- Eugene Braunwald and the Rise of Modern Medicine by Thomas H. Lee
Eugene Braunwald is unquestionably the most influential American cardiologist since Paul Dudley White (1886–1973), and this well-written book provides insight into his six-decade career that coincided with dramatic developments in the care of patients with heart disease. Born in 1929 in Vienna, Braunwald was fortunate to have escaped to England in the summer of 1938, a few months after Nazi Germany annexed Austria. His family arrived in Brooklyn the following year. Braunwald was sixteen years old when he started college at New York University. He remained at NYU for medical school and then served as an intern at Mount Sinai Hospital. By this time, Braunwald had already developed a special interest in heart disease, stimulated in part by his exposure to Charles Friedberg, a renowned physician and author of a popular cardiology textbook.
Braunwald understands the significance of serendipity and the importance of seizing opportunities. Thomas Lee’s biography includes several examples of these phenomena. In 1954 Braunwald started working in André Cournand’s cardiac catheterization laboratory at Bellevue Hospital. He fulfilled his military obligation by serving in the U.S. Public Health Service as a clinical associate at the National Institutes of Health, where he worked with physiologist Stanley Sarnoff and cardiac surgeon Andrew Morrow, among others. In 1959 Braunwald was appointed [End Page 580] director of the institute’s Cardiac Catheterization Laboratory. The NIH also provided him with access to state-of-the-art facilities for basic research in physiology and biochemistry, animal experimentation, clinical investigation, and inpatient and outpatient care.
Braunwald left the NIH in 1968 to become the first chair of the Department of Medicine at the University of California, San Diego. Disappointed that state funding cuts threatened the development of planned institutional programs and facilities, Braunwald moved to Boston in 1972 to become Hersey Professor of the Theory and Practice of Physic at Harvard Medical School and physician-in-chief at the Peter Bent Brigham Hospital.
Lee’s book provides fascinating glimpses into medical politics at the institutions with which Braunwald was affiliated. When he arrived at the Brigham in 1972, it was a highly respected Harvard teaching hospital. But Braunwald was frustrated by the outdated facilities and other obstacles that would interfere with his goal of transforming the Department of Medicine into an incubator for academic internists and medical subspecialists. It took money to attract and retain talented faculty to his department, so he established the Brigham Medical Group as a mechanism to gain control over some of the clinical practice income to help support the expanding research-oriented faculty. The strategy was controversial, and several well-established faculty members resigned in protest.
Braunwald recognized emerging trends in health care delivery and took steps to adapt to local, regional, and national changes. The Partners HealthCare System was established in 1993, in part to facilitate the development of a network of community-based physicians whose physicians would refer patients to Brigham and Women’s Hospital and the Massachusetts General Hospital. Three years later Braunwald was appointed to the new position of chief academic officer and vice president for academic programs at the Partners HealthCare System in 1996. This coincided with his retirement as chair of the Department of Medicine.
Another notable feature of Braunwald’s half-century career has been his talent for adopting new research approaches. In the 1950s he worked in small laboratories that focused on studying cardiac physiology in animals and individual patients. By the end of the twentieth century he was an international leader of major randomized clinical trials that involved tens of thousands of patients enrolled at multiple centers in several countries. The focus of these trials reflected his passion for identifying ways to limit the size of acute myocardial infarctions and to reduce the incidence and severity of heart failure. Several of these trials had a profound impact on patient care.
Braunwald is one of the world’s most prolific contributors...