Elie Wiesel in his interview with Professor Georg Klein6 on December 10, 2004, in connection with the Nobel Peace Prize that he was awarded for his work on genocide and for his message of peace, atonement, and human dignity, "It was not hatred that perished at AuschwitzâŠ.only the victims died." Hans Eppinger was born in Prague in 1879 supposedly into a part-Jewish family of so-called "Privileged Jews"7-10 who, thus entitled by the Emperor, enjoyed social, civil, and professional liberties that were out of reach to their less favored co-religionists. It may appear paradoxical that Eppinger was also apparently accredited years later as an "Official Aryan" by the National Socialist authorities, a designation that was clearly linked to his joining the Nationalsozialistische Deutsche Arbeiter-Partei (NSDAP); i.e., the National Socialist German Workers' Party, nicknamed the Nazi Party. Yet it was not uncommon that exemptions to the 1935 Nuremberg Racial Laws were granted to certain Mischlinge; i.e., Jewish half-breeds, and incongruously many DeutschblĂŒtigkeitserklĂ€rĂŒngen (Certificates of German Blood) were actually signed by Adolf Hitler himself, thereby officially classifying the recipients as Aryans when such outright hypocrisy suited the FĂŒhrer and his kind.11 An astounding number of these Mischlinge were promoted to high rank in the German Armed Forces, and some even prospered politically.11 It should be noted, however, that the truth about Eppinger's ethnicity is still not known, and more discovery about it is needed. In 1902, more than 30 years before these grotesque events transpired, Eppinger was awarded his Doctorate in Medicine in Graz, where 20 years earlier his father, Hans Eppinger senior, had been appointed Professor of Pathological Anatomy. After staying for a few years, Eppinger moved to the famed Allgemeine Krankenhaus (General Hospital) in Vienna, where he rose to become First Assistant in the First Medical Clinic, which was headed by the internationally acclaimed cardiologist Karel Frederik Wenckebach. Later, when he was a full Professor of Medicine, Eppinger accepted the position of Chair of Medicine in Freiburg im Breisgau, after turning down offers from Strassburg, Halle, Königsberg, Leipzig, Frankfurt, and even Berlin. He left for Cologne in 1930, but it was there that in April 1933âironically, probably because of his part-Jewish heritageâhe fell foul of the Brown Shirts, Hitler's Sturmabteilung (SA or Storm Division). He hurriedly returned to Vienna to head the First Clinic but, importantly, because of his tussle with the German Reich, this appointment was permitted only after the intervention of Kurt von Schuschnigg, the Austrian Education Minister, who was to succeed Engelbert Dollfuss as Chancellor when the latter was assassinated in July 1934. Eppinger's professional interests and expertise ran the gamut of internal medicine and pathology, and he published extensively on topics as diverse as bundle branch block, diaphragmatic defects, cardiac asthma, circulatory dysfunction, nephrosis, hemolytic anemia, the inflammatory reaction, parathyroid disease, and many more besides.7 He was a fanatical and overzealous experimenter and at the same time a much sought-after clinical consultant for monarchs, heads of state, and other notables, including Josef Stalin and the Dowager Queen Marie of Rumania. It was rumored that he had also attended Adolf Hitler, but this possibility was dismissed by the late Fritz Redlich (1910-2004) in his biography of the German dictator,12 on the grounds that Hitler did not like famous and overbearing academic physicians and was pathologically as secretive about his health as he was over other details of his personal life and history. By coincidence, Redlich, who was Chair of Psychiatry (1950-1967) and Dean of the Medial School (1967-1972) at Yale University, had been a medical student and resident in Vienna when Eppinger was Chair of Medicine, before he emigrated to the United States in 1938. There are several associations between Eppinger and modern hepatology. First, of course, was his fascination with liver disease, in which he undertook many studies. Arguably his most importantâone could say "Landmark"âcontribution was in helping to dispel the myth that jaundice in hepatitis, so-called "catarrhal jaundice," is due to biliary obstruction caused by ascending duodenal inflammation, swelling of the ostium of the bile duct, and mucus biliary plugging, as Gabriel Andral and his many followers maintained.13, 14 Eppinger reasoned instead that toxins absorbed from the intestines injured the endothelium in the liver ("capillaritis"), causing intralobular edema and allowing serum to escape from the blood and deposit in the space of Disse.15 Eppinger's monograph on liver pathology and therapy, in which this hypothesis of "serous hepatitis" is also discussed,16 was, in its time, the handbook or bible for anyone interested in liver disease. The second link between Eppinger and modern hepatology was his mentorship of and complex relationship with the late Hans Popper (1903-1988), the undisputed father of hepatology in the latter part of the 20th Century.8-10, 17 Hans Popper worked in Eppinger's laboratory both in Vienna as a medical student and later in Freiburg in 1928.9, 10 When Eppinger returned to Vienna in 1933, he persuaded Popper to transfer from the Institute of Pathology to the First Medical Clinic as an Assistant Physician. Next, Eppinger appointed Popper and Hans Kaunitz (who, like Popper, was Jewish) to supervise a new ward that he opened. During all of his activities, Eppinger's brilliance and achievements were indelibly stained by defects of personality and character, which were well recognized by all who knew him and of him. Notwithstanding Popper's admiration for him as a scientist and his profound debt to him as a mentor and supporter, these flaws alone were grave enough to mar Eppinger as a role model for young scientists and physicians. As John Cornwell points out in the opening of his book on Hitler's scientists,18 quoting François Rabelais,19 "Science without conscience is the ruin of the soul" â Science sans conscience n'est que ruine de l'Ăąme â a warning that might have been written with Eppinger in mind. Eppinger had no scruples10; he stole case histories from other physicians and had to be supervised while watching operations in case he stole instruments as well. He was banned from the University library after being caught cutting pages out of books and bound journals. He stole gallbladders from Wenckebach's laboratory and later, using these specimens without due acknowledgment, he published the phenomenon of gallbladder edema in patients who died of beriberi. Eppinger's callous handling of his patients was no less dishonorable or overt. In his autobiography, the esteemed German theologian Helmut Thielicke described the cruel, dangerous, and demeaning treatment he received from Eppinger, whose advice he had sought for severe tetany following inadvertent parathyroid injury.20 Otto Fleming, who had been a medical student in the 1930s in Vienna and who later was a general practitioner in south Yorkshire, UK, recalled how he and all his fellow students were shocked by Eppinger's brutality when he reduced a patient to tears by explaining to those present in the lecture theater that this man with nephritis was in the "final act of the tragedy" of his disease.21 Apparently even those in NSDAP circles in Vienna complained about, among other criticisms, Eppinger's brutality to his patients and his reckless driving.22 Werner Creutzfeldt, Professor Emeritus and former Chair of Medicine at the University of Göttingen for 28 years, recalled Hans Popper inferring that Eppinger had a hole in his brain where other people have a conscience. Creutzfeldt also related to me that even almost a score of years after Eppinger's departure from Freiburg, senior nurses still in practice there vividly remembered Eppinger's heartless attitude towards his patients, a contrast to the warmth of their nostalgia for Siegfried Thannhauser, who succeeded him briefly. There is no doubt that Eppinger was an ardent Nazi, as Redlich described him,12 and played a key role in the dastardly Sea Water Experiments in the Dachau concentration camp.22-24 However, these signature activities in his curriculum vitae are either glossed over euphemistically or omitted completely from the many available, albeit brief, biographical accounts of Eppinger's life.7-10, 25, 26 Eppinger was dismissed from his position in the University of Vienna after the war, in June 1945, because he had been a member of the then-illegal Nazi Party in Austria before the Anschluss; i.e., the annexation of Austria by Germany.27 He had also been a clandestine member of the nationalistic Deutschen Klub, to which he had paid dues since November 1937.22 He stood idly by when 153 of the 197 medical faculty in Vienna were sacked within weeks of the Anschluss, mostly for being Jewish.28 Eppinger may not have been driven by extreme racist views per seâafter all, he had appointed several Jews like Popper and Kaunitz to high positions in his Clinic. Rather, Eppinger fervently believed that the goals of the Third Reich offered the best future for Germans everywhere. Whether this was the main philosophy of so many other physicians, who it must be remembered represented the highest enrollment (45%) in the NSDAP of any professional group,29 is far from clear. Also, by joining forces with the NSDAP he sought to further his own megalomania for research opportunities and material support. Whatever his motivation, Eppinger did abet the militantly prejudiced, recently appointed Dean, Eduard Pernkopf, in ruthlessly promoting the Nazi medical ethos in the Vienna school. Hans Eppinger even celebrated the first anniversary of the "cleansing" of the faculty by authoring an upbeat newspaper article in the Neues Wiener Tagblatt, in which he declared, "Now that all disease (my italics) has been eradicated, the Viennese School of Medicine can in future dedicate itself to its great task without inhibition."28 Pernkopf, incidentally, rose to become the Rector of the University in 1943; after spending 2 years imprisoned by the Allies after the war, he was free to complete his notorious "Atlas of Topographical and Applied Human Anatomy," for which the bodies of almost 1,400 people executed by the Gestapo, mostly for "political" reasons, served as artists' models.30 To Eppinger, who threw in his lot wholeheartedly with the philosophy, doctrines, policies, and hierarchy of the Third Reich, it was but a small step to invest his medical research expertise in the planning and conduct of human studies for the benefit of the German military effort. Although Eppinger's other activities have not yet been exhaustively researched, there has been no evidence presented thus far that he also participated medically in the sickening racial hygiene work that aimed to perfect techniques of mass extermination and sterilization, nor in studies that sought to document and preserve the anatomical characteristics of inferior racial groups, those people referred to as Untermenschen, or "subhumans," considered to have Lebensunwertes Leben, i.e., lives unworthy to be lived, and other individuals, such as the enfeebled, retarded, and those with neurological or physical defects. Neither did he seem to engage in futile sadistic experiments, such as excruciatingly painful attempts at muscle, bone, and even whole limb transplantation. In this context, it is chilling to point out that numerous German physicians had already played key practical roles in forcible sterilizations (some 300,000 to 400,000 victims) and in legalized killings, mostly by gassing and cremation, of individuals with mental or physical handicaps. Therein was the prototype for the extermination process of the Final Solution of the Jews, which physicians not an of the German physicians to the Nazi the and the or and were of using their medical such as the early of the so-called of and have been The of how to and and in the for of time the and military The to in and studies were to this end on both of the military To a at the German over the of the of with an so-called which some already was true with an Eppinger and from that a be to the of and with that of or complete for to to the best of health and even may be by the Eppinger also that his recently promoted in Vienna, conduct the which had to be at the Dachau concentration because the of volunteers at the medical were so late in the The experiments were in the of but the of including the of a liver without not to mention that the experimental subjects of would and other in attempts to some The of and including between the of the Medical of the and Reich of the and Reich of the it that Eppinger was no but was instead a key the offered on was the that there was no of during the of the the that the physicians were only following the of their or the of the the that the Allies and other had experiments the that the victims were to and the that there were no or for human experimentation that could The also that to as would the of medical and it that their among some of the and on the Although it is true that human experiments have been in almost even after the Nuremberg was have the and human of the Third Reich. act of not Also, or not the no with or or the this responsibility has been expressed in all over the Also, the was recognized in where for human experimentation also had been before During his to with his was and his that there had been any of the that had and Eppinger's to that on his was to years of the other physicians and in the were of were to by 5 to life 2 to for years, and to 10 were Eppinger was not but he was to appear before the However, on the of 25, one before the of the was he and it not for the extraordinary events that occurred almost 40 years later, the of Hans Eppinger may well have with him. However, in the late the and of the that he in Freiburg in and the of many and in liver research that and to a for and in liver studies. he to his Hans Popper, the father of hepatology of the for advice on a for the and Popper the name of Eppinger. Werner Creutzfeldt, for was at the in the of Eppinger's and from other than Hans Popper himself, and so he Popper the Popper was on of his for Eppinger as a liver scientist and his to After all, when Popper Vienna in under the of the Gestapo, among the he with him were his his his and a signed of that he later to that of his own the it must be that it was and that Popper knew of Eppinger's role in and did as he his for The must be however, that Popper's was At the very he should have his mentor more knowing well of his and the that he had on in Vienna in the medical even when its faculty had been by The Eppinger which Popper to a Nobel Prize of was awarded first to in but he nor recipients were likely to have had any as to Eppinger's name In the early Professor of Medicine at Yale University and of the for in Medicine at the Yale University School of Medicine, of the and it with the Eppinger whose he had as a medical student and about he had later in the of The case was taken by the and Eppinger's name was from the but only after the on the of the New on November The New article caused great to who were the of the for the of in that very Armed with few facts at that time, were and between those who of the and those who were and that was The the years of Hans Popper's as he was of his earlier of but he no over the of the As he me while on a to he knew that when he to work for Eppinger in he had a with the years later, the for for the same to the name of Eppinger from a that had received its designation by the in on the anniversary of its latter and, we the between Hans Eppinger and modern us full to the at the of this namely, how to with the flaws of the when these are related to the conduct of the science itself and human and life are In this can be considered under the of which often to from studies that were or like the at who recently published that no from experiments should be by in the that experiments by such are likely to be as well as being there was evidence that even in Dachau the were this is not a since some and investigations, like the Nazi and for the link between and were even were on the same racial hygiene that to and have that the benefit of the research is of such that it more lives than were the and the could not or would not have been in any other without such human we should and the and at the same time the highest and to the time the are This the however, of on the and by our we their To between these is too a to As might be by such the to medicine would be for This was to the in the when the of the New England Journal of Medicine to the of Nazi studies that were to be in In the case of Eppinger, the decision is an of his earlier work is clearly it can be to have been and ethically yet at the same time and at one should him and for the he did and one should never his name to be as an for or as a role The more by however, and one that is both more and more to is so many physicians the and in so many have the their of and a commitment to Yet for all Wiesel still in us as a I in that medicine is still a he the highest ethical the still for And for us all, We to him. in of this the was of Professor that there was no evidence that Eppinger had any Jewish It was a that Eppinger's was of from the on both of Jewish of of the of The with and by and with and and with Werner Creutzfeldt and Elie Wiesel The also the for his and in the of this essay in Whereas the and of these the his a of and documents, the are his
George A. Savoy was born in Cohoes, New York, in 1873. He left the U.S.A. in 1921 to manage the Canadian branch of a large manufacturer of ledgers and looseleaf registers. This company was asked to supply Professor Jasper's laboratory with rolls of plain unlined paper and it was George Savoy who later developed fanfolded and lined EEG paper, which was first used at the Montreal Neurological Institute. He also had personal contacts with Wilder Penfield concerning their mutual interest in the needs of patients with epilepsy. He was a successful industrialist involved with several charitable organizations funding programmes for people with epilepsy. He was opposed to the sectarianism then prevalent in Quebec, which was unfamiliar to him, and in reaction built his own institution, Dieppe House, a home for people with epilepsy, later renamed <<Foyer Savoy>>. It was to operate without regard to race, language or religion. In 1971, his son Harold and other generous donors decided to create a foundation to support research in epilepsy. The Foyer Savoy was sold in 1988 and the proceeds used to increase the endowment of the foundation. His grandson George M. Savoy is the current president. The fourth generation is also represented by Caroline Savoy, daughter of the president, who joined the board of directors in 1992. The foundation will distribute from $300,000 to $400,000 yearly to researchers from many different countries working in the field of epilepsy in universities and hospitals throughout Canada.