Festschrift
A Tribute to John H. Laragh Michael H. Alderman1
RENIN AS A RISK FACTOR
John and his team had shown that an activated reninangiotensin system was associated with increased cardiovascular mortality in hypertensive patients. Not satisfied with the methodology, I proposed a prospective study. John was unconvinced. He felt more study to be unnecessary— the answer was already in! Nevertheless, his next National Institutes of Health program project grant included funds for an epidemiological study to determine the association of plasma renin activity with morbidity and mortality among our hypertensive patients. Once committed, his support never wavered —even when results were slow in coming and initially unpromising. In the end, of course, John was right. The study, and its 20-year follow-up, merely confirmed what he had known. John and Jean along the way found ways to
exploit this confirmatory epidemiological study to enrich their more fundamental research. John, and his gifted partner, Jean Sealey, never strayed from a laser-like focus on the renin-angiotensin system. Throughout a half-century collaboration, they explored brilliant conceptions through fastidious experimentation that translated biological insights into clinical practice. The result was a coherent strategy for effective and efficient individualized antihypertensive therapy. Jean’s development of a clinically applicable means to measure plasma renin activity made it possible for doctors everywhere to apply the Laragh method. WEDNESDAY MORNING
Every Wednesday morning, John’s group met to discuss cases, recent papers, and progress on the research front. Visiting scholars often attended. The meetings were lively, passionate, and even sometimes acrimonious. Rigorous unfettered criticism of research in progress brought out the best. John often quoted from Francis Bacon, “Reading makes a full man, conversation a ready man, and writing a precise man,” which concisely expressed the essential elements of his intellectual processes. John was the exemplar of that trinity. He was the one to recall the critical reference. He reveled in lively disputation and insisted that any paper bearing his name be crafted with precision. These weekly meetings remained the intellectual high point of my weeks for more than 20 years. JOHN AS INNOVATOR, LEADER, AND MAN OF PRINCIPLE
John was uncomfortable with elitism. Membership in the hypertension society of the time was sharply limited to established investigators. Consistent with his democratic willingness to entertain new people and their ideas, John took action. He was the founding president of the American Society of Hypertension in 1985. Membership, open to all with an “interest” in the field, grew rapidly, as did attendance at annual meetings. By the end of the 20th century, some 4,500 students, young investigators, and leading scholars from around the
Correspondence: Michael H. Alderman (michael.alderman@einstein. yu.edu).
1Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Initially submitted April 8, 2014; accepted for publication May 6, 2014.
doi:10.1093/ajh/hpu109 © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected]
American Journal of Hypertension 27(8) August 2014 1017
Downloaded from http://ajh.oxfordjournals.org/ at University of Hawaii, PBRC, Kewalo Marine Lab. on May 31, 2015
Just 40 years ago, John Laragh asked me to describe the Cornell program for detection and treatment of hypertensive employees at Bloomingdale’s Department store. It was flattering to be asked but somewhat daunting because John was already a towering figure in the world of hypertension— soon to be confirmed by a Time magazine cover. The program provided simple, one-size-fits-all, on-site antihypertensive therapy. As I saw it, neither diagnosis nor treatment of hypertension required any special medical knowledge. Direct physician care could be replaced by a system of physician supervision of nurses who provided protocol-guided care. My presentation was politely received, but the question period that followed was another matter. Having my innocence (like most other clinicians and “authorities” at the time) exposed was a humbling experience. Laragh’s team had already shown that hypertensive patients differed in their mechanism of blood pressure control. Optimal treatment needed to be individualized. A call from Jean Sealey the very next day relieved my chagrin. Jean and John were coming to Cornell. Would I join their group? Their compassionate expression of tolerance began a cherished professional and personal association that continues to this day.
Alderman
A MAN OF PARTS
John had an enormous and joyous appetite for life. His marriage was a genuine partnership that his son, Robert,
1018 American Journal of Hypertension 27(8) August 2014
and his wife, Marney, and their child took full part. He loved people and invariably brought out their best. Never content with small talk, his conversation was filled with real substance. Golf and finance were important, but the range of his interests, knowledge, and enthusiasms was truly catholic. One evening, over dinner, he picked up a comment by my wife about Rilke’s “Letter to a Young Poet.” John’s eyes twinkled as he recounted, in some detail, his memory of the letter, and Rilke’s poetry. His human interactions were always direct, generous, and honest. His patients were not just professional responsibilities, but real people, many of whom also enriched his life. Summary
The Laraghs have been widely and justly recognized for their many landmark accomplishments. The experimental steps that dissected the renin–angiotensin system were not ends in themselves but the means to benefit millions—one at a time. It is this linkage of fundamental biology to individual human health care that so uniquely distinguish John and Jean Laragh.
Downloaded from http://ajh.oxfordjournals.org/ at University of Hawaii, PBRC, Kewalo Marine Lab. on May 31, 2015
world gathered to present and discuss what was new in hypertension—much of which came from the Laragh center. In the same vein, in 1988, John established the American Journal of Hypertension. His lead editorial in volume 1, number 1, set the tone for his nearly 20 years as editor-inchief. “Hypertension is a sign … the cause for which must be found in each individual patient … the aim … of the journal is … to serve scientists and practitioners … eliminate non-scientific considerations ... to be non-elite, and encourage an egalitarian, open society.” To this end, John was particularly sensitive to the need for young and new investigators to publish. He courageously resisted pressure for the American Journal of Hypertension to open its pages to commercial interests. The survival of the American Journal of Hypertension as a successful independent journal is another tribute to John’s commitment to principle, integrity, and scholarly leadership.
A Tribute to John H. Laragh Michael H. Alderman1
RENIN AS A RISK FACTOR
John and his team had shown that an activated reninangiotensin system was associated with increased cardiovascular mortality in hypertensive patients. Not satisfied with the methodology, I proposed a prospective study. John was unconvinced. He felt more study to be unnecessary— the answer was already in! Nevertheless, his next National Institutes of Health program project grant included funds for an epidemiological study to determine the association of plasma renin activity with morbidity and mortality among our hypertensive patients. Once committed, his support never wavered —even when results were slow in coming and initially unpromising. In the end, of course, John was right. The study, and its 20-year follow-up, merely confirmed what he had known. John and Jean along the way found ways to
exploit this confirmatory epidemiological study to enrich their more fundamental research. John, and his gifted partner, Jean Sealey, never strayed from a laser-like focus on the renin-angiotensin system. Throughout a half-century collaboration, they explored brilliant conceptions through fastidious experimentation that translated biological insights into clinical practice. The result was a coherent strategy for effective and efficient individualized antihypertensive therapy. Jean’s development of a clinically applicable means to measure plasma renin activity made it possible for doctors everywhere to apply the Laragh method. WEDNESDAY MORNING
Every Wednesday morning, John’s group met to discuss cases, recent papers, and progress on the research front. Visiting scholars often attended. The meetings were lively, passionate, and even sometimes acrimonious. Rigorous unfettered criticism of research in progress brought out the best. John often quoted from Francis Bacon, “Reading makes a full man, conversation a ready man, and writing a precise man,” which concisely expressed the essential elements of his intellectual processes. John was the exemplar of that trinity. He was the one to recall the critical reference. He reveled in lively disputation and insisted that any paper bearing his name be crafted with precision. These weekly meetings remained the intellectual high point of my weeks for more than 20 years. JOHN AS INNOVATOR, LEADER, AND MAN OF PRINCIPLE
John was uncomfortable with elitism. Membership in the hypertension society of the time was sharply limited to established investigators. Consistent with his democratic willingness to entertain new people and their ideas, John took action. He was the founding president of the American Society of Hypertension in 1985. Membership, open to all with an “interest” in the field, grew rapidly, as did attendance at annual meetings. By the end of the 20th century, some 4,500 students, young investigators, and leading scholars from around the
Correspondence: Michael H. Alderman (michael.alderman@einstein. yu.edu).
1Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Initially submitted April 8, 2014; accepted for publication May 6, 2014.
doi:10.1093/ajh/hpu109 © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected]
American Journal of Hypertension 27(8) August 2014 1017
Downloaded from http://ajh.oxfordjournals.org/ at University of Hawaii, PBRC, Kewalo Marine Lab. on May 31, 2015
Just 40 years ago, John Laragh asked me to describe the Cornell program for detection and treatment of hypertensive employees at Bloomingdale’s Department store. It was flattering to be asked but somewhat daunting because John was already a towering figure in the world of hypertension— soon to be confirmed by a Time magazine cover. The program provided simple, one-size-fits-all, on-site antihypertensive therapy. As I saw it, neither diagnosis nor treatment of hypertension required any special medical knowledge. Direct physician care could be replaced by a system of physician supervision of nurses who provided protocol-guided care. My presentation was politely received, but the question period that followed was another matter. Having my innocence (like most other clinicians and “authorities” at the time) exposed was a humbling experience. Laragh’s team had already shown that hypertensive patients differed in their mechanism of blood pressure control. Optimal treatment needed to be individualized. A call from Jean Sealey the very next day relieved my chagrin. Jean and John were coming to Cornell. Would I join their group? Their compassionate expression of tolerance began a cherished professional and personal association that continues to this day.
Alderman
A MAN OF PARTS
John had an enormous and joyous appetite for life. His marriage was a genuine partnership that his son, Robert,
1018 American Journal of Hypertension 27(8) August 2014
and his wife, Marney, and their child took full part. He loved people and invariably brought out their best. Never content with small talk, his conversation was filled with real substance. Golf and finance were important, but the range of his interests, knowledge, and enthusiasms was truly catholic. One evening, over dinner, he picked up a comment by my wife about Rilke’s “Letter to a Young Poet.” John’s eyes twinkled as he recounted, in some detail, his memory of the letter, and Rilke’s poetry. His human interactions were always direct, generous, and honest. His patients were not just professional responsibilities, but real people, many of whom also enriched his life. Summary
The Laraghs have been widely and justly recognized for their many landmark accomplishments. The experimental steps that dissected the renin–angiotensin system were not ends in themselves but the means to benefit millions—one at a time. It is this linkage of fundamental biology to individual human health care that so uniquely distinguish John and Jean Laragh.
Downloaded from http://ajh.oxfordjournals.org/ at University of Hawaii, PBRC, Kewalo Marine Lab. on May 31, 2015
world gathered to present and discuss what was new in hypertension—much of which came from the Laragh center. In the same vein, in 1988, John established the American Journal of Hypertension. His lead editorial in volume 1, number 1, set the tone for his nearly 20 years as editor-inchief. “Hypertension is a sign … the cause for which must be found in each individual patient … the aim … of the journal is … to serve scientists and practitioners … eliminate non-scientific considerations ... to be non-elite, and encourage an egalitarian, open society.” To this end, John was particularly sensitive to the need for young and new investigators to publish. He courageously resisted pressure for the American Journal of Hypertension to open its pages to commercial interests. The survival of the American Journal of Hypertension as a successful independent journal is another tribute to John’s commitment to principle, integrity, and scholarly leadership.
