Those who knew Paul Beeson, MD - legendary clinician, researcher, teacher, academic leader, editor of seminal medical texts, editor-in-chief of the Journal of the American Geriatrics Society, and a founding father of geriatrics -recall his brilliance, dedication, integrity, compassion and commitment, but acknowledge that these strengths alone don't adequately convey the greatness of the man, who died this past summer at 97.
"Many of us who knew him well have spent many hours trying to figure out his mystique; it's not easily conveyed in words," says Fred S. Kantor, M.D., who was a resident and fellow under Dr. Beeson at Yale University School of Medicine during the 1960s and is now Paul B. Beeson Professor of Medicine at Yale. "There was something that he had and it was integrity and compassion and a sense of wanting to get it right - not get it done - but get it done right. There was this tremendous sense of caring, of responsibility to his patients, students, residents, interns and fellows, and this responsibility, as it turned out later, to the community, particularly the aging community."
Beeson made many key contributions to geriatrics. In the late 70s, when the field was still in its infancy, he headed the Institute of Medicine's seminal 1978 study on aging and medical training. The study raised national awareness of the challenges posed by the aging of the US population and called, presciently, for increased physician training in geriatric medicine. That same year, he took the helm of the Journal of the American Geriatrics Society, giving it and the field a considerable boost.
"He recognized early the importance of geriatrics and assumed editorship of the Journal in time to keep it and the field alive," recalls Daniel David Federman, MD, Carl W. Walter Distinguished Professor of Medicine at Harvard Medical School, former dean for medical education at Harvard, and a past member of the AGS Board of Directors.
Beeson's contributions to geriatrics, however, came relatively late in what was a life of remarkable and continued accomplishment. Born in 1908, the son of a rural physician and surgeon, Beeson spent much of his early years in Montana and Alaska, when the latter was largely frontier. After graduating from the University of Washington and McGill University School of Medicine, he completed his internship at the University of Pennsylvania and got further training at New York Hospital, the clinical arm of Cornell University. From there, Beeson went to Rockefeller Institute, where he and colleagues were the first to demonstrate that fever is often a bodily response to infection, and to isolate the protein interleukin -1, identifying it as the agent provoking the response. This work, for which Beeson is best known, opened up an entirely new field of research concerning inflammation and immune responses to infection.
From Rockefeller, Beeson went on to become chief resident at Harvard's Peter Bent Brigham Hospital under the famed Soma Weiss, MD. During World War II, he was chief physician the Harvard-Red Cross Field Unit Hospital, which conducted epidemiology research. He also volunteered to work at the Harvard Cross Hospital in Salisbury, England. There Beeson met American Red Cross nurse Barbara Neal. They later married and had three children.
In 1942, Beeson joined the faculty at Emory University School of Medicine. He chaired the faculty from 1946 to 1952, when Yale recruited him to chair its department of internal medicine. Beeson's compassion for and connection with his patients, and his dedication to giving his all to do right by them, galvanized students, residents and fellows to "do better than they might otherwise do," says Kantor. Not surprisingly, many of students and residents Beeson helped train have are now renowned leaders in research and academic medicine.
"He engendered not only this incredible sense of awe, but also this incredible loyalty and fondness," Kantor adds, recollecting how Beeson and his wife never failed to send a gift when a resident or fellow married or had a child, and how they took the time, each year, to decorate a meeting room with evergreen boughs for the medical school Christmas party. "He was not your hail-fellow-well-met; he was somewhat distant, seemingly cool. But underneath that cool, composed exterior he was an extremely warm human being.""
Beeson remained at Yale until 1965, when he was appointed Nuffield Professor of Medicine at Oxford. The appointment, to one of the most prestigious academic medical positions in England, was an almost unheard-of honor for an American, notes Richard Rapport, MD, author of Physician: The Life of Paul Beeson. In 1973, Queen Elizabeth bestowed another honor on Beeson, making him an Honorary Knight Commander of the Most Excellent Order of the British Empire. (Though appreciative, Beeson, who had an enduring modesty, "never wanted to be addressed as "Sir Paul,"" Kantor recalls.)
The following year, Beeson returned to the states to accept an appointment at the University of Washington as Professor of Medicine and Distinguished Physician of the US Veterans Administration in Seattle. It was a turning point. Beeson "was distressed by the relative neglect of the teaching and practice of geriatrics in the US," compared with Britain, Gene H. Stollerman, MD, Professor of Medicine and Public Health, Emeritus, at Boston University, and Editor Emeritus of JAGS, writes in a tribute to Beeson.
Focusing increasingly on the care of older adults, Beeson found that while older people made up the most rapidly growing segment of the US population, many of their needs were unmet. "The aspect that is being slighted is a special characteristic of the needs of the elderly: the kind of continuing (lifetime) medical care required for people who have multiple, chronic progressive disabilities," he wrote.
Despite increasing medical specialization, Beeson had long extolled the importance of the generalist, the physician who could take a holistic approach to patient care. In geriatrics in particular, he recognized and emphasized the importance of such an approach. He also advocated interdisciplinary care and training, calling for "clinical training that included teaching of ambulatory care by sociologists, psychologists, economists and home nurses (and) argued that medical schools should affiliate with chronic care institutions," Rapport writes.
Overall, Beeson lobbied for stronger curricula in aging for medical students. Among other things, the IOM's 1978 "Aging in Medical Education" report included recommendations that all medical schools and teaching hospitals include curricula on aging. These recommendations, Rapport writes, paved the way for the "Teaching Nursing Home" projects the NIA and the Robert Wood Johnson Foundation funded in the early 1980s.
Beeson gave geriatrics another leg up when he took over as editor-in-chief of the Journal of the American Geriatrics Society, in 1978. He held the post until 1984 and was an Editor Emeritus until his death. During his tenure as editor-in-chief, Beeson attracted a nationally eminent editorial board of experts in all relevant clinical areas, enhanced the status of the journal and the Society, and continued to raise awareness of the importance of the study of aging and effective care for older people.
In addition to his other gifts, Beeson had a gift for editing. With Walsh McDermott, MD, he edited the "Cecil-Loeb Textbook of Medicine" and helped edit both "Harrison's Principles of Internal Medicine" and "The Oxford Companion to Medicine." He appreciated good writing and sometimes found it difficult to refrain from marking up copy. "An old editor finds it almost impossible to resist penciled suggestions about wording and some thoughts about the substance of the report," he wrote after covering a draft of the IOM report with proofreader's marks. His edits were, inevitably, on target.
"As a first-year fellow at the National Institute on Aging, I fondly recall receiving a manuscript that I had submitted to JAGS which Dr. Beeson had hand edited," recalls AGS President Jane Potter, MD, director of the section of geriatrics at the University of Nebraska Medical Center. "I also recall that I received these comments only a few days after the manuscript had been submitted. It was so clear that what he wanted most was to be helpful, and this manuscript became the first paper that I published in JAGS."
In recognition of his numerous and significant contributions to medicine in general, and to geriatrics in particular, the National Institute on Aging and several foundations established the Paul B. Beeson Career Development Awards in Aging Research program in his honor in 1995. Since then, the program has supported the independent research careers of clinically trained investigators whose work enhances the care and quality of life of older adults. The program is just one part of Beeson's lasting and substantial legacy.
"Dr. Beeson's contributions as a scientist, clinician and beloved teacher have greatly expanded knowledge and understanding of the human condition and have profoundly influenced the career paths of generations of physicians," writes Jeremiah Barondess, MD, Immediate Past President of the New York Academy of Medicine. "Dr. Beeson never lost focus on the importance of care in serving the sick, of remembering the person who has the disease. He has transmitted those values to a very large number of today's physicians. In every way, Paul Beeson has been a powerful force for good in American Medicine."
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