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Giants in Chest Medicine
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Giants in Chest Medicine Richard W. Light, MD John H. Newman, MD Nashville, TN Editor’s Note: This series recognizes and highlights the accomplishments of individuals who have contributed greatly to chest medicine. To view the video interview with Dr Light, go to journal.publications.chestnet.org
Who is this man whose name is eponymously and famously attached to a laboratory diagnosis, based on a paper he wrote when he was a medical resident? Richard Light, MD, was born and raised in Steamboat Springs, on the western slope of the Colorado Rockies, before it was a popular ski resort. His family ran a clothing supply business and a fox and mink farm. His grandfather had migrated from Missouri to Colorado in 1905, taking a horse-drawn stagecoach from Denver across the Rockies, and the Lights became prominent citizens of this rural western town. Dr Light remembers a wonderful childhood. He grew up trout fishing and hunting rabbits with his father and playing sports in his small school. The rabbit later
became the perfect animal for his pleural research; did this early hunting herald future investigations? He was a natural athlete; he became an All-State football player, playing center on offense and linebacker on defense. He was a star basketball player, and ran a 10.2-s 100-yard dash as a 190-lb sprinter. Although he could not break into the top skiing group in his school, this was because four of the seven skiers ended up skiing for the United States in the Olympics! A good student, he credits his mother, who expected much of him and stimulated his desire to achieve. He had natural aptitude in math and was drawn to engineering and computing, which is what he majored in at the University of Colorado at Boulder. Dr Light always wanted to be a doctor, even without any formative experience with family illness or medical mentors. A guidance counselor unwisely tried to dissuade him from this hope. Taking up the challenge, he took premed subjects as his elective courses at Boulder and applied to Johns Hopkins Medical School.
Richard W. Light, MD
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146#5 CHEST NOVEMBER 2014
]
He was accepted and drove across the country to city life in Baltimore, Maryland, where he also did his residency and pulmonary fellowship. There he met and worked with numerous present and future luminaries in pulmonary medicine. His senior resident, A. Jay Block, MD, later Editor of CHEST and Chief of Pulmonary Medicine at the University of Florida, excited Dr Light by his infectious enthusiasm and love of medicine. Dick Winterbauer, MD, Chief Resident and later Chief at Virginia Mason, challenged him to study the problem of undiagnosed pleural effusion. Mary Betty Stevens, MD, showed him how to approach the patient as a person and to think clearly about medical diagnosis. Wil Ball, MD, was his main pulmonary mentor. Dr Light was attracted to pulmonary medicine by his engineering background, in an era where his talents were ideally suited to the quantification of physiologic tests, including the problems of ventilation/perfusion matching, body plethysmography, spirometry, and exercise physiology. The story of Light’s criteria has been well told. As with many important and durable changes in medical thinking, the abstract and paper initially had a difficult time finding acceptance. Within a few years of publication, the new Light’s criteria had swept the medical establishment and became the new standard of diagnostic thinking. This paper, published in the Annals of Internal Medicine in 1972, was Dr Light’s first publication. A swing and a home run! In typical Richard Light fashion, he did not rest on these laurels. Within 7 years of this first paper, he had published 12 articles on pleural effusions, ranging from Boerhaave syndrome to the metabolic activity of pleural effusions and postoperative complications. During the same interval, he published 20 other articles ranging from treatment of sarcoidosis, to heroin-induced pulmonary edema, to asthma and emphysema. Clearly, this was a man with insights, original thinking, high productivity, and broad interests.
ABOUT THE AUTHOR/AFFILIATIONS: John H. Newman, MD, is Elsa S. Hanigan Professor of Pulmonary Medicine at Vanderbilt University School of Medicine. FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. CORRESPONDENCE TO: John H. Newman, MD, Vanderbilt University School of Medicine, T1218 MC, Nashville, TN 37232; e-mail: john. [email protected] ADDITIONAL INFORMATION: See video interview of Dr Light online at http://dx.doi.org/10.1378/chest.14-0622 © 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details. DOI: 10.1378/chest.14-0622
journal.publications.chestnet.org
In 2014, he now has an astonishing 428 papers, 121 chapters and reviews, two complete books on the pleura, and many presentations around the world. Dr Light is a world citizen. He spent 2 years running the Respiratory Disease Unit in Okinawa in the Army Medical Corps. He traveled widely in Asia and the South Pacific, exploring other cultures and befriending people from a variety of backgrounds. It is in part because of this experience that he has eagerly mentored physicians from all over the world, many of whom have gone on to their own careers in pleural disease. This partly explains his visiting professorships, which now number in the hundreds, with invitations to lecture in . 50 countries worldwide. Dr Light is a wonderful dinner companion; he loves good food, good stories, and great wines, and he shares his amazing experiences with humor and humility. Dr Light has an unusual story and is almost unique in his place in medical history. He wrote one of the classic papers in modern medicine as a resident in 1972 and has continued to produce new work and ideas continuously for the last 40 years. He has a most unusual combination of original thinking, mathematical logic, clinical savvy, broad interests, and relentless drive to create new knowledge. His colleagues, friends, students, mentees, and physicians everywhere have benefitted massively from his presence in the field. He is truly a giant in medicine.
Suggested Readings Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77(4):507-513. Sherr HP, Light RW, Merson MH, Wolf RO, Taylor LL, Hendrix TR. Origin of pleural fluid amylase in esophageal rupture. Ann Intern Med. 1972;76(6):985-986. Block AJ, Light RW. Alternate day steroid therapy in diffuse pulmonary sarcoidosis. Chest. 1973;63(4):495-504. Light RW, Ball WC Jr. Glucose and amylase in pleural effusions. JAMA. 1973;225(3):257-260. Light RW, Erozan YS, Ball WC Jr. Cells in pleural fluid. Their value in differential diagnosis. Arch Intern Med. 1973;132(6):854-860. Light RW, Luchsinger PC. Metabolic activity of pleural fluid. J Appl Physiol. 1973;34(1):97-101. Light RW, MacGregor MI, Ball WC Jr, Luchsinger PC. Diagnostic significance of pleural fluid pH and PCO2. Chest. 1973;64(5):591-596. Light RW, Dunham TR . Vertebral osteomyelitis due to Pseudomonas in the occasional heroin user. JAMA. l974; 228(10):1972. Light RW, Dunham TR. Severe slowly resolving heroin-induced pulmonary edema. Chest. 1975;67(1):61-64. Light RW, Summer WR, Luchsinger PC. Response of patients with chronic obstructive lung disease to the regular administration of nebulized isoproterenol. A double-blind crossover study. Chest. 1975;67(6): 634-639.
1153
Cush R, Light RW, George RB. Clinical and roentgenographic manifestations of acute and chronic blastomycosis. Chest. 1976;69(3):345-349.
an excellent pleurodesis in rabbits. Am J Respir Crit Care Med. 2000; 162(1):98-104.
Light RW, George RB. Incidence and significance of pleural effusions after abdominal surgery. Chest. 1976;69(5):621-625.
Light RW. Disorders of the pleura and mediastinum. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2008:1658-1661.
Nelson O, Light RW. Granulomatous pleuritis secondary to blastomycosis. Chest. 1977;71(3):433-434. Light RW. Diseases of the pleura, mediastinum, chest wall, and diaphragm. In: George RB, Light RW, Matthay MA, Matthay RA, eds. Chest Medicine: Essentials of Pulmonary Critical Care Medicine. 2nd ed. Baltimore, MD: Williams & Wilkins; 1990:381-412. Light RW, Wang NS, Sassoon CS, Gruer SE, Vargas FS. Comparison of the effectiveness of tetracycline and minocycline as pleural sclerosing agents in rabbits. Chest. 1994;106(2):577-582. Light RW, Cheng D-S, Lee YC, Rogers J, Davidson J, Lane KB. A single intrapleural injection of transforming growth factor- b(2) produces
1154 Giants in Chest Medicine
Broaddus VC, Light RW. Pleural effusion. In: Mason RJ, Broaddus VC, Martin TW, King TE Jr, Schraufnagel DE, Murray JF, Nadel JA. Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010:1719-1763. Light RW, Gary Lee YC. Pneumothorax, chylothorax, hemothorax and fibrothorax. In: Mason RJ, Broaddus VC, Martin TW, King TE Jr, Schraufnagel DE, Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010:1764-1791. Light RW. Pleural Diseases. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2013.
[
146#5 CHEST NOVEMBER 2014
]
Giants in Chest Medicine
]
Giants in Chest Medicine Richard W. Light, MD John H. Newman, MD Nashville, TN Editor’s Note: This series recognizes and highlights the accomplishments of individuals who have contributed greatly to chest medicine. To view the video interview with Dr Light, go to journal.publications.chestnet.org
Who is this man whose name is eponymously and famously attached to a laboratory diagnosis, based on a paper he wrote when he was a medical resident? Richard Light, MD, was born and raised in Steamboat Springs, on the western slope of the Colorado Rockies, before it was a popular ski resort. His family ran a clothing supply business and a fox and mink farm. His grandfather had migrated from Missouri to Colorado in 1905, taking a horse-drawn stagecoach from Denver across the Rockies, and the Lights became prominent citizens of this rural western town. Dr Light remembers a wonderful childhood. He grew up trout fishing and hunting rabbits with his father and playing sports in his small school. The rabbit later
became the perfect animal for his pleural research; did this early hunting herald future investigations? He was a natural athlete; he became an All-State football player, playing center on offense and linebacker on defense. He was a star basketball player, and ran a 10.2-s 100-yard dash as a 190-lb sprinter. Although he could not break into the top skiing group in his school, this was because four of the seven skiers ended up skiing for the United States in the Olympics! A good student, he credits his mother, who expected much of him and stimulated his desire to achieve. He had natural aptitude in math and was drawn to engineering and computing, which is what he majored in at the University of Colorado at Boulder. Dr Light always wanted to be a doctor, even without any formative experience with family illness or medical mentors. A guidance counselor unwisely tried to dissuade him from this hope. Taking up the challenge, he took premed subjects as his elective courses at Boulder and applied to Johns Hopkins Medical School.
Richard W. Light, MD
1152 Giants in Chest Medicine
[
146#5 CHEST NOVEMBER 2014
]
He was accepted and drove across the country to city life in Baltimore, Maryland, where he also did his residency and pulmonary fellowship. There he met and worked with numerous present and future luminaries in pulmonary medicine. His senior resident, A. Jay Block, MD, later Editor of CHEST and Chief of Pulmonary Medicine at the University of Florida, excited Dr Light by his infectious enthusiasm and love of medicine. Dick Winterbauer, MD, Chief Resident and later Chief at Virginia Mason, challenged him to study the problem of undiagnosed pleural effusion. Mary Betty Stevens, MD, showed him how to approach the patient as a person and to think clearly about medical diagnosis. Wil Ball, MD, was his main pulmonary mentor. Dr Light was attracted to pulmonary medicine by his engineering background, in an era where his talents were ideally suited to the quantification of physiologic tests, including the problems of ventilation/perfusion matching, body plethysmography, spirometry, and exercise physiology. The story of Light’s criteria has been well told. As with many important and durable changes in medical thinking, the abstract and paper initially had a difficult time finding acceptance. Within a few years of publication, the new Light’s criteria had swept the medical establishment and became the new standard of diagnostic thinking. This paper, published in the Annals of Internal Medicine in 1972, was Dr Light’s first publication. A swing and a home run! In typical Richard Light fashion, he did not rest on these laurels. Within 7 years of this first paper, he had published 12 articles on pleural effusions, ranging from Boerhaave syndrome to the metabolic activity of pleural effusions and postoperative complications. During the same interval, he published 20 other articles ranging from treatment of sarcoidosis, to heroin-induced pulmonary edema, to asthma and emphysema. Clearly, this was a man with insights, original thinking, high productivity, and broad interests.
ABOUT THE AUTHOR/AFFILIATIONS: John H. Newman, MD, is Elsa S. Hanigan Professor of Pulmonary Medicine at Vanderbilt University School of Medicine. FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. CORRESPONDENCE TO: John H. Newman, MD, Vanderbilt University School of Medicine, T1218 MC, Nashville, TN 37232; e-mail: john. [email protected] ADDITIONAL INFORMATION: See video interview of Dr Light online at http://dx.doi.org/10.1378/chest.14-0622 © 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details. DOI: 10.1378/chest.14-0622
journal.publications.chestnet.org
In 2014, he now has an astonishing 428 papers, 121 chapters and reviews, two complete books on the pleura, and many presentations around the world. Dr Light is a world citizen. He spent 2 years running the Respiratory Disease Unit in Okinawa in the Army Medical Corps. He traveled widely in Asia and the South Pacific, exploring other cultures and befriending people from a variety of backgrounds. It is in part because of this experience that he has eagerly mentored physicians from all over the world, many of whom have gone on to their own careers in pleural disease. This partly explains his visiting professorships, which now number in the hundreds, with invitations to lecture in . 50 countries worldwide. Dr Light is a wonderful dinner companion; he loves good food, good stories, and great wines, and he shares his amazing experiences with humor and humility. Dr Light has an unusual story and is almost unique in his place in medical history. He wrote one of the classic papers in modern medicine as a resident in 1972 and has continued to produce new work and ideas continuously for the last 40 years. He has a most unusual combination of original thinking, mathematical logic, clinical savvy, broad interests, and relentless drive to create new knowledge. His colleagues, friends, students, mentees, and physicians everywhere have benefitted massively from his presence in the field. He is truly a giant in medicine.
Suggested Readings Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77(4):507-513. Sherr HP, Light RW, Merson MH, Wolf RO, Taylor LL, Hendrix TR. Origin of pleural fluid amylase in esophageal rupture. Ann Intern Med. 1972;76(6):985-986. Block AJ, Light RW. Alternate day steroid therapy in diffuse pulmonary sarcoidosis. Chest. 1973;63(4):495-504. Light RW, Ball WC Jr. Glucose and amylase in pleural effusions. JAMA. 1973;225(3):257-260. Light RW, Erozan YS, Ball WC Jr. Cells in pleural fluid. Their value in differential diagnosis. Arch Intern Med. 1973;132(6):854-860. Light RW, Luchsinger PC. Metabolic activity of pleural fluid. J Appl Physiol. 1973;34(1):97-101. Light RW, MacGregor MI, Ball WC Jr, Luchsinger PC. Diagnostic significance of pleural fluid pH and PCO2. Chest. 1973;64(5):591-596. Light RW, Dunham TR . Vertebral osteomyelitis due to Pseudomonas in the occasional heroin user. JAMA. l974; 228(10):1972. Light RW, Dunham TR. Severe slowly resolving heroin-induced pulmonary edema. Chest. 1975;67(1):61-64. Light RW, Summer WR, Luchsinger PC. Response of patients with chronic obstructive lung disease to the regular administration of nebulized isoproterenol. A double-blind crossover study. Chest. 1975;67(6): 634-639.
1153
Cush R, Light RW, George RB. Clinical and roentgenographic manifestations of acute and chronic blastomycosis. Chest. 1976;69(3):345-349.
an excellent pleurodesis in rabbits. Am J Respir Crit Care Med. 2000; 162(1):98-104.
Light RW, George RB. Incidence and significance of pleural effusions after abdominal surgery. Chest. 1976;69(5):621-625.
Light RW. Disorders of the pleura and mediastinum. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2008:1658-1661.
Nelson O, Light RW. Granulomatous pleuritis secondary to blastomycosis. Chest. 1977;71(3):433-434. Light RW. Diseases of the pleura, mediastinum, chest wall, and diaphragm. In: George RB, Light RW, Matthay MA, Matthay RA, eds. Chest Medicine: Essentials of Pulmonary Critical Care Medicine. 2nd ed. Baltimore, MD: Williams & Wilkins; 1990:381-412. Light RW, Wang NS, Sassoon CS, Gruer SE, Vargas FS. Comparison of the effectiveness of tetracycline and minocycline as pleural sclerosing agents in rabbits. Chest. 1994;106(2):577-582. Light RW, Cheng D-S, Lee YC, Rogers J, Davidson J, Lane KB. A single intrapleural injection of transforming growth factor- b(2) produces
1154 Giants in Chest Medicine
Broaddus VC, Light RW. Pleural effusion. In: Mason RJ, Broaddus VC, Martin TW, King TE Jr, Schraufnagel DE, Murray JF, Nadel JA. Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010:1719-1763. Light RW, Gary Lee YC. Pneumothorax, chylothorax, hemothorax and fibrothorax. In: Mason RJ, Broaddus VC, Martin TW, King TE Jr, Schraufnagel DE, Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010:1764-1791. Light RW. Pleural Diseases. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2013.
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146#5 CHEST NOVEMBER 2014
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