Dr. Gerald Reaven in Memoriam: Leading the resistance

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July 28, 1928 – February 12, 2018

When Dr. Gerald Reaven (or Jerry as he liked to be called) entered the field of endocrinology in the 1950’s, the prevailing view of diabetes was that insufficient insulin was the primary cause. It would be an understatement to say that when Jerry introduced the concept of ‘insulin resistance’ or the gradual decreased sensitivity of the body to insulin as a more common cause of diabetes, it was not initially accepted by the scientific community. But Jerry worked to prove the importance of insulin resistance by developing an ‘insulin suppression test’ to measure the ability of the body to take up glucose in an insulin-dependent manner. He passionately argued in favor of the now-accepted idea that insulin resistance was a major risk factor for not just diabetes but a constellation of metabolic conditions leading to cardiovascular disease that he termed ‘Syndrome X’ (now called the Metabolic Syndrome). And he was right!

His legacy goes beyond the concept of insulin resistance and when he passed away a year ago on February 12, 2018, he left behind a wealth of knowledge including more than 800 publications in collaboration with over 500 researchers and thousands of patient samples made available for fellow researchers. During his life, Jerry also mentored many scientists who went on to become leaders in the field at Stanford and elsewhere.

The Lancet’s obituary for Jerry begins with a description of his now legendary American Diabetes Association’s Banting lecture of 1988 that delivered a stunning impact on diabetologists at the time and challenged widely held beliefs about diabetes. In many ways, that lecture embodied the lifelong spirit, independence and determination of a man who would not back down from unpopular positions when the data supported those positions. Dr. Rick Kraemer, Professor of Medicine at Stanford and member of Stanford Diabetes Research Center (SDRC), who worked with Jerry for 4 decades notes, “Jerry was incredibly insightful. He was able to identify key questions and key issues. He was never lost as far as being able to see the forest through the trees”, emphasizing Jerry’s extraordinary focus on insulin resistance and the potential conditions that feed off it”.

Jerry often attributed his way of thinking to the training he received at the University of Chicago where there was an emphasis on independent thinking and trainees were always encouraged to go back to the original source for information on a topic to think deeply about it. Dr. Sun H Kim, (Associate Professor of Medicine (Endocrinology) and SDRC member), who collaborated with Jerry and published papers on several studies exploring the role of insulin resistance in obesity, hypertension, diabetes and cardiometabolic risk had this to say about Jerry, “I think what I learned from him was how to think about a problem. He was an independent thinker”. Dr. Kim valued immensely his focus on the data and the evidence even if it flew in the face of the general opinion at the time. “He always looked at the data and usually tried to rethink based on his data”, she says, adding, “He was always proud that he was never wrong, and I must say, most of his theories did bear out”.

Jerry’s dynamic and forthright style was inspiring to Dr. Philip Tsao (Professor of Medicine, Division of Cardiovascular Medicine and SDRC member) who recalls, “He was brilliant in the sense that he had a vast sea of knowledge that he readily drew upon and an amazing memory up until his last days where he could recall experiments from years before and bring them into an argument. It was daunting to get into a debate with him because in the end you knew that he had the facts on his side”. Dr. Tsao notes that Jerry was instrumental in helping young investigators like him formulate their thinking about problems at a physiological and organismal level, saying, “Jerry was a physiologist at heart and I came to Stanford with a PhD in Physiology, so from that standpoint, we were kindred spirits”.

Jerry’s manner of writing manuscripts is the stuff of legend as his mentees fondly recall how he physically cut and pasted pieces of their manuscript drafts together interspersed with his comments. Dr. Joshua Knowles (Assistant Professor of Medicine, Division of Cardiovascular Medicine and SDRC member) says, “A classic Jerry story would be – he would read something, and he would walk over, knock on my door and say ‘Do you have a few minutes – I saw this paper and I think we should write something about it. Would you mind if I got started on that?’ I remember 2-3 occasions like that. And I would just try to keep up with him”. Dr. Knowles notes in a European Medical Journal interview that Jerry was productive not just in terms of research output and collaborations but also in his mentoring of future leaders in the field. His curiosity and collaborative spirit were unquenchable till the very end and Dr. Knowles says with a grin, “Jerry’s going to be publishing papers five or ten years after his death”.

Jerry was also a person of extraordinary generosity. Dr. Kraemer recalls a Juvenile Diabetes Foundation (now called JDRF) grant that the two of them had written while he was a Fellow, that Jerry transferred to him after he joined the faculty to pursue his own research on lipid metabolism. To this date, thousands of patient samples collected by Jerry continue to be available to researchers in the field and have already led to multiple publications.

In addition to being an exemplary role model to his peers and mentees, Jerry enjoyed many warm and deep friendships with his colleagues. Dr. Kim treasures the memories of joint birthday celebrations with Jerry – they both had birthdays in July. “We always went to a baseball game and somehow we would just talk about science and think about great ideas – that happened so many times. We had a lot of fun talking about science and physiology”. Jerry’s impact on her can be best summed up by how she describes his dedication, “He loved, loved his work. He was here Saturdays and Sundays because he loved it. He is the epitome of someone that you would want to be if you found that in your career.” Jerry is survived by his wife Eve Reaven, an electron microscopist, their three children Marci, Nancy and Peter.

The Stanford community mourns the loss of this great force in the field of endocrinology and has found ways to honor his memory. Dr. Kraemer said, “One of the ways we tried to honor him even before he died was to change the name of the Stanford University Professorship in Endocrinology to the Gerald M. Reaven Professor in Endocrinology”. After Jerry’s death, several people and organizations including the Stanford Diabetes Research Center, where he was a member, wanted to honor his legacy and mentorship. Thus, the Gerald M. Reaven Memorial Education and Research Fund was set up to support young scientific investigators and a Reaven Memorial lecture series.

Acknowledgements: We thank Dr. Frederic Kraemer, Dr. Sun H. Kim, Dr. Philip Tsao and Dr. Joshua Knowles for their input for this article. We also thank Dr. Sun H Kim, Dr. Joshua Knowles, Cynthia Lamendola, Dr. Kiran Kocherlakota and Alicia Rydzewski for providing pictures of Jerry.