It Runs in the Blood

For these doctors, hematology is “the family business”

The term “family business” may conjure images of stores, restaurants, and other commercial enterprises, but it turns out to apply to the business of hematology, too. The American Society of Hematology (ASH) membership includes several bloodlines of hematologists, including a few families with multiple hematologists, one whose involvement spans three generations, and another with an octogenarian still actively practicing hematology.

This month, ASH Clinical News speaks to members of four hematology dynasties to learn more about how these relatives came to their respective career choices and how they navigate being bound by blood!

The Bergsagels

No fewer than five members of the Bergsagel family have contributed or continue to contribute to the field of hematology. Daniel Egil Bergsagel, CM, MD, DPhil (1925-2007), grew up in Canada’s prairie region during the Great Depression. Although he initially planned to be a small-town general practitioner, a classmate urged him to study hematology in Salt Lake City, Utah, with the legendary Max Wintrobe, MD, PhD. From there, Dr. Bergsagel went to Oxford University, earning a DPhil working with Rosemary Biggs, MD, and Robert Gwyn MacFarlane, CBE, FRS, as they studied the coagulation process. While at Oxford, Dr. Bergsagel noted a unique coagulopathy in Ms. Prower and in the Stuart family, which he eventually named Stuart-Prower factor – now known as factor X.

His interest in proteins and electropheresis led him to the MD Anderson Cancer Center in Houston, Texas. There, he developed a mouse model of multiple myeloma (MM) and tested new chemotherapy drugs in an attempt to find one that would work for humans. Dr. Bergsagel ultimately became physician-in-chief at Princess Margaret Hospital in Toronto, Canada, where his children grew up.

Two sons, Leif and John, both followed in his footsteps to become hematologists. Their sister, Karin, studied nursing and worked in intensive care; later co-authoring an epidemiology paper on familial MM.

Leif Bergsagel, MD, is the David F. and Margaret T. Grohne Professor of Novel Therapeutics for Cancer Research at the Mayo Clinic in Scottsdale, Arizona and, like his father, studies MM. Leif’s wife, Marta Chesi, PhD, is a biochemist who works with her husband on identifying the genetic mutations that drive MM. John Bergsagel, MD, is a pediatric hematologist/oncologist at Children’s Healthcare of Atlanta and an assistant professor at Emory University School of Medicine in Atlanta, Georgia.

Sometimes, in a family business like medicine, the profession hits too close to home. In 1996, Karin Isgur Bergsagel’s husband, physicist Nathan Isgur, PhD, was diagnosed with MM, the very disease for which his father-in-law was a world expert. Dr. Isgur passed away in 2001.

An Interview with John and Leif Bergsagel

How did each of you decide to study hematology? Was your choice influenced by your father’s career?

John Bergsagel: My father told me he wanted me to move to California and become an oenologist [who studies the science of winemaking]. His attitude toward medicine was that he already knew everything that he needed to know – he wanted us to go learn something different so we’d have interesting things to talk about at the dinner table!

He was always fascinated by many things in life; he’d come home from a medical meeting and, before he’d tell us about the latest medical breakthrough, he’d tell us about the restaurants he tried and the museums he visited.

Leif Bergsagel: I always thought I would be a doctor, but I didn’t know what kind. I was interested in studying cancer, so I did a fellowship in medical oncology at the National Cancer Institute (NCI) in Bethesda, Maryland. Back then, the fellowship was designed so that, after a year of clinical work, I spent a couple of years in the laboratory. I asked a few of my father’s friends at the NCI to recommend a good fit for me, and – likely influenced by the fact that my father studied MM and that I was interested in molecular genetics – they recommended joining the laboratory of W. Michael Kuehl, MD, who was studying the molecular genetics of B-cell lymphoma.

Ultimately, I focused on the molecular genetics of MM. I met my wife in the lab, which she joined shortly after I did. Right about the time she arrived, we identified a number of chromosome translocations that characterize MM, and I’ve been studying those ever since.

What would you be if you weren’t a hematologist?

LB: I would have done something involving math, I think.

JB: I imagine I would have been working in Silicon Valley, maybe for Apple. Engineering would probably have been a good fit for me.

What was it like when your brother-in-law was diagnosed with MM? What are the chances of that?

LB: We were able to give him information and advice and get him access to some of the new myeloma drugs that were just being investigated. Being on those clinical trials extended his life, but had he been diagnosed earlier in the disease, the outcome would have been better.

JB: Nathan was a physicist and mathematician, so the first thing he did when he was diagnosed was calculate the odds that someone who was married to a nurse whose brother and father studied myeloma would develop myeloma. He said it would never happen; the odds are way too small.

Is there any chance your children make hematology a three-generation family business?

JB: My daughter has expressed other interests, and one of my sons is studying journalism, so it may end with me from my side of the family.

LB: My boys are into math and physics, so it’s not looking good for hematology.

The Brodskys

The Brodsky family wins the award for the longest generational streak of hematologists, though the third generation is still in medical school. Isadore Brodsky, MD (1930-2007) was a hematologist/oncologist who performed the first bone marrow transplant in the tristate area of Pennsylvania, New Jersey, and Delaware. At the time of his retirement, Dr. Brodsky was the chief of hematology/oncology at Drexel University’s College of Medicine and managing partner in an oncology and hematology practice at Hahnemann University Hospital in Philadelphia.

His son, Robert Brodsky, MD, is the director of the Division of Hematology at Johns Hopkins Medicine and the T32 Training Program in Hematology. In November 2016, he was elected to a 4-year term as ASH Secretary. Dr. Brodsky has previously held several other ASH positions, including chair of the Scientific Committee on Bone Marrow Failure.

Robert’s son, Max Brodsky, is a medical student at Drexel University and recipient of a 2017-2018 ASH Physician-Scientist Career Development Award. He will spend a year in the Ross Levine Lab at Memorial Sloan Kettering Cancer Center studying mechanisms of ruxolitinib resistance in JAK2/ASXL1 double-mutant myeloproliferative neoplasms.

An Interview with Robert Brodsky, MD

How did the tradition of hematology in your family start?

My father was actually interested in cardiology at first, but his experiences as a “Yellow Beret” at the National Institutes of Health during the Vietnam War, when he studied viruses in mice and myeloproliferative disorders, spurred his interest in blood disorders and hematology.

How did your father’s career influence your choices?

My father was an incredible role model. He was passionate not just about hematology, but all science. I came to medicine kind of late – I was a political science major at the University of Pennsylvania until I developed an interest in medicine. Like my father, I became fascinated with blood diseases. The ability to make a diagnosis by looking [through] the microscope captured my attention initially, then I set my sights on trying to understand the basic science underpinning hematology and spent a fair amount of time in the lab.

Have you worked together?

We’ve co-authored a few papers, and some of my fondest memories are of going to the ASH annual meetings with him; we probably went to eight or 10 together. In 2016, I had the chance to attend the ASH annual meeting with my son, where he presented his poster. I think we might be the only family with three generations who have presented at the ASH annual meeting.

Do you think your choices influenced your son?

My father never pressured me to follow in his footsteps; he was kind of surprised when I decided to pursue hematology.

I think part of it has to do with whether the parent is professionally happy. My father saw some exciting times and discoveries, and so did I. It was something I wanted to be a part of. When my sons were in high school, they volunteered in the sickle cell clinic at Johns Hopkins, and I think it affected them in many ways. They saw that there are people a lot less fortunate than them, and they got a sense of how much impact one can have just by listening. They also saw how much I’ve enjoyed this specialty, in the same way I watched my father.

The Escobars

Miguel A. Escobar, MD, may just be one of the oldest practicing hematologists in the world. At the age of 87, he still sees patients regularly in his hometown of Cali, Colombia, where he works in transfusion medicine. Dr. Escobar was the first practicing hematologist in Cali; spent many years as the dean of the medical school at Universidad Libre de Colombia; and, until the mid-1980s, ran a foundation that treated children with leukemia at no cost.

His son, also named Miguel A. Escobar, MD, is a pediatric hematologist/oncologist at Children’s Memorial Hermann Hospital in Houston, Texas. He is also the medical director of the Gulf States Hemophilia and Thrombophilia Center, a federally funded hemophilia treatment center affiliated with the University of Texas Health Science Center–Houston Medical School.

An Interview with the Younger Miguel Escobar

How did your father become a hematologist?

My father was in the first residency class in internal medicine at the University del Valle in Cali, Columbia. I’m not sure how he became interested in hematology, but at the time, there were no fellowships in Latin America, so he went to the University of Chicago in 1950 to do a hematology fellowship.

I was born in Chicago, but after he finished his fellowship, my father returned to Colombia to care for my grandfather. I was raised [in Colombia], went to medical school there, and then returned to the United States for my residency and fellowship.

What interested you in hematology?

Even in high school I was involved with my father’s work; I went on rounds with him at the hospital and to his clinic. I knew early on that I was going to be a doctor, and once I started to understand more of what he does and witness the way he practices – the respect he has for patients and families, his strict adherence to moral and ethical principles – I decided, “This is what I want to do.” I wanted to be the same kind of doctor.

Does your father have any plans to retire from practice?

I hope so! He still goes to work every day. Actually, just last week he told me that he was invited to a symposium to give a talk on transfusion medicine, so he’s still active in seeing patients and teaching.

Have you had the opportunity to work together?

He was the dean of my medical school and he taught me during hematology rotations. It was amazing because he was the one who handed me my diploma. Of course, he had high standards for me, so I had to live up to them! I was the top graduate in my class in 1989.

We never worked together after medical school, when our fields diverged – I went into hemostasis and thrombosis, and he does mostly general hematology – but we have written a few papers together.

Did he encourage you to become a hematologist?

He never explicitly told me to; rather, he encouraged me to do what I felt I would enjoy and where I felt I’d be able to help patients and contribute to the scientific community. Hematology was always my first choice, and that had a lot to do with my father. By my first year of medical school, I was already performing bone marrow biopsies with him.

Do you think your children will go into hematology?

My daughter just graduated from high school and definitely wants to be a doctor. She has spent time at the hospital with me – just like I did with my dad – and she might want to be a hematologist, but we’ll see how that turns out.

The Narlas

Mohandas (Mohan) Narla, DSc, is a basic scientist who came to hematology quite by “accident.” Dr. Narla studied engineering before switching to red blood cell physiology and pathology. He is now the vice president of research at the New York Blood Center and the head of the Red Cell Physiology Lab there. His daughter, Anupama (Anu) Narla, MD, made a more conscious choice to follow in her father’s footsteps. She is a pediatric hematologist/oncologist at the Lucile Salter Packard Children’s Hospital at Stanford University.

Her brother, Goutham Narla, MD, PhD, is a geneticist, but has an adjunct appointment in oncology/hematology at University Hospitals in Cleveland and the Mount Sinai School of Medicine in New York. In his laboratory, he focuses on the identification and characterization of the key tumor suppressor proteins of cancer development and progression. Last, but not least, their mother, Jyothsna Narla, MD, is a pathologist in San Jose, California.

An Interview with Mohan and Anu Narla

How did you become involved in hematology, Mohan?

Mohan Narla: I was looking for some projects earlier in my research career, and I ended up working on red cells – learning how flexible [and] adhesive they are. At the time, there was a lot of interest in developing kidney dialysis and heart-lung machines, so there was a need to better understand blood flow. In 1973, I moved to Paris to do 3 years of postdoctoral research at the Institute of Cellular Pathology, which dealt exclusively with hematology research, and where I quickly learned about red blood cells and hematologic disorders. The biology was fascinating and my time there set the stage for the next 40 years of my research career.

Anu, did your father push you toward becoming a hematologist?

Anu Narla: No, and my parents have never been able to force me to do anything in my life! [MN agrees.] They never pressured me, but, growing up, I saw how much my mother and father loved their careers. I loved science, so I applied to medical school. I became interested my father’s work and hematology, so I just followed right in his footsteps without him planning it at all!

Was this a sore point with your mother, that you didn’t choose pathology?

AN: I’m pretty much a carbon copy of my father, so anything I do, she says, “Oh, just like your father!” It was kind of predestined.

Mohan, how did you react when she chose hematology?

MN: I was surprised! The first patient she met in clinic at the University of Pennsylvania had sickle cell disease, and the second patient had Diamond-Blackfan anemia. These are the two areas of research I’ve been working on for many years. She called and asked for some information and some slides.

AN: My attendings were confused about how I had such detailed research slides in a day. I may have taken credit for them …

Do you ever work together?

AN: I’ve published papers with my father over the years, and I recently published a hematology-related paper with my mother. It’s a circle of nerdy, family fun.

What would you be if you weren’t hematologists?

MN: My first choice was to be a mathematician, and though I’m in biology, my background in analytic science and mathematics was helpful. In the late 1960s and ’70s, biology was quite a descriptive science; there was not as much analytic quantitation, so I think having that ability gave me an advantage.

AN: I would be a combination of a teacher and a socialite. On the more serious side, I love teaching, and I wish I could just go to school every day and learn new stuff; I also like to hang out and wear fabulous things and travel to lovely places.

When asked what compelled them to enter hematology, the younger generations we spoke with issued a common refrain: the love their parents had for their chosen profession. Every day was “Bring Your Kid to Work Day,” with many of the interviewees intimately involved with their parents’ work lives. The connections seemed to grow organically as well. Parents never pushed their children into the family business. That’s food for thought for others hoping to keep the blood lines flowing.—By Debra Beck