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James Freston, M.D., Ph.D - U of U School of Medicine

Jun 12, 2011

James Freston, M.D. Ph.D, is an internationally recognized expert in the clinical pharmacology of gastrointestinal drugs and diseases. Trained in clinical pharmacology, gastroenterology, hepatology, and aerospace medicine, he received his M.D. degree from the University of Utah and his Ph.D. degree from the University of London. He directed the gastroenterology and clinical pharmacology divisions at the U, where he won the Outstanding Professor Award six times, and then became the chair of internal medicine at the University of Connecticut for 17 years. He was the founding Chair of the Gastroenterological Association's Foundation, President of the AGA, and also the past Chair of the American Digestive Health Foundation. A prolific researcher, Freston was instrumental in the development of several blockbuster drugs, including Prevacid and Actos. He stills spends about 30 percent of his time consulting to NIH and pharmaceutical and device companies. He lectures worldwide and is the author of more than 140 journal articles and 40 books and chapters. Freston also enjoyed a military career as a full colonel in the Air Force, logging a minimum of 100 flying hours per year as a flight surgeon, and a pilot in his own right. He was the former surgeon general of Connecticut. He currently lives on Kiawah Island in South Carolina with his wife Margie (whose “career has been even more interesting than mine”), and is the proud father of four and grandfather of 11.

Summary of the Roundtable Discussion

On what medical school at the U was like in 1957-1961:

The grading system was diabolical. They kept our GPA a secret and never told us how we were doing. Traditionally, they’d flunk out a quarter of the class, so you didn’t know until the end of the year if you’d be invited back. There were 64 people in my class and I counted about 12 of my classmates who I thought were dumber than I was. They were gone after Christmas break, which meant I was sure to be right on the cusp of flunking out. I spent the rest of the year working really hard to keep my place. As it turned out, I ended up second in the class.

On why he chose gastroenterology: I was interested in every specialty . . . except for pediatrics. That’s because I had a child die in my arms and it shook me deeply. So I looked for opportunity. In my second year of medical school I was taught the concept of the dose-response curve—when you increase the dose, the response is steep, but then it flattens out—and quite frankly I have tried to apply it to my career. I've tried not to get on the flat part. At the time, there were three gastroenterologists and no hepatologists in the Intermountain area. Gastroenterology was just taking off scientifically. A lot of very smart people were starting to publish lots of good science: the discovery of gastrin, secretin, the relationship of Banting and Best’s discovery of insulin and its relationship to beta cells and then islet cells of the pancreas. I caught GI at the start of the curve, rode it up, got hepatology training and rode it up, and then tried to marry pharmacology with hepatology and gastroenterology. That’s what led to the drug discovery part.  

Dr. Freston On how he got to London: Back in those days, medicine was a club. Dr. Maxwell Wintrobe [chair of the U’s Department of Medicine] would call A. McGehee Harvey [the chairman at Hopkins] for example, and say “I’m sending my best student to you.” And he would say "okay" and that was that. I wanted to go away for an internship because I had been educated entirely in Utah, and so I applied to a couple of really fine places in the East. Well, I wasn’t the best student, so when it got down to me, he said, “I can’t match you with the three places you want to go so you’re staying here.” He told me not to worry because it was easier to transfer as a resident than an intern. That was the end of the discussion.  So in the middle of my second year, I said I’d really like to transfer, and he said, "No, you are staying here. We want you and Dr. McArthur [a colleague of mine in the same predicament] to be the chief medical residents.”  And I guess my jaw dropped.  I hadn’t aspired to be chief resident because I wanted to get on with pharmacology and gastroenterology, and I guess he noticed. So he said “You do that, and when you are finished, I’ll send you anyplace in the world.” So I started looking at good places and came back and said, “I want to go with Dame Sheila Sherlock at London’s Royal Free Hospital. He sent a one paragraph letter to Dame Sherlock, and she sent a one paragraph letter back saying, “We are delighted to accept him into our program. Tell him that two years are better than one.”

On adjusting to the British:  I was so intimidated when I got there that I developed a stammer because the Brits were so eloquent. About halfway through the year, I realized they weren’t smarter than I was, they just sounded better.

On how he ended up getting his Ph.D.: While I was in London, I figured I might as well get my Ph.D. So I walked across the street to the University of London and enrolled. It was just a matter of doors opening and taking advantage of opportunities as they presented themselves.

Secret to his success: There’s no substitute for hard work. But I think the reason I’ve enjoyed success is that I was somehow able to get myself associated with very capable people and good ideas. I trained under tremendous mentors, who influenced me profoundly. Louis Goodman and Max Wintrobe in Utah and Dame Sherlock in London. They helped shape my ideas and work habits and taught me the importance of associating myself with talented people who shared my values and sense of what’s important. I tried to apply those principles throughout my career.

On what sparked his interest in pharmacology: I’m reluctant to tell people this story. But we were really poor and my job during medical school was to catch feral cats under the old County Hospital, which they used in experiments in the physiology and pharmacology departments. I got two dollars a cat and a lot of scratches. Well, I guess I was so diligent, that a professor of pharmacology, Don Esplin, a brilliant neuropharmacologist, gave me a summer job working as a technician in his lab. He also gave my wife, who was a nurse supporting us, a job as a technician. I loved pharmacology so much I was thinking of dropping out of medical school and becoming a pharmacology graduate student.  Dr. Louis Goodman heard about that and he came in and practically grabbed me by the ear and said, “Don’t do this. Go get your clinical training and if you want to get your Ph.D. later, fine.”  I took his advice, as usual, but I never got over my affection for clinical pharmacology.  I realized that there were very few people in the world who were pharmacologists and gastroenterologists or hepatologists at that time. So I said that will be my niche to get research funding and to get clinical trials going. When I came back to Utah, we had vacant space in the University Hospital so we created a clinical pharmacology program and a clinical trials center right there. Pretty soon, companies started coming to us.

Dr. Freston and Dr. LeeOn how he got involved in developing drugs: It’s a long story, but the short of it was that one of these companies asked me to help them develop a new drug—Prevacid— for treating ulcers and acid reflux, among other things, and I was intrigued. There wasn’t anything like it on the market, and I could see the potential. This was a partnership between Abbott Laboratories in this country and Takeda Pharmaceuticals in Japan. They wanted to develop this mega drug that was right down my alley. This was a new pharmaceutical class. Nothing like it had ever been seen before, certainly not given to man extensively. There was concern that it might be a carcinogen.  The drug before it, called Prilosec had caused a bizarre tumor in the stomach of rats called gastric carcinoids. So there were many toxicology issues.  I was allowed to form a committee of expert consultants to guide development and address all safety issues.

On the kind of advice consultants gave to the company: We recommended what experiments they should do, and then after have an all-day seminar to analyze the data and then suggest the next experiments they should do. The FDA approved it and within 3 years it was selling 3 billion dollars a year worldwide. It was a blockbuster drug that helped millions of people. The money generated by that funded the diabetic drug called Actos, and we applied the same practice to that. It was exciting. These were really smart people. Out of the 15 consultants, six or seven went on to be chairs of medicine, and five became presidents of the AGA.

On how his pharmacology background helped him:  I could talk to the pharmacologists and translate the discussion between the basic scientists and the clinicians. So we were doing translational medicine before it became fashionable. I think being able to do this helped me enormously. Still does. Many of my publications are in clinical pharmacology.

On why he didn't work for pharmaceutical companies full time: I was asked many times, and I said, “Are you kidding me?” All they would do is pay me more money. I was having the time of my life. No, it was never even a consideration. 

On the collaborative approach to treating patients:

I learned at a very young age here at the University of Utah that silos are very counterproductive. When I was chief of gastroenterology here, I was blessed with having a chairman of surgery (Frank Moody, M.D.), who was a terrific GI surgeon, and really a fun man to work with, and he liked to collaborate as much as I did.  We had combined GI surgery conferences and we were right together all the time. It was easy. We can’t do it without the surgeons, and the surgeons can't be as effective as they need to be without input from us.

And other career reflections:

I feel fortunate that I’ve been able to pursue several careers simultaneously, each of which has given me a tremendous sense of satisfaction. I told my wife the other night; I can’t imagine a more fulfilling life.