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David Sachar

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ScienceHeroes.com Exclusive Interview:
David Sachar - December 2009
On his crucial role in the development of Oral Rehydration Therapy

cimg0914_cropped
Sachar at work
Mount Sinai School of Medicine
New York, NY


Let's Start - Questions about Your Lifesaving Discovery
ErleFlaskOutline1_tilt Your Discovery:

70% Inspiration
30% Perspiration

ErleFlaskOutline1_tilt How many hours a week were you working when you made your most important discoveries? 

40

ErleFlaskOutline1_tilt Where do you have the best ideas? For example, at work, at home, on the way to work, in the shower?

In bed at night and in the shower in the AM

ErleFlaskOutline1_tilt At what time of day do you think most clearly and have the most creative ideas?

Early AM

ErleFlaskOutline1_tilt Did the insight(s) that led to your discovery occur in an instant, on a specific day – or did it unfold over time?
Describe any ‘aha’ moment.


Step one: a particular day when I read a relevant article in a journal; Step two: a particular instant when we saw the transmural electric potential in a cholera patient respond vigorously to glucose infusion. Step three: a particular moment when Dr. Hirschhorn proposed applying our discovery to oral therapy.

ErleFlaskOutline1_tilt When did you first realize the immense worldwide impact your discovery would have?

As soon as we saw the net intravenous fluid requirement of cholera patients drop dramatically with peroral infusion of glucose-electrolyte solution.

ErleFlaskOutline1_tilt For many people, fleeting images come to mind when asked to remember an event. What images come to your mind when you think back about your discovery (both the moments of insight and the years of research)?

The precise instant when the needle on the intestinal intraluminal electric monitor moved up and off the dial within seconds of our beginning the glucose-containing infusion.

ErleFlaskOutline1_tilt Can you describe your thought processes? Both your routine research thought processes and your creative processes.

The key to the creative thought process is the application of a principle or an observation from one sphere to a process or a phenomenon in another previously unrelated sphere.

Working_at_Kelly_cropped
Sachar performing relief
work following Hurricane Katrina,
fall of 2005

Questions about Your Personal Scientific Career
ErleFlaskOutline1_tilt Describe your office/desk. Is it tidy or messy? What personal/sentimental items do you keep there?

The desk tends to be messy. The personal items are primarily family pictures.
ErleFlaskOutline1_tilt When did science first spark your imagination and arouse your passion? 

In elementary and junior high school in the few years preceding teenage.

ErleFlaskOutline1_tilt Who is your scientific (or other) hero and why?

Scientific heroes would include John Snow for his epidemiologic observations regarding cholera and Lister, Pasteur, Koch, and Semmelweiss for their insights regarding communicable infectious disease. But my three “life heroes” are (1) my 11th grade English teacher, Mr. M. Roland Heintzelman, for teaching me high standards of writing; (2) my late older brother, Edward, for teaching me how to balance the demands of work with the pleasures of life; and my father, A. L. Sachar, for inculcating the highest standards of academic achievement welded to public service.

ErleFlaskOutline1_tilt What's the coolest thing about your work – what excites you the most?

Entering the bodies and spirits of people in need of assistance and applying medical knowledge and empathetic communication in ways to give them help and hope.

ErleFlaskOutline1_tilt What thing most frustrates you about your work that, if you could avoid it, might make you a better scientist?

It is not the work itself that frustrates me most, but rather the difficulties in keeping my thoughts and activities sufficiently well organized to accomplish the work with optimal efficiency.

Questions about Your Childhood and Schooling
ErleFlaskOutline1_tilt Describe your family life, growing up. 

Constant movement from one part of the country to another in the wake of my father’s work, and growing up in a family where my father—while an inspiring role model—was absent more than he was present.
ErleFlaskOutline1_tilt Describe your community and social environment, growing up.

From the age of 8 and for the rest of my childhood, community and society were defined almost exclusively by my father’s mission as Founding President of Brandeis University.
ErleFlaskOutline1_tilt What was delightful about your childhood?

Meeting famous people in connection with my father’s university life.
ErleFlaskOutline1_tilt What was challenging about your childhood?

Being intellectually precocious but socially awkward and immature.
ErleFlaskOutline1_tilt What were your favorite subjects in high school and college, and why?

History and literature were always my favorite subjects, even though I was destined for a career in medicine.
ErleFlaskOutline1_tilt What teacher most influenced you?

My eleventh grade English teacher, Mr. M. Roland Heintzelman (see above).
ErleFlaskOutline1_tilt What was your worst subject in school? 

Although I was generally very good in math and science, and even won a physics prize in college, for some unfathomable reason I had terrible trouble with high school physics.
ErleFlaskOutline1_tilt What was your very first paying job?

Hospital laboratory technician during medical school.
ErleFlaskOutline1_tilt Was there an event that turned you onto the path to becoming the scientist you are?

No one specific event.
ErleFlaskOutline1_tilt What message would you pass on to today’s youth?

Do not try to be too clever in over-planning your career moves. So much will depend upon chance and unpredictable circumstance that you should let your passions and your instincts be your guide.

Anecdotes   
One or two paragraph length stories often provide great insight into people
.
ErleFlaskOutline1_tilt Please share one or more profound or moving occurrences in your science career.

The life of one of my patients as a first-year medical intern was transformed when I figured out that her easy fatigability and intermittent diplopia indicated a possible diagnosis of myasthenia gravis. The instant that an injection of physostigmine caused her drooping eyelids to fly up, leading her to say, “It’s like a veil has been lifted from my eyes!” we knew that a defining moment had occurred in our both our lives.

A second “profound occurrence” was the opportunity to reactivate my commission in the U.S. Public Health Service in order to serve a month assisting in Hurricanes Katrina/Rita relief in San Antonio in Spetember-October 2005.

But perhaps most significantly in the broad context of public health, my life and the life of the planet were transformed the moment that an infusion of glucose into the intestine of a cholera patient prompted an instantaneous leap of the needle measuring his intestinal transmural electric potential (see above).
ErleFlaskOutline1_tilt Please share one or more unusual anecdotes from your science career.

One day as a medical student I was examining a patient who was about to undergo exploratory surgery for a mysterious lump in her axilla. Noticing a Band-Aid® on her hand, I asked her what happened and she told me that her cat had recently scratched her there. My failure to make the connection between that injury and her ipsilateral axillary adenopathy robbed me of the chance to achieve early fame by making a correct preoperative diagnosis of cat-scratch fever (feline granulomatosis)!
ErleFlaskOutline1_tilt Please share one or more humorous anecdotes from your science career.

The immediately preceding anecdote appears somewhat humorous—in retrospect!

Just for Fun
ErleFlaskOutline1_tilt What are your favorite non-scientific interests and activities?

Reading, playing piano, and learning Italian.
ErleFlaskOutline1_tilt Describe your Favorite:

Food:
Ice cream and cookies
Scientific instrument:
The stethescope
Science periodical/journal:
Inflammatory Bowel Diseases
Author and/or book:
A Suitable Boy by Vikram Seth
Artist and/or specific work of art:
Claude Monet
Music and/or song:
Beethoven’s Seventh Symphony
Movie:
Casablanca
ErleFlaskOutline1_tilt If you were given one million dollars, what would you do with it?

Endow a chair at my medical school.
ErleFlaskOutline1_tilt What three items would you take to a deserted island? (Besides survival items):

A digital reader (like a Kindle or Nook) loaded with books I hadn’t yet read; an MP3 player loaded with music that I had already heard and loved; an inexhaustible supply of writing materials.
ErleFlaskOutline1_tilt On average, how many hours a week do you spend on:

Family:
20
Personal Things:
30
Socializing:
5
Play:
5
TV:
15
Hobbies:
5
Work:
35
Science:
15
Reading:
10
Exercising:
2
Other significant parts of your life (please name):
10=traveling and preparing for travel
ErleFlaskOutline1_tilt How many hours a night do you normally sleep?

8
ErleFlaskOutline1_tilt To be well rested, how many hours a night of sleep do you need?

8
ErleFlaskOutline1_tilt What is one thing about you that people would be most surprised to find out?

That I have ADHD.

Now a pause for some more Mundane Questions
ErleFlaskOutline1_tilt Date of Birth: 03/02/1940
Birthplace:  Urbana, Illinois (USA)
Your parents and siblings names: Mother=Thelma Horwitz Sachar; father=Abram Leon Sachar; older brother=Edward Joel Sachar (deceased); oldest brother=Howard Morley Sachar
Current residence: Englewood Cliffs, New Jersey (USA)
Current position: Clinical Professor of Medicine, Mount Sinai School of Medicine, New York, NY (USA)
Field: Gastroenterology
Spouse/Partner: Joanna Silver Sachar
Children, including year of birth: Mark Benson, dob 09/24/64; Kenneth Hulbert Belford, dob 01/16/67, deceased 09/05/95


Academic and Professional Experience
ErleFlaskOutline1_tilt Key Published articles describing your remarkable discovery:

Sachar DB, Taylor JO, Saha JR, et al. Intestinal transmural electric potential and its response to glucose in acute and convalescent cholera. Gastroenterology 1969;56:512-21.

Hirschhorn N, Kinzie JL, Sachar DB, et al. Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions.  N Engl J Med 1968;279:176-81.


Questions about being a Lifesaving Scientist
ErleFlaskOutline1_tilt What are your thoughts about the people whose lives you have saved? Have you met any?

Every life is precious and unique but the scale of the tens of millions of lives saved over the past four decades is too vast to be able to grasp them as individuals.
ErleFlaskOutline1_tilt If you could interview any of the lifesavers on the website, who would it be and what would you ask them?

On a strictly personal level, I would be interested in Alfred Sommers’s recollections about what role if any our early contacts with each other as medical residents in Boston had on his subsequent illustrious career in international public health.
ErleFlaskOutline1_tilt What is the current most pressing problem that if solved, could save the most lives?

The excess of water in flood areas and the dearth of water in drought areas.
ErleFlaskOutline1_tilt Going forward, what is the most important thing scientists can do to save the most lives?

Figure out how to redistribute water from areas of excess to areas of insufficiency.
ErleFlaskOutline1_tilt If you were to head up a foundation or the NIH, how would you change the way funding is granted?

I might earmark a little extra for promising projects that had not yet accumulated so many preliminary data as to be half-completed before funding was granted.
ErleFlaskOutline1_tilt Should the federal government devote more money to healthcare research (how much)?

Yes, an extra 8-10%

Questions about the Current State of Science
ErleFlaskOutline1_tilt What excites you about the current direction of scientific research and discovery? 

The emphasis on translational research.
ErleFlaskOutline1_tilt What concerns you?

The over-emphasis on areas of current “fashion” (e.g., genetics) at the expense of less fashionable areas (e.g., environment).
ErleFlaskOutline1_tilt What would you change about the way science is taught, from elementary school through the university level?

More excitement, more relevance to different varieties of student, more passion, more imagination.
ErleFlaskOutline1_tilt What is one thing not taught in school that you believe should be?

Critical thinking.

Fun Philosophical Questions
ErleFlaskOutline1_tilt What would you like your tombstone to say?

“He’s not here yet.”
ErleFlaskOutline1_tilt What’s your motto?

“People will always forget what you tell them; they might remember some of what you show them; but they will never forget how you made them feel.”
ErleFlaskOutline1_tilt Imagine yourself on a leisurely journey with plenty of time for long conversation. Which famous people would you like to accompany you, and why?

Thomas Jefferson, James Madison, and Benjamin Franklin. Their concepts of government, society, politics, and philosophy will continue to enrich us for the foreseeable future.

Serious Philosophical Questions
ErleFlaskOutline1_tilt What was the most meaningful experience(s) in your life and why?

The two years spent between PGY2 and PGY3 in Dhaka, East Pakistan (now Bangladesh), because they helped me and my family grow in independence (and gave birth to our younger son), opened our eyes to the wider world, and had a measurable impact on the health of populations around the globe.
ErleFlaskOutline1_tilt What is the meaning of life?

To spend it for something that outlasts it.
ErleFlaskOutline1_tilt Are you religious? Expound:

I am steeped in the historical, cultural, and ethical precepts of Judaism without adhering to most of its orthodox traditions.
ErleFlaskOutline1_tilt You are extremely intelligent and knowledgeable.  What two suggestions do you have for students to prepare them for life?  

Don’t over-plan. Be prepared to accept the unexpected.
ErleFlaskOutline1_tilt What two suggestions do you have for world leaders? 

Think of what is best for your people and all the people of the world. Be nice.

Questions from The Edge
Each year, a website named The Edge.org (http://www.edge.org/questioncenter.html) asks leading scientists and intellectuals a single question, and then posts each fascinating answer on their website. Please answer two (or more) of the questions listed.
ErleFlaskOutline1_tilt The Edge Annual Question — 2006
What is your dangerous idea?
The history of science is replete with discoveries that were considered socially, morally, or emotionally dangerous in their time; the Copernican and Darwinian revolutions are the most obvious. What idea, not necessarily of your origin, is dangerous not because it is assumed to be false, but because it might be true?


Is it possible that there really are genetic and consequently ethnic differences in average intelligence?? The implications for social policy would be dangerously explosive.
ErleFlaskOutline1_tilt The Edge Annual Question — 2004
What is your law?
There is some bit of wisdom, some rule of nature, some law-like pattern, either grand or small, that you've noticed in the universe that might as well be named after you. Gordon Moore has one; Johannes Kepler and Michael Faraday, too. So does Murphy. Since you are so bright, you probably have at least two you can articulate. Send me two laws based on your empirical work and observations you would not mind having tagged with your name. Stick to science and to those scientific areas where you have expertise.
 
Sachar’s Law #1: You don’t always have to know what a patient has, but you always have to know what to do.

Sachar’s Law #2: Nothing in clinical medicine is about you; it’s only about the patient.