American Pediatric Society John Howland Award 1997: Presentation

President Johnston, Madeline, Mel, members of the Grumbach clan, APS members, and guests. It is with considerable pride and the greatest of personal pleasure that I introduce to you the recipient of this year's John Howland Award of the American Pediatric Society, Melvin Malcolm Grumbach(Fig. 1). Through his tireless and creative leadership over more than 40 years, Mel has made major contributions to science, clinical practice, education, and institution building. In doing so, he has left a permanent mark on virtually every aspect of academic pediatrics.

Figure 1

Sketch of Mel as others have seen him, essentially unchanged for years. His ever present pipe and thoughtful demeanor are evident. The drawing is by Rod Phibbs, Professor of Pediatrics at UCSF.

Melvin M. Grumbach, or as he has fondly been known to several generations of trainees, colleagues, and friends...Dr. Melvin M. Grumbach, was born in New York City four days before Christmas in 1925. Mel enjoyed an idyllic childhood (Fig. 2), and much like another New York native son, Woody Allen, developed a reputation for being wise beyond his years as a precocious philosopher and careful observer of the human condition. It was one of the two of them that said “Eternal nothingness is fine if you happen to be dressed for it.”

Figure 2

Mel with his parents and brother at an early age outside their home in New York.

After his early education in the New York City public schools, Mel entered Columbia College and then matriculated to the College of Physicians and Surgeons, from which he received his M.D. degree at the tender age of 23 in 1948. Residency training in pediatrics followed at Babies Hospital before Mel joined the Air Force in 1951. Although most people enter the armed services as a private, our hero was inducted as a Captain. Within six months, he was a four star general and chairman of the joint chiefs of staff...or so he told me. It is of some interest that during this time in the Air Force, he was assigned first to the Institute for Nuclear Studies at Oak Ridge, and then to the Biological Warfare Laboratories at Frederick, Maryland. (This is actually true.) I am told, however, that due to a certain lack of dexterity, he was ordered not to touch anything in either of these laboratories for fear of a catastrophic accident. Over the intervening years, this same request would be restated many times by his long time colleague and collaborator, Selna Kaplan.

After a general courts martial for smoking a pipe near the base gunpowder magazine, Mel realized he needed to find some new direction in his life. Fortunately, he met, wooed, and wed Madeline Butt, his partner, confidant, and best friend for more than 45 years. This was, without a doubt, the best and most important decision of his life. Those who know Mel well will attest to the fact that he is a high maintenance individual. He has always surrounded himself with staff, residents, fellows, and faculty to cater to all of his needs. I contend that this is because from the very first, Madeline has spoiled Mel terribly.

In 1953, Mel became a fellow at Johns Hopkins with Lawson Wilkins. Those were heady days when the then new field of Pediatric Endocrinology was open to be explored and charted. Among others in that group of trainees were Jud Van Wyke, Claude Migeon, and Tom Sheppard, all of whom have gone on to exceptionally distinguished careers. In 1955, Mel returned to Columbia to join the faculty where he would remain for the next decade and build a Division of Pediatric Endocrinology and the underpinnings of a career in Pediatric Investigation. His early work was focused on disorders of sex determination, making use of the then new tools of cytogenetics. In a 1962 paper in theProceedings of the National Academy of Sciences, Mel described the asynchronous replication of the human X chromosomes in female cells and the relationship of this phenomenon to the sex chromation or Barr body. Later that year, Mary Lyon published her famous theory of X chromosome inactivation, and but for some chance events, today's students of biology might associate X chromosome inactivation with the Grumbach hypothesis, but that is a story for another time.

In the early 1960s, Mel teamed up with Selna Kaplan to study the physiology of growth hormone and human chorionic somatomammotropin using the recently described technique of radioimmunoassay. This collaboration, which endures until the present, has been superbly productive and richly rewarding. Together, they characterized the hormonal regulation of growth from fetal life through puberty. Mel and his colleagues were the first to demonstrate the exquisite sensitivity of the hypothalamic negative feedback mechanism to sex steroids during the prepubertal period and the change in the set point of this feedback mechanism which heralded the onset of puberty.

After a decade of substantial accomplishment, Mel was called to the chair at UCSF. Of course given that this was San Francisco in 1966, “the call” was probably something like “Hey, Mel, make love not war!” In 1966 UCSF was generally viewed by most as having a small, regional pediatric program that produced solid general pediatricians and a few good subspecialists. But these were extraordinary times in San Francisco for a variety of reasons. Julius Comroe had created the Cardiovascular Research Institute a few years before, and his first fellow was Bill Tooley, who established the newborn intensive care unit at UCSF. Bill worked closely with John Clements studying a wondrous new substance called surfactant. Abe Rudolph also joined the mix and brought with him the South African mafia and a focus on fetal physiology. The year before Mel arrived, Holly Smith became the Chairman of Medicine and helped to recruit both Mel as Chairman of Pediatrics and Bill Rutter as Chairman of Biochemistry. It was in this exciting milieu that Mel set out to build the Pediatric Program at UCSF. Mel became the quintessential San Franciscan, with a love for everything in Baghdad by the Bay. But most specially, his 49ers. Mel and his son Kevin rarely miss a home game, but thankfully, sometimes Kevin has other duties and I get adopted for a Sunday afternoon.

Well, it's time to get serious for a couple of minutes. What has Mel accomplish during the past 31 years in San Francisco? He completely transformed the enterprise, enabling it to grow in size and influence such that, with all lack of modesty, at the UCSF there is one of the leading academic departments of pediatrics in the country. Although such accomplishments are rarely the result of a single person's effort. there is no doubt about the role that Mel played. He supplied the intellect, the plan, and the energy. He set the standards for uncompromising quality of performance, and created an environment in which inquiry and learning were cherished. Mel was joined in San Francisco by a group of true academic leaders, each of whom, with Mel's support, has had a profound impact on our discipline. People like Abe Rudolph, Julian Hoffman, Michael Heymann, Bill Tooley, John Clements, Rod Phibbs, Art Ammann, Diane Wara, Charlie Epstein, Selna Kaplan, Mish Grossman, Mac Holiday, Joe Kitterman, and Walt Miller practiced their art and skills there at the bedside, in the laboratory, and as teachers. Mel personally revamped the pediatric residency training program and also established what was arguably the best Pediatric Endocrinology Fellowship Program in the country.

One hundred and twenty-four fellows have been trained by Mel, Selna, Felix, and Walt (Fig. 3). Among these former trainees are two medical school deans, 31 full professors, and 23 Chiefs of Pediatric Endocrine Divisions. Ralph Nader said “I start with the premise that the function of leadership is to produce more leaders, not more followers.” As a Department Chair, hundreds of residents have been influenced by Mel. Mel did, however, have a reputation for not always remembering the names of the residents. However, sometimes, as they say, “what goes around comes around.” Let me elaborate. Mel used to regularly conduct teaching rounds on the Moffitt Hospital wards, and all residents were expected to attend. On one particular Saturday, one of the patients to be presented to Professor Grumbach was a three-year-old girl with hypothyroidism due to thyroid dysgenesis. During the week, the patient's mother had been told by the intern that a noted expert on thyroid disease, who also happened to be the new Chairman of the Department of Pediatrics, would see her daughter on Saturday morning. As Dr. Grumbach and entourage entered the patient's room, the nervous intern turned to the mother and said, “Mrs. Smith, I would like you to meet the famous expert on thyroid disease. Doctor um...um...um....” Whereupon the Chief resident whispered, “Grumbach!” Mel handled the situation with his usual aplomb and his well known response of flushing from the neck to the top of his pate. Some have actually calibrated this physiologic response and referred to it as the Grumbach index. The embarrassed intern has since gone on to a productive academic career at another medical center, well to the east of San Francisco-and not in Pediatric Endocrinology.

Figure 3

Mel and Selna Kaplan (center) at a reunion of former endocrinology fellows during a recent international congress.

As much of an impact as Mel has had at UCSF, it has probably been surpassed by his achievements of national and international scope in Pediatrics and Endocrinology. Mel has served in a leadership role in virtually every major academic society. He has been president of the American Pediatric Society, the Endocrine Society, the Association of Medical School Pediatric Department Chairmen, the Lawson Wilkins Pediatric Endocrine Society, the Western Society for Pediatric Research, and the International Pediatric Research Foundation to name but a few. Among his many honors and awards are the Borden Award for Research of the American Academy of Pediatrics, the Robert H. Williams Leadership Award from the Endocrine Society, the Winthrop Award of the American Fertility Society, the Koch Award from the Endocrine Society, and an honorary doctorate from the University of Geneva. Just this past November, he was honored by the American Academy of Pediatrics with its Lifetime Achievement Award in Medical Education. Mel has been elected to fellowship status in the American Association for the Advancement of Science and to membership in the Institute of Medicine, the American Academy of Arts and Sciences, and to the National Academy of Sciences. Due to his widely recognized expertise, good judgment, and fairness, he has chaired innumerable important national committees. He has served as an advisor to many federal agencies, universities, and private foundations. In all of these capacities, Mel served in an important way as an educator; a teacher of lay boards about the importance of pediatric research, a major proponent for the need for the highest standards of pediatric education, and as an unfailing advocate for children and their special medical requirements.

How did Mel accomplish all of this? Well the secret is now out. Years before Dolly became a household word, Mel had himself cloned. In reality, he did have substantial help from his long time executive assistant and friend, Pat Hunter, from Felix Conte and Selna Kaplan, from Abe Rudolph and Mish Grossman, and a host of others. Mel has been a frequent traveler and visitor to many parts of the globe. He has been invited to give a large number of prestigious and named lectures because of the clarity and importance of his presentations. In his capacity as a world traveler and lecturer, he has had a direct educational impact on a large number of pediatricians and endocrinologists. But Mel's greatest achievements in education are best seen in the one on one mentoring and support that he has provided to so many budding and aspiring pediatric scholars. This has been true both for his own trainees and for many others. I experienced this in a very personal way when as a frightened, young fellow at the National Institutes of Health, I presented my first paper to a large national meeting. In fact, it was at this meeting (APS/SPR) more than 20 years ago that Mel came up to me after that talk and gave me some words of encouragement which I recall to this day. Furthermore, he took a very personal interest in my career development over the ensuing years. He would frequently call or stop to chat, and he has continued, to this day, to offer sage advice and encouragement. This was done for no personal gain or recognition, but purely as an expression of his generous spirit. I know that my experience is not unique.

Mel and Madeline (Fig. 4) enjoy a wonderful family life. Mel always looks forward to seeing his three sons Ethan. Anthony, and Kevin (Fig. 5) and also the more extended Grumbach family.

Figure 4

Madeline and Mel celebrating.

Figure 5

Mel with his sons Ethan, Anthony, and Kevin at a party honoring Mel after 20 years of accomplishment as Chair at UCSF.

One other noted Grumbach trait that cannot escape mention is Mel's fastidiousness with regard to his immediate work environment. Abe Rudolph relates the story of his first audience with Chairman Grumbach. He was ushered into the inner sanctum, but Mel was not there. Abe stepped out to inform the secretary of this fact, but was directed back into the room and told to sit in a chair next to the far wall. Only then did the single open passageway through the papers piled high on the desk become apparent, enabling the great Oz of Grumbach to be seen!

After the Loma Prieta earthquake in 1989, the two major concerns in the city of San Francisco were the fires that burned in the Marina district and the disruption that would be caused to Mel's filing system. In truth, Mel always knew where virtually every important piece of paper was just as he knew an incredible array of facts and data about almost every aspect of Pediatrics. His encyclopedic knowledge combined with fierce determination is the formula for his academic success. I believe it was actually Mel and not Dan Quayle who first said. “If we do not succeed, then we run the risk of failure.”

Some have suggested that Mel doesn't know how to relax, but this is clearly not true. Mel's interests outside science, medicine, and the 49ers are eclectic and rich. However, like several other prior recipients of the Howland award, perhaps the key to Mel's success has been that he loves what he does and has been doing each day for the past half century in which he has been involved in pediatrics.

Mel, on behalf of the American Pediatric Society, we salute your vision, and your steadfast values. Your leadership has been of the very best kind...by example. You have taught us all the importance of commitment to being the best that we can be as physicians, as teachers, and as investigators, and you have done it with style, with grace, and with class. It is my honor to ask you to come forward and to receive the Howland Award.