A Conversation with Dr. Andrew S. Levey, 2013 Belding H. Scribner Awardee

Dr. Andrew S. LeveyThe American Society of Nephrology presented the 2013 Belding H. Scribner Award to Dr. Andrew S. Levey, AJKD’s Editor-in-Chief, at this year’s Kidney Week. As described by the ASN, the award “is presented annually to one or more individuals who have made outstanding contributions that have a direct impact on the care of patients with renal disorders or have substantially changed the clinical practice of nephrology.” Dr. Levey (ASL) reflects on his career, mentors, and the field of nephrology with Liz Bury (eAJKD), AJKD Associate Managing Editor.

eAJKD: Congratulations on winning the Belding Scribner Award. You are being recognized for your contributions to nephrology. Why did you choose nephrology?

ASL: I chose nephrology because I was inspired by my teachers at Boston University School of Medicine. I was a medical student at a unique time in the ‘70s when the leaders of academic departments of medicine in Boston were mostly kidney specialists. Nephrology was the discipline where the great breakthroughs in science in the late ‘50s and early 60s occurred, which led the best and the brightest in academic medicine to go into the field.  They were measuring electrolytes and acid-base parameters in body fluids, and describing unique physiology.  They were my teachers in school.  I did not have any particular inclination to study kidney diseases before that, but wanted to be like them! I took lots of electives in the field, and became fascinated not just by the physiology but also the diseases of the kidney.

eAJKD: Would you still choose nephrology today?

ASL: Certainly, I would.  I think that young people today still choose fields where they have inspirational teachers.  There are many fields where great scientific breakthroughs being made today, so students have choices. I still find all aspects of nephrology fascinating. There are other factors influencing people’s choices today, and sadly one of the most important is the amount of student debt. It’s very expensive to go to medical school, and people often finish medical school with mountains of debt, and need to look at careers in specialties with high earning potential. Nephrology is not a high-end specialty, so a lot of people may not choose nephrology because they can’t afford it.

eAJKD: You mentioned that your teachers inspired you to choose nephrology. As you look over your career, who do you think was critical for your development? Who were your mentors?

ASL: I was very fortunate to come to Tufts.  Dr. William Schwartz was one of the first investigators to measure sodium in body fluids. He had assembled around him a tremendous group of scientists studying electrolyte and acid-base physiology, and I wanted to work with them. I came to Tufts and found a very supportive environment that has been instrumental in my being able to do the kind of work that I’ve done. The leaders at Tufts, the disciples of Dr. Schwartz, including Dr. Jerome Kassirer, Dr. Jordan Cohen, Dr. John Harrington, and Dr. Nicolaos Madias, have been lifelong mentors and stood with me during my career.

eAJKD: As a mentor yourself, what advice would you give to fellows and nephrologists just starting out?

ASL: The most important thing is to stay focused on what will help patients. There are many types of careers in academic medicine and many careers in nephrology.  Whether it’s clinical practice, research, or public health, we should stay focused on what’s most helpful to patients.  In addition, I think it’s important to be focused on big ideas. It takes just as much work to develop and prove a small idea as it does a big idea. But the big ideas are the ones that will help patients. Belding Scribner, for whom the award is named, won the Lasker Award in 2002, a very prestigious award for medical science. Dr. Scribner said at that time that he had accomplished much with his colleagues, but there was much more to be done in order to help patients. I find myself echoing his remarks more than 10 years later.

eAJKD: What do you think have been the most important advances in nephrology during your career?

ASL: My time in nephrology has seen the elucidation of the acid-base and electrolyte disorders, the systematic categorization of diseases based on kidney pathology, the refinement of techniques for dialysis and transplantation, and the emergence of the widely-accepted theory for the progression of chronic kidney diseases via a common pathway. Through my own work, I’ve had the opportunity to be part of a widespread movement to apply epidemiology, clinical trials, and outcomes research, especially in the earlier stages of kidney disease before kidney failure. The contribution of our work to advancing patient care is that it allows uniform communication about earlier stages of kidney disease based on objective clinical measures, rather than hypothesized pathologic or physiologic mechanisms.

eAJKD: Where do you see nephrology as a field going in the future?

ASL: The most urgent need is the development of new treatments. During my career, I have not witnessed a large number of new treatments.  In order to develop new treatments, we’ll need to find new targets.  These advances will come from the laboratory, and then we’ll need clinical trials to test therapies, and epidemiologic studies to understand the impact of these treatments on the burden of kidney disease. That’s what I look forward to the most.

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