James Findling, MD, is a veteran of the endocrinology field, a clinical practitioner and a Cushingâs syndrome expert. For his efforts in these areas, particularly clinical practice, the Endocrine Society is honoring him with its Outstanding Clinical Practitioner Award at ENDO 2019 in New Orleans.
Findling, who currently serves as director of community endocrinology services and clinical professor of medicine at the Medical College of Wisconsin in Milwaukee, has made his clinical practice a national one as, according to the Endocrine Society, he receives referrals from across the U.S. In addition, he has played an important role in Cushingâs syndrome research, including breakthroughs that the Endocrine Society has incorporated into its own clinical practice guidelines.
In a conversation with Endocrine Today, Findling discussed his serendipitous entrance into endocrinology, his own experience with medical history and his dream of playing golf with Barack Obama.
What was the defining moment that led you to your field?
Findling: In 1977, I was a resident in internal medicine at what was then the Milwaukee County General Hospital, which doesnât exist anymore. I did an endocrinology rotation, and my attending physician was James Cerletty, MD. Endocrinology was the farthest thing from my mind as something I would be interested in, but I was assigned to do this rotation and it changed my life. I thought, âOh my goodness. This is fascinating.â Dr. Cerletty was a fabulous teacher and great mentor. The reason I chose endocrinology was because of that 1-month rotation. I had never done it previously, and I just fell in love with it. It was primarily because of this one man, who just died recently. He changed my life.
I was a chemistry major in college, and I enjoyed the pathophysiology and the biochemistry of it. I remember in those days, it was a little bit more complicated and convoluted to assess thyroid function, and it was never something I appreciated or understood. The concepts like T3 resin uptake I didnât quite understand. Jim Cerletty made me understand how to interpret thyroid function studies, how they were done, how T3 resin uptake was measured, and it made all the difference in the world; a light bulb went off.
What area of research in endocrinology most interests you right now and why?
Findling: Pituitary-adrenal disorders. How I got interested in that, itâs kind of an interesting story in itself. After I did the month with Dr. Cerletty, I got interested in endocrinology, and 6 months later, I was in a general medical clinic seeing a woman with obesity, hypertension and diabetes. I went in and said to the attending physician at the time, âWell, maybe she has Cushingâs syndrome,â and I got kind of reamed out. âThatâs rare. Nobody has that. Itâs a stupid thing to think about.â He was trying to embarrass me and it upset me. I said, âHow do you know she doesnât have Cushingâs if you donât do the testing?â
So, I started looking into it and realized nobody knows. Maybe some of these people with obesity and hypertension do have Cushingâs syndrome, but the testing was cumbersome and stupid and didnât make any sense to me. About that time there was an article in The New England Journal of Medicine about pituitary surgery for Cushingâs disease from UCSF. I read that and said, âThatâs where Iâm going. Iâm going there to learn about Cushingâs.â I applied and, fortunately, I got in and the rest is history. Itâs because some attending physician embarrassed me by saying, âThatâs stupid. Nobody could have Cushingâs syndrome,â and Iâve spent the rest of my life trying to figure that out. Itâs been my passion for the last 40 years.
What advice would you offer a student in medical school today?
Findling: You need to find something that youâre passionate about in medicine. For many young people, that requires specialization into a relatively focused area so that they can develop a higher level of expertise. For some, that may be a more general area, and for some it may be based on location. For example, they might like to be a family physician in a small town where they can do a great deal of good. Either way, you must find something that youâre passionate about within our field, because if youâre not, youâre going to be unhappy. This is hard work and youâre going to spend many hours doing this, so you better find something you enjoy doing, whatever it is. There are so many different aspects from psychiatry to surgery to hospitals. There are so many different things you can do, but you have to find something that you like.
I hear a lot about work-life balance, and I understand that particularly in young physicians, this is a critically important part of being a doctor. The problem is if youâre going to be a physician, thereâs going to be a lot of work. Half of your time or more is going to be working. You better enjoy that part of it because if you donât enjoy the work part of it, youâre not going to enjoy the life part of it.
Have you ever been fortunate enough to witness or to have been part of medical history in the making?
Findling: I was lucky to go to University of California, San Francisco. Shortly after I got there, there were several people cloning the growth hormone gene and the insulin gene. The foundation of Genentech and the idea of making growth hormone was just fermenting at UCSF when I was there. In one of the labs was Herb Boyer, PhD, who was one of the first people to clone growth hormone, and he was on the cover of Time magazine. The head of the metabolic research unit and my boss was John Baxter, MD, who was president of the Endocrine Society years ago. There is now a prize named after him; he was on the cover of The New York Times magazine. So, here I am at UCSF and somebody in the lab down the hall is on the cover of Time magazine and my boss was on the cover of The New York Times magazine, so it was an exciting time to be at UCSF in the late â70s and early â80s.
Another defining moment in my career from a research perspective was when I was a fellow, I had to do a project. We were seeing a lot of patients with Cushingâs â of course, thatâs why I went there â and in those days we had no good imaging. There were no CT scans, no MRI, there was no way to image the pituitary gland to find out whether there was a tumor. By the late â70s it became obvious that some patients with Cushingâs syndrome didnât have pituitary tumors. They had tumors in their lungs and other places, and there was no good way of sorting these patients from the pituitary patients.
My mentor at UCSF, Blake Tyrrell, MD, had the idea of sampling from the jugular vein to see if there was a gradient across the pituitary. I took the project up because I didnât think this is going to be helpful due to there being too much venous admixture in the jugular vein from other sources of cerebral venous drainage. We went into the radiology suite to do the first patient. As I was sampling blood from the peripheral veins, the interventional radiologist, David Norman, MD, says, âWould you like to sample the inferior petrosal sinus?â I said, âWhy not? It sounds like a good idea to me.â That turned out to be helpful. We then studied several patients, and it eventually went to publication. Now everybody acknowledges it is necessary, maybe not in all patients with Cushingâs, but in many patients with Cushingâs to separate pituitary from nonpituitary Cushingâs syndrome.
That was kind of a defining moment in terms of my research career because it was complete serendipity. I had never even heard of this vessel before. I went to the library to get a bunch of books to try to figure out what the venous drainage of the pituitary gland looked like. That was not easy to find. That was the defining moment of my research career as a postdoctoral fellow in endocrinology at UCSF. I was blessed because there were so many people smarter than me that it was a big help and an inspiration.
What do you think will have the greatest influence on your field in the next 10 years?
Findling: Most people would say genetics. The genetic diagnosis of so many disorders and the connection of disorders because of germline mutations or somatic mutations in tumors is just exploding. Whether you talk about pheochromocytomas, pituitary tumors in Cushingâs disease or adrenal tumors, you can go on and on and on.
Genetics wasnât even on the radar screen when I was in training, so I feel a little bit lost because Iâm behind the eight ball in terms of trying to keep up with that. Nobody was talking about that back in 1979, and I wish I understood it a lot better than I do. If I was going to think that thereâs going to be anything thatâs going to change the future of endocrinology itâs that, and not just for diagnosis but its potential applications for therapy.
What are your hobbies/interests outside of practicing medicine?
Findling: Iâm an avid golfer. I live in Wisconsin, so right now itâs only 4° â so not too much golfing going on. I golf in the summer about once a week. I have a nice group of people I play with, and its one of my passions.
I run a lot. Not in 4° weather, but when the weatherâs nice I run a lot and my goal is to run a half marathon this year. Iâve done one in the past, but itâs been many years since Iâve run one. I still enjoy running. Fortunately, my hips and knees and ankles and feet are capable of withstanding it. I donât run very far. Maybe 8 to 10 miles per week.
I enjoy gardening. My wife and I, she loves flowers and I love vegetables, so we have a nice garden we put up every spring. So thatâs another passion I have. We also love live theater, so we go to a lot of theater here in Milwaukee and all over Wisconsin.
Whom do you most admire and what would you ask that person if you had 5 minutes him/her?
Findling: The person Iâd most like to meet is President Barack Obama. Heâs one person I have a lot of admiration for. I would tell him I want more than 5 minutes. Iâd want to play golf with him. I think his skill level is about the same as mine, so weâd have a competitive game. Weâd probably do a lot of trash talking along the way.
I would ask him, âHow did you stay so calm and have so much grace with all the criticism he got from so many people?â Some criticism is always a little bit justified, but a lot of it was so unjustified. How did he stay so calm and not raise his voice? Sometimes when youâre getting a lot of criticism and people are saying negative things about you, how do you stay professional and graceful? Itâs not easy to do.
What was the last book you read , and what did you think of it?
Findling: The last one I finished was American Dervish. Itâs a novel by Ayad Akhtar, who grew up in the suburbs of Milwaukee. His parents are from Pakistan, and he grew up as a Muslim. This young man is going to be a force in American literature.
This particular book is the story of a young Pakistani-American boy growing up in the American Midwest and a growing up story with the struggle of identity and religion. Itâs a fascinating read.
In fact, Akhtar has won a Pulitzer Prize for one of his plays called Disgraced. Heâs just had a play on Broadway that was nominated for a Tony Award called Junk, which the Milwaukee Repertory Theater just performed here. My wife and I saw it recently and it was entertaining
Much of what heâs written is regarding Muslims and the struggles they have living in the United States. If you havenât seen one of his plays or read any of his stuff, I think heâs going to be a real force. Heâs still a young man and heâs creative and provocative. This book, as I understand it, heâs going to make it into a play, and I wouldnât be surprised if someday it might even be a movie. Itâs an interesting perspective and I enjoyed it.
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