Life and Times of Leading Cardiologists With Rob Califf. Guest: Sidney Smith

Robert M. Califf, MD; Sidney C. Smith, Jr., MD

Disclosures

December 11, 2013

In This Article

Engineering at Virginia Tech

Dr. Califf: Where did you go to college?

Dr. Smith: I went to Virginia Tech.

Dr. Califf: So you followed the old man?

Dr. Smith: Yes.

Dr. Califf: That must have been quite an experience. Virginia Tech was an old military school, right?

Dr. Smith: It was. I had received a National Honor scholarship to Cornell University (Cornell National Scholarship). They give out 25 a year. I thought seriously about it, but I went back to my roots.

At the time that I went to Virginia Tech, they were transitioning. I was on the football team, so the military was a very small part of my life. The H company was not a very well-disciplined place. But after 2 years, I was in the civilian group. That was about the time that I really started to think seriously about whether I wanted to stay in chemical engineering.

I went to the Dean of the School of Engineering, and he asked me, why are you here? I said that I am here to tell you that I am out of here; I want to go into biochemistry. Why? Well, I want to be a doctor. He helped me. He said, stay in engineering; you are a good student, you will get into medical school somewhere, don't worry about it. In those days, you know, if you didn't take premed it was unusual to go to medical school.

Dr. Califf: What year did you graduate from college?

Dr. Smith: I graduated in 1963.

Dr. Califf: So you were in the pre-Vietnam era.

Dr. Smith: Yes.

Football

Dr. Califf: What position did you play in football?

Dr. Smith: I was a running back. I weighed about 30 pounds more. I was 185 at 5'10", and I was a running back. I ran in the Penn Relays in track -- the dashes -- and I was fast enough. Around the outside I was okay, but going up through the line could be difficult.

Dr. Califf: What conference did Virginia Tech belong to?

Dr. Smith: It was in the Southern Conference then. That was an era that you probably remember. We played Navy, University of Virginia, West Virginia, the Citadel in our freshman year, and then William and Mary and the whole group of teams.

Dr. Califf: What do you think about football now, with all of the information about head injuries? That has been interesting. There was a big story about Jim McMahon, the famous quarterback, who already has dementia at age 45.

Dr. Smith: Yes, that worries me. They may be tackling in ways that we didn't. We always drove our shoulders in. The use of the head is much more prominent now. I love the sport, and this issue of head injuries is important.

Chemistry and Ethics

Dr. Califf: As an undergraduate, you were quite a sports person. Did any professors have a profound influence on you?

Dr. Smith: My professor in physical chemistry, which was probably my favorite course, was very important, and the other was a professor of ethics.

Dr. Califf: That's an interesting combination, chemistry and ethics.

Dr. Smith: Yes.

Dr. Califf: I have recently been very involved in empirical ethics, and we are just getting ready to start a big project with the National Institutes of Health (NIH) on what patients actually want in the way of informed consent. What was it about ethics that interested you?

Dr. Smith: I was interested in getting some notion (and it applies to industry and to chemical engineering) of the ethical issues with respect to the products that we are involved in designing, and what should be governing our behavior.

Dr. Califf: That has carried on throughout your career and your interest in the organization of cardiovascular medicine from the public health perspective.

A Thesis on Lipoproteins at Yale

Dr. Califf: As you looked at medical schools, how did that play out? How did you decide where to go?

Dr. Smith: There were 2 at the top of my list -- Duke and Yale -- and I was lucky; I got in early. It was a tough decision. They were both 4-letter words, both their colors were blue and white, and I didn't know how to handle it. But ultimately I decided on Yale.

Dr. Califf: It seems as though it worked out pretty well.

Dr. Smith: Yes. At that time, they had a requirement that you write a thesis at Yale, and that was attractive to me. I wanted to do that.

Dr. Califf: What did you do your thesis on?

Dr. Smith: That's another interesting story. I did it on lipoproteins. I worked at the NIH during my first summer there as a freshman. They had a practice that if a speaker who came to talk to the medical students came from your medical school, you would introduce him. Robert Levy, who was working with Donald Fredrickson, spoke, and he was from Yale, so I had to introduce him. Afterward he said, "What are you doing?" I said, "Well, they have me in biomedical engineering running an ultra-centrifuge because I have an engineering degree."

He said, "Are you happy?" I said, "No. I'm having a great time in Georgetown and renting an overpriced apartment and spending all of our money on it, but I'm not happy at the NIH." He said, "Why don't you come and work with us?" So for 3 summers I did, and it turned out that there is an abnormal lipoprotein in patients with biliary cirrhosis. Yale had one of the largest groups of patients with biliary cirrhosis, so I wrote my thesis on that.

Bob Levy and Hormone Therapy

Dr. Califf: Bob Levy was a great person, wasn't he?

Dr. Smith: Did you know him? Yes.

Dr. Califf: I got to know Bob when he moved to Wyeth-Ayerst. He was the head of the National Heart, Lung, and Blood Institute. Initially, it was heart only. Eventually he went into industry with Wyeth, where he was convinced that hormone replacement therapy was beneficial. So I was involved with him in the HERS trial, which was the industry version before the Women's Health Initiative. He really pushed Wyeth to do the trial.

We all thought it was going to show a benefit, but it showed the opposite, of course. He handled that extraordinarily gracefully, because it was contrary to what he expected.

Dr. Smith: He and Richard Gorlin were the 2 key figures for me. I was with the American Heart Association (AHA) when HERS came out, and AHA had been saying that hormone replacement therapy should be for all women. I remember a telephone call, and someone on the call was saying, what are we going to do? What are we going to do? I said we are going to tell the American public what we have learned. They respect us as a source of information, not as people who believe in hormone replacement therapy. And Levy, who had designed that trial, was right behind that.

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