As the American College of Surgeons (ACS) celebrates its Centennial by reflecting on the achievements of the College’s founders and other surgeon leaders, it’s clear that the organization has a long history of providing opportunities for promising young physicians. In 1957, Charles O. Finley, MD, FACS, Administrator of the College’s disability insurance program, agreed to personally fund two research fellowships in the amount of $20,000 each. His generosity made him the first Fellow to contribute a major gift that funded a College scholarship.* Since Dr. Finley’s inaugural gift nearly 60 years ago, hundreds of promising young surgeons have benefitted from the College’s scholarship program, which awards nearly $2 million annually.† The majority of this funding comes from past and current philanthropy, stewarded by the ACS Foundation. Today, many of those surgeons serve as chairs of distinguished surgical departments, while others are developing innovative methods to provide better quality care to surgical patients.
In this article, several former ACS scholars describe how the ACS scholarship program had a notable effect on their career path and why these programs will continue to play an essential role as the College enters its next century.
Bridging the gap between science and surgery
“My advice to young surgical research fellows and faculty is to follow your passion,” said N. Scott Adzick, MD, MMM, FACS, surgeon-in-chief and director of The Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia (CHOP), PA. “It is very difficult to do both clinical work and research, but it is vitally important in order to advance the field.” To that end, Dr. Adzick underscored the importance of the ACS scholarship program as a viable way for young surgeons to bridge the gap between the demands of science and surgery.
According to Dr. Adzick—whose pediatric surgical expertise is centered on neonatal general and thoracic surgery with a particular focus on clinical applications of fetal diagnosis and therapy—several ACS awards have been “crucial for my career development and for any impact my career has had on the field of fetal surgery.” These awards include the ACS Resident Research Scholarship, 1983–1985; the Schering Scholarship Award, 1986–1987 (pediatric surgical fellow); the ACS Faculty Research Fellowship, 1989-1991; and the Australian and New Zealand Chapter of the ACS Traveling Fellowship, 1998.
His research proposal for the ACS Scholar Award was titled Correction of Congenital Hydronephrosis In Utero, which according to Dr. Adzick, was the first area in which fetal therapy was successfully applied. (He worked closely with pediatric surgeon Michael R. Harrison, MD, FACS—an internationally known expert and pioneer in fetal surgery—at the University of California, San Francisco.) Specifically, Dr. Adzick sought to establish an effective animal model for fetal urethral obstruction that simulates human congenital hydronephrosis, which permits in utero correction of urethral obstruction and allows for assessment of the pathophysiologic consequences of the obstruction.
As an ACS scholarship recipient, Dr. Adzick recalls meeting with the ACS Scholarship Selection Committee several times to report on his research activities. “In particular, I recall Frank C. Spencer, MD, FACS, who was the Chair of the Scholarship Committee,” said Dr. Adzick. (Dr. Spencer is a former ACS President, 1990–1991). “Dr. Spencer had the endearing habit of shaking the hand of everyone on the committee and all of the scholarship winners after their reports to personally congratulate them and to encourage them in their work.”
In addition to offering young surgeons the opportunity to conduct both scientific and clinical research, the ACS scholarship program also gives surgical investigators a foundation for applying for other awards, particularly National Institutes of Health (NIH) funding. Dr. Adzick noted the importance of his ACS-supported research as it would to relate to his future investigative work as a pediatric surgeon in a report he submitted to the Scholarship Selection Committee in 1985:
I have had a wonderful time in the laboratory working on the largely new and unexplored area of fetal diagnosis and treatment. This time was also very productive: 17 paper presentations at major medical meetings and over 40 publications. This research experience will serve as a foundation for future investigative work during my pediatric surgical career.
“The ACS awards helped me obtain NIH funding in 1989, launching 24 productive years of NIH support for our team,” said Dr. Adzick, the C. Everett Koop Professor of Pediatric Surgery at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
In the late 1980s and early 1990s when Dr. Adzick was on the faculty at the University of California, San Francisco, he was the recipient of the ACS Faculty Fellowship. At that time, according to Dr. Adzick, clinical use of fetal surgery became more widespread, and thereafter ultrafast fetal magnetic resonance imaging was introduced to enhance prenatal diagnosis. “In the first decade of the 21st century, refinements in patient selection and treatment were introduced, and randomized clinical trials elucidated the safety and efficacy of fetal surgical therapy,” explained Dr. Adzick. “Indications for fetal surgery were extended to non-life-threatening but serious birth defects, such as spina bifida. At CHOP, we practice in the relatively new field of fetal diagnosis and fetal surgery, and we have a unique special delivery unit within the children’s hospital for the care of mothers carrying unborn patients with birth defects.”
Dr. Adzick has mentored many academic pediatric surgeons in training and many research fellows who he said deserve most of the credit for many of the advances in fetal surgery. He advises young surgical research fellows and faculty members to determine what excites them and then to relentlessly pursue that area of study with the support of scholarship funding, if possible.
Scholarships are a career booster
“The George H.A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award of the American College of Surgeons (Clowes Award) provided essential support during a very formative part of my career,” observed Timothy Billiar, MD, FACS, George Vance Foster Professor and chair, department of surgery, University of Pittsburgh, PA. “In 1993, we reported the first cloning of a critical human gene [the human inducible Nitric Oxide Synthase Gene], and that led to the generation of patents, which then generated industry support for clinical pharmacological approaches to this gene pathway. The Clowes Award contributed to our capacity to do that,” explained Dr. Billiar. His research project proposal was titled Regulation of Hepatocyte Nitric Oxide Synthase and was submitted to the ACS Scholarship Committee in the early 1990s.
Today, Dr. Billiar, chief academic officer at University of Pittsburgh Physicians and principle investigator of the Billiar Laboratory, is involved in several research projects within his lab, particularly investigation of the mechanisms leading to immune dysfunction after injury. The Billiar Laboratory also maintains a strong interest in the regulation and function of the inducible nitric oxide synthase. As a result of his work, Dr. Billiar, who holds seven U.S. patents, has gained an international reputation for his contributions to the understanding of the immune mechanisms following injury, pathobiology of liver disease, and the clinical translation of laboratory observations.
“From a financial aspect, winning one of these awards can be an incredible career boost and can make a young surgeon’s career because of the flexibility they provide,” said Dr. Billiar. “I advise my faculty, especially those who want a career as a surgeon investigator, to aggressively pursue these opportunities, especially regarding NIH funding, which can be very difficult to get.” Dr. Billiar said he used the Clowes Award to leverage additional funding, and by 1997 he had received two NIH R01 grants. “The Clowes Award allowed me to pursue more sustainable sources of funding. Today, I am the chair of the department, maintain a large research facility, and we continue to be supported by NIH grants.
“I actually met Dr. Clowes,” added Dr. Billiar. “He was a well-known surgeon and researcher and meeting him is one of the best memories I have from that time. He attended one of my first presentations and he actually got up and asked me a question. It was a great honor to win this award, which is all the more meaningful because it is a link to such an excellent surgical investigator.”
According to Dr. Billiar, surgeon investigators are not always taken seriously, due to the fact that if a surgeon pursues research, they have to find ways to concentrate on the clinical side of practice as well. “The Clowes Award is a great example of the commitment the College has to this group. It’s a very specialized subset of individuals. There is an overall need for active investigators to address questions that are particularly relevant to surgical patients—and that is what these scholarships do,” observed Dr. Billiar.
Seed money for future funding
“One of the things about being a surgeon-scientist is that you are competing against other individuals who spend 100 percent of their time on research, whereas a surgeon is trying to balance research and operating room time, clinical time, and teaching time,” observed Herbert Chen, MD, FACS, professor of surgery; chairman, division of general surgery; and vice-chairman of research, department of surgery, University of Wisconsin School of Medicine and Public Health, Madison. “Surgeons who get this kind of support, such as the Clowes Award, as young surgical investigators are able to be competitive later in their career.”
Awarded the Clowes Research Award in 2004 for his proposal titled Inhibition of Gastrointestinal Neuroendocrine (NE) Tumor Progression by Signal Transduction Pathways, Dr. Chen acknowledged the importance of the award in his summary report to the ACS scholarships committee. “There is a lack of funding opportunities to study NE tumors and even less opportunities to pursue translational research in this field,” wrote Dr. Chen, leader of the endocrine cancer group at the University of Wisconsin Carbone Cancer Center.
“This award permitted the establishment of my lab from a small, early-career program to a large research team funded through two R01 grants. I am truly grateful to the ACS for supporting my research over the last five years.”
Dr. Chen said the Clowes Award is unique because some comparably sized grants aimed at developing a young surgeon’s specialty only last a couple of years, but the Clowes supports research for five years. “The Clowes Award gave the surgeon more time and money to develop a sustainable program, and it allowed you to take some risks and pursue directions that you normally may not have pursued otherwise.”
The Clowes Award also provided Dr. Chen with a solid research foundation to apply for other grants, including NIH funding. “NIH funding is more competitive than it used to be, for example, and there’s less of it to go around. The amount of money departments devoted to research is diminishing, and so it is important to have grants, which provide the seed money necessary to obtain a major grant,” explained Dr. Chen.
In his letter of recommendation in support of Dr. Chen’s application for the Clowes Award, Layton F. Rikkers, MD, FACS, ACS First Vice-President-Elect, Editor of ACS Surgery News, and professor emeritus, University of Wisconsin-Madison, underscored the extraordinary qualities exemplified by Clowes Award scholars, including Dr. Chen.
“The Clowes Award seeks to support the research of a promising new investigator,” wrote Dr. Rikkers. “Dr. Chen is an ideal candidate for this award and by far one of the most promising new investigators our department has had. At this relatively early stage in his career, Herb has already become the complete academic surgeon and serves as a role model for students and residents…and is clearly destined to become a leader in American academic surgery.”
As Dr. Chen mentors young surgeons today, he encourages them to apply for grants from the ACS, the Association of Academic Surgery, and other organizations and institutions that specifically support young investigators. “I always tell young surgeons that getting a grant is like hitting a home run. Interestingly, most big home-run hitters are also big strikeout leaders. When writing a grant, you’ll never get that home run if you don’t hit hard and hit big. You will definitely strike out, but swing as many times as you can, and swing hard,” he said. “As surgeons we are fortunate to have these opportunities to get funding from surgical organizations like the American College of Surgeons. I don’t think enough young surgeons take advantage of that.”
Freedom to explore new ideas
“The prestige of receiving the Clowes Award was something special to me—an affirmation that the American College of Surgeons and the world of surgery recognized what you were doing was important,” recalled Yolonda Colson, MD, PhD, FACS, director, Women’s Lung Cancer Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA. “This scholarship allows a young surgeon to follow a scientific idea without fear of how you’re going to keep the lights on while you try something new—and that is what I did in my work.”
Her original Clowes Award proposal was titled The Mechanism of Facilitating Cell Induced Regulatory T Cell Networks, and it was during the time that she began her research that she switched to a surgical oncology focus—something that was a higher risk, but also with a potentially higher pay off. “It is this freedom to explore new ideas that will allow surgeons to expand our horizons and advance our field with new technologies and discoveries rather than repackaging older ideas in new surgical wrappings. Such a change happened to my career during the Clowes Award,” said Dr. Colson. Her research interest moved from a focus on the induction of immunologic tolerance to surgical oncology, specifically to investigating lymphatic trafficking and the use of nanoparticle targeting as a means to prevent the development of locoregional disease.
In addition to providing flexibility for a young surgeon, scholarships such as the Clowes Award are key because they make a commitment to support a surgeon’s academic goals over an extended period of time. “With the Clowes Award you are given more time to gather preliminary experience and the preliminary data you need to apply for other grants,” explained Dr. Colson, an associate professor of surgery, division of thoracic surgery, Brigham. “The average age at which an NIH investigator receives funding has increased significantly over the last 15 years, which means we need to support these investigators so that they are able to get the preliminary data they need. These longer-span awards are very important so that you have time to actually do the research and discover new things, rather than constantly spending your time writing grant proposals.”
Since receiving the Clowes Award, Dr. Colson has been awarded or filed three patents on polymer-mediated drug delivery and has received a total of 12 grants, including two current R01 grants from the NCI, an Agency for Healthcare Research and Quality grant, and several foundation grants.
Beyond the patents and the grants, more than a dozen students (undergraduate to residency) have trained in Dr. Colson’s lab, and many of those students have changed career paths into surgery, of which she is particularly proud. “There isn’t a better recruitment tool for surgery than a surgeon loving their job, and this was much easier with support from the Clowes Award,” said Dr. Colson.
As a young physician, Dr. Colson completed a six-year MD/PhD program, then residencies in general and cardiothoracic surgery, plus a postdoctoral fellowship. She was one of the first women cardiothoracic surgery residency chiefs at Brigham. “A lot of women worry that ‘I might be the first, therefore it will be a problem,’ but you don’t know that. And you just do it,” said Dr. Colson. “You can’t be afraid of a big opportunity—and that includes applying for scholarship and grant funding to pursue your academic goals. You might be surprised; it often works out much better than you expected.”
The ripple effect
After receiving the Franklin H. Martin, MD, FACS, Faculty Research Fellowship in 1993, Kevin J. Tracey, MD, FACS, a neurosurgeon known for his contributions to inflammation research, wrote the following in his report to the ACS scholarship committee: “The changes in our health care system have made it increasingly difficult to develop a career as an academic surgeon, to obtain NIH grants, and to balance the rigors of ‘good’ research with a clinical practice. Through its Fellowship program, the American College of Surgeons provided me with an opportunity to focus on my research and to develop data for an NIH R01 grant.”
“I was struck by how timely that quote would be if I said it yesterday or even tomorrow. It’s very interesting that while I was thinking that way in 1995, it is perhaps even more relevant today,” said Dr. Tracey, president of the Feinstein Institute for Medical Research and professor and president of the Elmezzi Graduate School of Molecular Medicine, Manhasset, NY. “It takes a very special department to launch careers in academic surgery—not every department has the resources to launch surgeons on dual career paths of clinical work and research work. In fact, I would say many departments that have historically supported these surgeons through various programs and funding are no longer able to do it today,” observed Dr. Tracey. “The Franklin H. Martin Fellowship was incredibly important to launching my career—it was extremely important to me. Were I starting today, as a young surgeon, it would be even more important.”
Dr. Tracey’s original research proposal was titled Mediators of Post-Traumatic Catabolism. The goal of the project was to gain a clearer understanding of the mediation of protein catabolism by macrophage factors produced during injury or infection. His research led him to investigate the direct inflammatory activity of tumor necrosis factor (TNF), which, in turn, led Dr. Tracey to find ways to inhibit TNF with the goal of seeking out how to make a molecule that would block or regulate the amount of cytokines produced during inflammation—CNI-1493.
Along the way of understanding how this agent can work at the molecular level to prevent cytokine release, Dr. Tracey and his team made what he called a shocking discovery. In animal models, they could attenuate TNF production in the brain, but vanishingly small amounts of this material in the brain completely blocked the appearance of TNF in the bloodstream. That insight led his team to begin manipulating the electrical activity of the vagus nerve to control inflammation, and they developed nerve stimulators to suppress the release of inflammation-causing cytokines, even making a small vagus nerve stimulator to treat inflammatory disease.
In September 2011, the first stimulator was implanted in a 45-year-old man with severe rheumatoid arthritis, who was essentially housebound, and according to Dr. Tracey, he has since had a tremendous clinical response.
“From the Martin Memorial grant came the molecule, and from the molecule came the stimulator—and from both of those came successful clinical trials,” explained Dr. Tracey, summarizing the ripple effect the award has had on his career.
“I was happy that my career would start on a kind of accelerated trajectory that would not have been possible without this award,” he added. “I remember thinking at the time that all those years training with G. Tom Shires, MD, FACS, a pioneering surgical leader who helped establish one of the nation’s pre-eminent burn centers, would now result in something successful. Everything that I hoped to accomplish from my training with Dr. Shires seemed possible.” (The William Randolph Hearst Burn Center, New York-Presbyterian/Weill Cornell, New York, NY, co-founded by Dr. Shires, is reportedly one of the largest burn centers in the U.S.)
It wasn’t only Dr. Shires who inspired Dr. Tracey as a surgical investigator. One of his first patients after medical school was Janice, an infant who died due to complications of severe burns as a result of an overturned pot of boiling water. Dr. Tracey later wrote a book about the case: Fatal Sequence: The Killer Within—the title referring to septic shock caused by TNF.
“I remember taking care of Janice in the burn unit that Dr. Shires built,” recalled Dr. Tracey. “Unfortunately, we had no real understanding of why she died, and that event drove me to ask many of these research questions. With this award, I could now pursue answers to the mystery of why Janice died.”
For more information on research scholarships, fellowships, and awards, visit the ACS Member Services section.
The author would like to recognize Susan K. Rishworth, MLS, CA, ACS Archivist; Dolores J. Barber, MSLIS, ACS Assistant Archivist; and Kate Early, Scholarships Administrator, for their assistance in researching this article.
*Nahrwold DL, Kernahan PJ. A Century of Surgeons and Surgery: The American College of Surgeons 1913-2012. Chicago, IL: The American College of Surgeons;2012:250-251.
†American College of Surgeons Foundation. Philanthropy at work. September 2012. Available at: www.facs.org/acsfoundation/news/sept2012.pdf. Accessed January 10, 2013.