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Health Guidance Under Dr. Foa's Leadership

Sinai Medical Research for Today and Tomorrowi

By Avrum Schulzinger
Last week, a press conference at Sinai Hospital of
Detroit announced development of a Ruby laser for eye
surgery.
Next month, a revolutionary new dental prosthetic
device researched and perfected at the hospital will be
announced.
These are but two of the more glamorous products
of Sinai Hospital's research program, which actually had
its beginnings back in 1953 when the hospital first opened.
A small 1,500 square foot area approved by the admin-
istration and the Board of Trustees enabled the Medical
Research Committee to consider seven projects that first
year of the hospital's existence. The late Dr. David J.
Sandweiss helped pioneer the research efforts of the
hospital, as did Dr. Sidney D. Kobernick, the hospital
Director of Laboratories; and the latter later served as
Coordinator of Research. Then, in 1962, the hospital. en-
gaged Dr. Piero P. Foa as full time Director of Research,
later to become Chief of the Department of Research.
Under Dr. Foa and his associate, Dr. Albert J. Whitty,
the budget of Sinai's Department of Research has grown
from a few thousand dollars to almost $1,000,000 a . year,
in some 12 years.
Where the first research allowance was a Modest
grant from the Gift Shop operated by the Women's Guild
of Sinai Hospital, today's funding comes from a variety
of sources: the Women's Guild itself, the Jewish Wel-
fare Federation, the Michigan Heart Association, _ the
Michigan Diabetes Association and other voluntary health
agencies; the pharmaceutical industry and, the National
Institutes of Health, U.S. Public Health Service.
Currently, more than 60 research projects are under-
way at the hospital. Some are directly conceived by the
Research Department. Others are the concepts of prac-
ticing physicians. The problems range from diabetes to
hypoglycemia, from obesity to pituitary function, from
infertility to contraception, from heart disease to arterio-
sclerosis. from the perfection of medical lasers to that of
an auxiliary heart pump, from the study of drugs to the
development of new diagnostic procedures.
Dr. Foa came to Sinai after 18 years as Professor of
Physiology and Pharmacology at the Chicago Medical
School, and believes that a hospital has the social obliga-
tion to engage in those fields of medical research that can
only be carried out in a hospital. But there is more to it,
because, he says, "A strong research activity attracts
good clinicians to head medical departments, helps to train
physicians, young and old alike, satisfies their intellectual
curiosity and thus improves the level of patient care."
"Clinicians may be short of time and specific technical
knowledge or they may lack laboratory facilities and
technicians to pursue their areas of inquiry," says Dr.
Foa. "This is where we come in, by placing the resources
of the department at their disposal and taking on part of
the load."
Thus, when a few years ago, Dr. Hyman Mellen
wanted to check if a drug, widely used in treating coronary
heart disease, was indeed effective, the Department
helped him carry out a study that backed Dr. Mellen's
judgment: The drug did not match the claims of its
manufacturer.
When Dr. Harvey Gass had an idea for a new, less
traumatic surgical approach to the removal of pituitary
tumors, the Research Department assisted him in per-
fecting the necessary equipment.
When Dr. Hugh Beckman thought of harnessing the
energy of the Ruby laser for eye surgery, the Research
Department was ready with space, manpower, animals and
money. A Ruby laser of new design was developed and its
usefulness was demonstrated first in rabbits, then in man.
The work of Dr. Adrian Kantrowitz to perfect an
auxiliary heart pump requires plastic and electronic lab-
oratories, animal operating rooms, computer services and
other facilities and equipment.
Dr. Foa himself leads a group of workers interested

JAW%

in the role played by glucagon, insulin and other hormones
in diabetes. This work, funded by the U.S, government —
with more than 20 years of uninterrupted grants — led to
more than 150 scientific papers, to many lectures in the
United States and around the world and to six PhD and
four MS degrees in physiology for his graduate students.
This year, the American Medical Association awarded
the prestigious Hektoen Gold Medal, to a scientific exhibit
illustrating this work.
An Italian by birth, son of a distinguished physiologist,
Dr. Carlo Foa, Professor of Physiology at the University
of Milan; grandson of Dr. Pio Foa, Professor of Pathology
at the University of Turin, Sinai's Dr. Foa is the third
in a distinguished line of medical leaders. His son,
Richard, is a resident in Neurology at Emory University.
The family name figures prominently in the Universal
Jewish Encyclopedia. Its history dates back to the middle
of the •16th Century when a Tobia Foa established a
Hebrew press in the small Italian town of Sabbioneta. In
face, the six-pointed Magen David made one of its earliest
known appearances in the printer's crest designed by
Tobia Foa; it is shown backed by a palm tree and flanked
by two licins. According to Gershom Scholem (Commentary,
1949) this gave prominence to the Star of David which,
up to that trine was not generally used as a Jewish
symbol. A few books inherited from Tobia are among
Dr. Foa's prized possessions.
D. Foa's department occupies the four-story Ham-
burger-Jospey Research Building, made possible through a
gift from the Hamburger and Jospey families and opened
in 1968. It contains mostly laboratories and equipment
(Dr. Foa believes in reducing office space to a minimum),
filled with sophisticated machines that measure, analyze
and calculate the data fed to them by the investigators.
Its corridors are lined with framed photographs of medical
men, groups attending international conferences, construc-
tion shots of the research facility and scientific diagrams.
"You run one experiment to prove something," says
Dr. Foa, "then you turn around and run 99 more
experiments to prove that the first one was wrong. If the
notion survives the test it will serve as the basis for more
research."
Nothing happens fast. Everything takes time. Like
the analysis of 200 small vials of blood. They stand in
rows in a large machine, kept under refrigeration. Every
minute, one vial moves forward into a compartment where
it. is automatically analyzed. The results are shown in a
digital recorder and on a computer print-out. Thousands
of vials go through the machine and tens of thousands of
numbers come out of it every day: their meaning under-
standable only to the technicians and to the. scientists.
In other laboratories, other experiments are taking
place. Normal mice in one cage are active and playful.

The prestigious Hektoen Gold Medal was awarded Dr.
Piero P. Foa, director of research, Sinai Hospital, left,
at the American Medical Association's convention in
Chicago this summer. The medal was awarded "for the
department's outstanding display exhibiting its original
research work' . in the study of the role played by the
hormone glucagon in diabetes."

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In the next cage, mice of the same litter are sluggish,
spending all of their living days sleeping or eating.
In yet another part of the building Dr. Adrian
Kantrowitz's staff works at perfecting the design of an
artificial heart pump and at developing computerized
systems for the instantaneous and continuous monitoring
of vital signs in patients with heart disease . . . and Dr.4
Irwin Small has been invited to present the prestigious
Chalmers Lyon address at the annual convention of the
American Society of Oral Surgeons next October. This
lecture will illustrate a new dental prosthetic de.
developed by him and Dr. Herbert Metz of Sinai's
partment of dental and oral surgery.
And, sometimes, there is an emergency:
As on the day when Dr. Ralph Cash was suraw.
to Sinai's emergency room to see a young boy lying
a coma. Dr. Cash became convinced that something had
impaired or destroyed the child's adrenal glands.
The child's life was saved, but Dr. Cash was dis-'
turbed about the incident. He investigated the youngster's
medi-zal history and discovered he had been under treat-
ment for epilepsy, with a little known drug. Could this
drug have been the villain? Dr. Cash called on Dr. Foa
and together they set up an experiment. The drug was
administered to laboratory rats and promptly destroyed
their adrenals. The matter was brought to the attention
of the drug's manufacturer and of the Food and Drug
Administration and, eventually, the drug was removed
from the market. Another potential "Thalidomide story"
was thus nipped in the bud.
Not every research project ends that well. For most,
there is never enough time, never enough personnel,
nver enough money.
Says Dr. Foa: "In this country, we spend $1,500 on
liquor for every $1 spent on medical research—$30 for
treating cancer, for each $1 spent to find its causes, its
cure, its prevention.
"It is often stated that a community hospital cannot
afford to do research because this increases the cost of
patient care. In fact, the reverse is, true. Research funds
support a number of physicians who provide some care,
offer consultation and diagnostic services and house staff
guidance: All of direct benefit to the patients even though
it does not show on their bills."
And on the record, Sinai's Department of Research
has produced abundant returns for its financial investment:
Like setting up methods for measuring digitalis in
blood and helping in the determination of its correct
dosage in patients with heart disease . . . By developing
procedures for measuring insulin and other hormones in
the blood, or for determining if a baby is ready to be
delivered.
"The most necessary ingredient in research," says
Dr. _Foa, "is manpower: the creative, intelligent, disci-
plined mind that will recognize problems and seek solu
tions. This is why training at all levels is one of the most
important activities of our department.
"And then there is 'fie - bontiffaii16- problem of financ-
ing research. We have been very fortunate to date. We
are very proud of the recognition that our work has re-
ceived. This year alone, we have received more than
$512,669 in grants from the National Institutes of Health.
at a time when many pretigious institutions of learning
are losing theirs. We have the support of the Jewish Wel-
fare Federation. We have been aided generously by the
Women's Guild of Sinai Hospital, which has contributed
more than $350,000 from profits of the Gift Shop and by
many private gifts, and we've received large contributions
from the medical staff of Sinai through the hospital's
Education Corporation.
"But how much manpower, how much money do you
need? How much is an artificial heart worth? How much
for the prevention of diabetes, blindness, cancer or heart
disease? How much should it cost to prove that a drug
destroyed a little boy's adrenal glands?
"And think of him as your child . . . "

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Study is an inherent and continuing part of Research, as in this photograph where
Technician Tova Levi rehearses the presentation of a scientific paper with Dr. Foa's
wife, Naomi L. Foa, Research Technologist.

80 Friday, Sept. 13, 1974

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THE DETROIT JEWISH NEWS

A team of technologists and research associates study a computer print-out with
Dr. Piero P. Foa, extreme right. They come from many nations and diverse back
grounds to work at Sinai's department of research. Shown are: Dr. Tatsuo Matsuyama
research associate; Ms. Freda Lengel, research technologist; Dr. Ludwig Loreti; Mrs
Mary Walsh, research technologist; and Dr. Michael Dimino, research associate.