Matula Thoughts March 7, 2014
Michigan Urology Family
Curiosity, polar thoughts, cats, dogs, & the human element

Amundsen at South Pole

Amundsen dressed for polar vortices

1. The days of winter are counting down now that March is here. It has been a curious season of drastic shifts in weather, highlighted by the Polar Vortex. Last month in “Matula Thoughts” we touched on Norse mythology and today want to include some Norse reality, specifically Roald Amundsen, the polar explorer and man of many firsts. Born as a fourth son in 1872 to a family of ship owners and captains in Borge, in the United Kingdoms of Sweden and Norway, his mother hoped for him to avoid the family business. As a young man he promised her he would become a physician, but after she died when he was 21 he quit his studies and went to sea. He made his mark early and became first mate on the Belgica in the first expedition to winter in Antarctica (winter of 1898-99). He then led the first expedition to traverse Canada’s Northwest Passage (1903-1906). Arriving in Nome in 1906 Amundsen learned that Norway had just become independent of Sweden and he sent the new Norwegian King a patriotic note regarding the expedition’s success. Amundsen’s 1911 Antarctic expedition was the first to reach the South Pole (but lacking satellite phone technology the world didn’t learn of the fact until this very day March 7, 1912). His 1926 Arctic expedition was the first to indisputably reach the North Pole. Earlier claims from others were controversial, but the 16 man-expedition with Amundsen as leader and navigator was the first as their hydrogen-filled semi-rigid airship, the Norge, on May 12, 1926 flew directly over the North Pole. Amundsen disappeared in an Arctic rescue mission in June 1928. One can only marvel at the Norse Human Element and speculate what Amundsen’s curiosity might have elicited had he focused on medicine.
   

   Nansen the cat

   

   Nansen the Nobel laureate

2. Curiosity did kill the cat, by the way. Nansen was the name of the ship’s cat on the Belgica in Amundsen’s Antarctic Expedition. The cat, named for Fridjof Nansen, died on June 22, 1898 while the Belgica was wedged in pack ice for nearly a year. The mascot’s namesake, Nansen the human (1861-1930), was a great athlete, biologist, explorer, and Nobel Peace Prize Laureate. As a prominent citizen he was a strong advocate for the independence of Norway. The cat had a lot to live up to. [a. Cat drawing by his owner, cabin boy and assistant zoologist Johan Koren; b. Fridjof Nansen, Nobel laureate.]

   

   

3. Last month we mentioned some elements listed on the periodic table, including thorium and radium, and now want to continue that theme with bromine and chlorine. Although not radioactive, these halogens are corrosive and toxic (bromine) and strongly oxidizing (chlorine). The fact that elements of the periodic table have somehow assembled throughout the universe to produce such things as H₂O, NaCl, larger compounds, creatures like Nansen’s cat and then the human brain is perpetually astonishing. This thought makes me marvel, as well, at the advertising ingenuity of Dow Chemical Company that developed a campaign with the powerful idea of the “human element.”
4. Herbert Dow was born February 26, 1866) in Canada, and after early childhood in Connecticut, he grew up in Cleveland, where he attended the Case School of Applied Science. His interest in chemistry led to the study of underground brines, and his discovery that groundwaters in Canton, Ohio and Midland, Michigan were unusually rich in bromine, an important ingredient in medicines and the merging photography business. A year after graduation he obtained a patent for a process to extract bromine and expanded his electrolysis methods to produce chlorine and other products. In 1897 he founded the Dow Chemical Company in Midland and the company stands today as one of the great global businesses. Dow died in 1930 and his widow Grace in 1936 established the Herbert H. and Grace A. Dow Foundation. You may have seen the Dow diamond logo last month as one of the partners in the Olympic & Paralympic Games.
5. Our Urology Department at the University of Michigan owes a large debt to the Dow name, for it was the Herbert H. and Grace A. Dow Foundation that delivered us from the trailer. By this I mean our fledging Health Services Research (HSR) Division, created by Jim Montie and inaugurated by John Wei started out in a part (709 sq. ft.) of the “temporary” trailer adjacent to our old Women’s Hospital. The trailer still stands, just like the fabled Hewlett-Packard Garage in Palo Alto (that too has relevance to the University of Michigan Medical School).
   

   Our fabled HSR trailer

   The Dow Foundation generosity allowed our HSR Division to move into much more favorable space in the Martin Corporation’s Michigan House (4600 sq. ft.). This beautiful endowment propelled our Dow HSR Division into the intellectual stratosphere, educating the leaders and best of the next generation of educators, investigators, and clinicians in urology. Success creates a new set of issues and under the successive leadership of Brent Hollenbeck our Dow HSR Division outgrew even that ample space in the Michigan House, causing recent relocation to more spacious room for growth in Building 16 at our North Campus Research Complex (NCRC).

   

   Jim Montie

   

   John Wei

6. David Miller now heads our Dow HSR Division, leading a talented team to ask and answer important questions related to how we deliver urological care. What is the “right” treatment for an individual patient? When and where are the optimal times and places for treatments? How should society allocate costs of urologic healthcare? Our patterns of practice must be dissected and rebuilt even as health care practice is changing in front of our eyes. The Dow HSR has stimulated a cadre of superb students, residents, fellows, and faculty who are asking good questions and finding important answers. Their work has attracted serious attention of policy makers, scientists, and care providers.
   

   Brent Hollenbeck
   Former HSR Director

7. David Miller,
   Current HSR Director

   A number of years ago The Lancet had a curious Editorial entitled “What is the point of surgery?” and that question has stuck in my mind. [The Lancet 376:1025, 2010] I put the article in a folder of “curious thoughts” and the following year added another paper to it: “What patients really want from health care” by Allan Detsky. [JAMA 306:2500, 2011] Detsky considered three levels of priority. The first level listed 9 items that the public wants most: restoring health when ill, timeliness, kindness, hope & certainty, the “three C’s” of continuity/choice/coordination, private room, no out of pocket costs, the best medicine, and finally medications & surgery. The second level priorities were; efficiency, aggregate-level statistics, equity, and to some extent transparency of conflict of interest. The lowest level of priority for patients consisted of two things: real cost and percent gap of GNP devoted to health care. Questions like these may once have seemed rude and pointless to proud ivory towers in academia, but today they are exactly what the public wants to know. Academic medical teams can answer these better than politicians and pundits. While Detsky among others can pose important questions like he did, the best answers and solutions will come from groups such our Dow HSR unit.

8. Italian engineer Umberto Nobile, as a young man became an enthusiast of semi-rigid airships and after a period of work in Akron, Ohio with Goodyear, he returned to Italy to build a new airship. Hearing of this Amundsen developed a collaboration with Nobile to find the North Pole, naming his hydrogen filled airship the Norge. The actual flyover, however, turned into a “circus wagon in the sky” according to Amundsen. Nobile had brought his dog Titina, 12-pound Fox Terrier, aboard as ship’s mascot. Nobile had rescued the starving puppy on a street in Rome only the year before. Amundsen was furious that his Italian partner had brought the dog along since the airship quarters were so cramped. Tensions increased when Amundsen noticed as the American, Italian, and Norwegian flags were dropped on the pole, the Italian flag was noticeably larger than the others. Although the expedition fueled national jealousies, it was the first to actually find the pole. Other expeditions that claimed the pole lacked navigational accuracy, and Admiral Richard Byrd’s alleged “fly-over” in a Fokker F-VII, the Josephine Ford (named for Edsel’s daughter) on May 9, 1926 turned out to be inaccurate, with falsification of navigational journal data. Titina proved to be a worthy companion for the grumpy explorers on the Norge and helped the human element remain moderately human throughout the difficult days of the journey.
9. It’s difficult to escape the power of Dow’s metaphor of the human element. Companionship, of any kind – even canine or feline – maximizes the human element. Whatever forces (selfishness or selflessness) propel human curiosity to explore, innovate, and discover the net results have served our species in aggregate far more than serving the individuals. Amundsen died at 55 disappearing in the Arctic while flying on a rescue mission. The mission was to recover survivors of the crash on sea ice of the, Italia, another airship of Nobile who was on board with his companion Titina. On May 25, 1928 after a series of mishaps the Italia lost altitude and hit sea ice. The gondola smashed open, dumping supplies, nine personnel including Nobile, and Titina. Relieved of the weight, the airship rose with 6 crew still on board, drifted away and was never seen again. The survivors on the ice radioed for help. Several rescue missions set out to recover the crew over the ensuing weeks, but it was Amundsen’s group on a Latham 47 flying boat that disappeared on June 18. The Italia survivors were spotted by other rescuers on June 20, and saved in turns between June 23 and July 14. Nobile, Titan, and eight other crew members survived. Curiosity obviously has its downsides, and perhaps dogs are more durable than cats in polar explorations, but the future depends on human curiosity and innovation. Those of us in urological practice, science, and health services research have the advantage of extending our curiosity in safer and warmer environments.
10. What’s next in urology? What’s the next North, South Pole, or Midland brine to be discovered for Uro-Oncology, Pediatric Urology, Neuropelvic Reconstructive Urology, Sexual Reproductive Urology, Health Services Research, or Urology in general?  Michigan Urology has been a key player in pushing back many urologic frontiers since the time Hugh Cabot came to town in 1919 and placed Ann Arbor on the center stage of genitourinary surgical practice, research, and education. While it is inspiring to understand the history of one’s institution, every new generation, each new faculty cohort, each new residency and fellowship class must start anew from the baseline of knowledge and skills they find at entry to the profession. The spirit of exploration can get dampened by the necessities of every day’s work, but every generation has its leaders and best in whom curiosity is not just retained, but even energized by the annoyance of their confinements in their time, geography, and knowledge.

Best wishes, and thanks for spending time on “Matula Thoughts.”

David Bloom