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A gastroenterologist moves around the country and into a top job at UCSD

Yale Medicine Magazine, 2008 - Spring


An academic journey that began at Yale’s Ezra Stiles College in 1971 has led David A. Brenner, M.D. ’79, HS ’82, from coast to coast and, most recently, to the top leadership role at the medical school of the University of California, San Diego (UCSD).

After an internal medicine residency at Yale-New Haven Hospital—“I escaped after 11 years,” he chuckled—a fascination with basic research brought him to the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases. In 1985 he went to UCSD for a gastroenterology fellowship, later joining the faculty. Next he joined the University of North Carolina at Chapel Hill as chief of the Division of Digestive Diseases and Nutrition, and in 2003 he became chair of medicine at Columbia University’s College of Physicians and Surgeons, where his daughter Laura is currently a medical student. (His son, Nathan, is a recent graduate of the University of Georgia.) San Diego, though, has lured him back. In February he became vice chancellor for health sciences and dean of the school of medicine after his predecessor, Edward W. Holmes, M.D., accepted two research positions in Singapore. Brenner is head of the schools of medicine and pharmacy as well as of the hospital and its faculty, and his duties bring him into close contact with students, bench researchers, patients and decision makers for the university as a whole.

Brenner’s interest in research began early. At Yale College he majored in biology. In medical school, he began working with researchers in the Yale Liver Study Unit. “I was always interested in biochemistry and genetic diseases, and I picked this because it looked interesting, not because I thought there was something intrinsically interesting about the regulation of metabolism by the liver,” Brenner said. “Gerald Klatskin, one of the most famous hepatologists ever, was director of the liver study unit, so I just stayed, and got interested in liver disease.” With his mentor, Joseph R. Bloomer, M.D., FW ’72, a student of Klatskin’s and now director of the Liver Center at the University of Alabama at Birmingham, Brenner published several papers in the late 1970s on the group of diseases known as the porphyrias, enzyme disorders that cause skin problems or neurological complications. He and Bloomer remain in touch. Brenner continued to make important contributions to knowledge about protoporphyria; intracellular signaling and regulation of gene transcription in the liver; and the process of hepatic fibrosis. From 2001 to 2006 he served as editor in chief of the field’s most prestigious journal, Gastroenterology.

His current research explores why so many types of liver disease lead to the same ends—cirrhosis or permanent fibrotic change. “The liver’s not that smart; it’s not like the brain. There’s a limited repertoire of responses to insult, it doesn’t matter what the initial insult is; the final common pathway is very similar,” he said. “The only effective drugs now for fibrosis are directed at the treatment for the underlying condition. But the goal is to develop specific therapies that are directed at fibrosis itself, and not the underlying agent. Maybe half the patients with hepatitis C in the real world will fail to respond to the current standard-of-care treatment. They will go on to scarring, fibrosis, decompensation and liver cancer.”

Asked how gastroenterology has changed since he began his training, he says he is concerned about what he considers to be a shrinking of its focus. Screening colonoscopy, a procedure that has saved innumerable lives since becoming routine, now dominates many gastroenterologists’ practice. “It’s incredibly important, relatively straightforward and very profitable. I’m worried it’s gotten too narrow. The whole field is keyed on this one single disease [colon cancer] and one single procedure.” Indeed, recent advances in imaging technology may force gastroenterologists, ready or not, to alter their practice pattern. “This interest in CT virtual colonographs [a less invasive means of screening for colon cancer]—what if it becomes the major way of screening? Then all these millions of patients will not need an endoscopist. … In 10 more years, diagnostic endoscopy might no longer be done. I wish the field would be more general, more entrepreneurial about issues of nutrition, obesity and GI diseases.” European gastroenterologists have been more inquisitive in this sense than their American colleagues. “When a new technology becomes available, they bring it into their practice, whether it’s ultrasound or CT.” In the United States, cardiac ultrasound is done by cardiologists, but abdominal ultrasound is still the province of radiologists. Gastroenterologists, he thinks, should do their own ultrasounds.

Brenner’s new job suits his eclecticism. His career has been replete with accomplishments in research, clinical work and administration, and at UCSD he is still able to round on patients, troubleshoot gels in the lab and maintain leadership roles in several medical and philanthropic organizations.

“I decided that if at all possible I want to continue teaching and seeing patients; I want to continue my research program,” he said. “Sometimes hands-on experience is the best.”

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