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Imagine an active and comfortable retirement, pursuing your hobbies at will and taking time to enjoy the golden years. Sound like fun? Not to Leon Smith, M.D., it doesn’t. After almost 55 years as a practicing physician, Dr. Smith is every bit as enthralled and impassioned about being a doctor as he was as a young medical student paging himself just to hear his name on the PA system. “I just love being a doctor, I love the challenge of solving diagnostic problems, I love tough cases — the tougher the better,” the octogenarian says. “I’m reluctant to give it up. What would I do? I can’t play golf every day.” Not only is Dr. Smith someone who loves what he does, he is also one of the greatest authorities on infectious diseases in the world. He has made a difference in the lives of students, fellow doctors, and patients. And his influence continues to be felt through the creation of scholarships for underprivileged kids wanting to study medicine, medical education initiatives in the developing world, his diagnostic insights, and the continued treatment of patients in Newark at Saint Michael’s Medical Center, a nonprofit tertiary-care, teaching, and research center. When Dr. Smith first joined Saint Michael’s in 1962, he was the only doctor trained in infectious diseases in New Jersey, and his expertise was constantly in demand. He brought countless bright young doctors to the center, creating a top-class teaching hospital and reinvigorating the quality of care. And at home, four of his five children have followed him into medicine, including one son who has become an infectious diseases expert at Saint Michael’s. “I enjoy taking my experiences and transferring them to my children and students,” he says. “I’ve trained probably more infectious diseases doctors than anyone in history, and I’d like to continue that. I’m 80 years old now, so I don’t know how much longer I can keep going, but I still have the energy. I wake up in the morning and I can’t wait to get to work.” Within the community of Newark, he has helped kids in the community to fulfill their dreams of becoming doctors. Family Practice At the tender age of 15, young Leon Smith watched his father, in his 40s, die of Graves’ disease, an autoimmune disorder that leads to overactivity of the thyroid gland; a misdiagnosis and poor treatment led to his untimely death. The experience changed Dr. Smith’s life; he vowed to become not just a doctor, but the best doctor he could possibly be. With little money and the challenge of getting into medical school at a time when veterans were returning from war, it was not an easy start. His mother and sisters all went to work to raise money for his tuition and when he did get into Georgetown University Medical School, he made sure he was top of his class. His move into infectious diseases was more by chance than by design. To pay his room and board, Dr. Smith worked in a children’s convalescent hospital, drawing blood and taking care of the children. During that time the hospital was involved in research with the National Institutes of Health (NIH), and Dr. Smith was involved in helping to identify the adenovirus. As a result, he was invited to go to the NIH, and so began a remarkable journey into understanding and uncovering infectious disease. A pioneer, Dr. Smith says his secret was to team up with some of the brightest doctors in the field. He became part of a quartet of inner-city infectious disease experts, which included Dr. Donald P. Louria, Dr. Michael Grieco, and Dr. Donald Armstrong. “For 48 years, we met once a week; we went to different hospitals in New York City and in New Jersey where, in front of a large audience of our peers, we were presented with cases and were asked to give our diagnoses and opinions,” he says. The fantastic four were privy to many world firsts in terms of diagnosis, including toxic shock syndrome, bacteria resistance, methicillin-resistant Staphylococcus aureus (MRSA), and even HIV/AIDS. “We worked with all the new antibiotics, all the new antiretrovirals, all the new drugs for HIV; we were among the first to recognize and start treating HIV; and we were among the first to recognize all of the diseases associated with organ transplants,” Dr. Smith says. “When we started, there was no HIV, there was no toxic shock, so it’s been a historical journey,” Dr. Smith says. A Community Act After completing his fellowship in infectious diseases and his two-year residency in internal medicine at Yale, the newly married Dr. Smith was offered a position at Yale. But he received a request from Dr. Harold Jeghers, his mentor at Georgetown University, to spend a year at Saint Michael’s Medical Center in Newark, and Dr. Smith has been there ever since. Though there were a number of doctors who were receiving grants when Dr. Smith first arrived at Saint Michael’s, when the grants ran out, most of the doctors left, leaving the residency program in trouble. In response, Dr. Smith began recruiting young doctors from some of the best schools in the country. To attract them, he made them chiefs, straight out of fellowships. The result was a highly progressive and exciting hospital center with the best teaching program in the state. The initiatives Dr. Smith has put in place for the center established both excellent healthcare to the poor, inner city Newark community, as well as a fine teaching hospital with a progressive fellowship program. At the same time, he was reaching health practitioners across the state, country, and globe through various other programs. The first of these was a column called Chances Are, which has been ongoing for more than 40 years. It was prompted by Johnny Mathis’ song Chances Are that was popular when Dr. Smith was still a student. Through the column, a patient’s symptoms are described, and from this the healthcare practitioner is asked to make a diagnosis. For years, the column appeared in various family practice magazines until those publications stopped being produced. Dr. Smith kept accumulating material and recently the column was picked up by QuantiaMD, an online physician community. “QuantiaMD is all over the world, so the column gets great exposure, and Chances Are is the most popular item in the site’s educational armamentarium,” Dr. Smith says. Early in his career, Dr. Smith found himself racking up 60,000 miles a year visiting hospitals across New Jersey to consult on infectious disease cases. But with a young family these demands began to take their toll and so, in response, Dr. Smith established a free hotline called Fevers of Unknown Origins Hotline, for any doctor who needed help with prescribing the right antibiotic or cases that they were struggling to solve. “It was established as a self-defense mechanism because I just couldn’t keep running around with a family at home,” he says. “But it worked out very well; we received calls from all over the world — great cases with some unbelievable challenges. I was constantly being challenged and I learned a great deal from interesting cases. For example, I met a nurse from the Philippines who had a rash that turned out to be leprosy.” Even at 80, Dr. Smith is constantly looking for new ways to reach healthcare practitioners and improve health globally. In an effort to improve the diagnosis and treatment of HIV in Kenya and Afghanistan, he is working on an initiative to deliver free Blackberrys to every doctor in these countries. The goal is to communicate and educate these physicians on treatment best practices for AIDS, hepatitis C, and TB. The QuantiaMD platform will be used to deliver the information. Dr. Smith says ultimately it would be ideal to get Blackberrys to all doctors worldwide so he and his colleagues can communicate doctor to doctor, either through QuantiaMD or a direct line. “We found that in Afghanistan one of the biggest problems is maternal mortality,” he explains. “One of my sons is a renowned perinatologist; he is going to have a direct line from his house, which will allow him to train midwives and doctors in Afghanistan on how to prevent infection, including training on ultrasound machines. Most of my kids are doctors and my son-in-law is a respected gynecological oncologist, so I’m getting all of them involved in serving the world.” There are plans to roll the program out in the Sudan and Bangladesh. “A similar program is being run in Puebla, Mexico, by a woman who spent time working as a nurse at Saint Michael’s; she became interested in how HIV was being spread from migrant workers to their families back in Mexico,” Dr. Smith says. “There is now a huge epidemic in Puebla, and she is working on education and diagnosis. We sent one of our associates to work with her. Through a grant from Coca-Cola, we’re now going to be able to work with her via phone to diagnose and treat HIV in Puebla.” A Historic Perspective Given his years and extraordinary expertise in so many areas of health, Dr. Smith has a unique insight into medical developments. One of his greatest concerns is a dearth of research into new antibiotics, particularly in the wake of gram-negative resistance to existing antibiotics. “Most companies have dropped their antibiotic programs because they can’t make their money back,” he says. “They’d rather focus on such diseases as hypertension or cholesterol where people take medication for years, as opposed to antibiotics, which are only taken for about seven days. “There is a void, and it worries me to no end,” he says. “With resistance increasing by the day, we’re back using polymyxin E, Colistin, which is very toxic. It’s like 1956 again, because we don’t have effective antibiotics.” He believes incentives, such as patent extensions, are needed to get the industry back into antibiotic research. On the other hand, he believes the industry has excelled in the area of antiretrovirals, particularly those for HIV. “My son, who is a world-renowned HIV doctor, says it’s easier to treat HIV/AIDS than it is to treat diabetes now, thanks to the drug companies,” he says. “Despite all of the attacks they came under from activist groups, the pharmaceutical companies have done a fantastic job. These days, patients live for years thanks to the breakthroughs from companies, such as Gilead, Bristol-Myers Squibb, Roche, and Glaxo.” He believes vaccines are another area where pharmaceutical companies have excelled in eradicating disease, despite the fear that so many people have. Dr. Smith believes on a population level the biggest challenge is overcoming the fear so many people have of vaccines. “In the past, we saw case after case of meningococcal meningitis, but since the meningococcal vaccine produced by Wyeth, we just don’t see the same level of occurrence,” he says. “Similarly, with the HPV vaccine, there is the potential for cervical cancer to be eradicated in a generation, just like polio and measles were wiped out.” In talking with Dr. Smith, it’s impossible not to be swept up by his enthusiasm and to wonder whether this 80 year old will ever, in fact, slow down. His efforts to ensure high-quality treatment for disease sufferers, regardless of income, his dedication to encouraging young people to enter the medical profession, and the programs he has helped to start to ensure students from all backgrounds have an opportunity to get the education they deserve, have had an impact on so many lives. With all this in the balance, one has to hope Dr. Smith will be doing his rounds for many, many years to come. F PharmaVOICE welcomes comments about this article. E-mail us at email@example.com. Dr. Leon G. Smith is showing no signs of slowing down. He continues to make a difference in the lives of patients, teach and encourage up-and-coming doctors, and spread knowledge and information about infectious diseases and treatments to doctors far and wide. Age of Excellence 1987 – Present. Professor and Chairman of Internal Medicine, Seton Hall University, School of Graduate Medical Education 1974 – Present. Professor of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School 1973 – Present. Professor of Preventive Medicine/Community Health, University of Medicine and Dentistry of New Jersey 1971 – 2004. Director of Medicine, Saint Michael’s Medical Center, Newark, N.J. 1971 – 1975. Admission Committee at the University of Medicine and Dentistry of New Jersey 1970 – 1972. Research Committee at the University of Medicine and Dentistry of New Jersey 1964 – 1971. Director of Medical Education, Saint Michael’s Medical Center 1962 – 2005. Chief of Infectious Diseases, Saint Michael’s Medical Center 1962 – 1964. Director of Bacteriology Laboratory, Saint Michael’s Medical Center Education: 1960. Fellowship, Infectious Disease Yale, Department of Medicine and Preventive Medicine 1956. M.D., Magna Cum Laude, Georgetown University Medical School 1952. Graduate School, New York University 1951. B.A., New York University An Honorable Career A Higher Calling — Dr. Leon G. Smith When Leon Smith, M.D., received an Honorary Doctorate of Science from New Jersey Institute of Technology (NJIT) in May, it marked just the latest accolade to be bestowed on this extraordinary physician, teacher, and father. Dr. Smith’s contributions to the area of infectious diseases during his 50 odd years of practice are considerable. Dr. Smith developed the first viral diagnostic laboratory in New Jersey, and he was instrumental in creating the Peter Ho Memorial Clinic, among the state’s oldest and largest HIV and AIDS treatment centers. Last September, St. George’s University School of Medicine created the Dr. Leon G. Smith Scholarship of Promise. The full-tuition scholarship program is for 12 qualified men and women who agree to pursue training in primary or family care and who pledge to work in a medically underserved or urban area. The scholarship means a great deal to Dr. Smith, who said his own family struggled to pay his medical school tuition. “The scholarships are for inner city kids, and in return they must work, for example, in Newark for eight years,” he says. “There’s no free lunch here; you pay it back by giving service.” Even at 80, Dr. Smith continues to see patients, and he is known for diagnosing some of the most rare and difficult to detect illnesses. He is Chairman of the Leon G. Smith Committee for the Advancement of Infectious Disease Medicine and has published more than 250 scholarly papers on infectious disease. A practicing physician and teacher, Dr. Smith has trained thousands of young doctors throughout his career and has been instrumental in helping many young inner-city kids to go to college. He recalls in particular a young woman from a wonderful family who he encouraged to go to medical school and helped financially from time to time. “She’s now a doctor at Saint Michael’s,” Dr. Smith says. Dr. Leon Smith (left) with Fadi Deek, Dean, NJIT College of Science and Liberal Arts receiving his honorary degree. A Healthy Calling eon Smith, M.D., was on a star-studded course to success at Yale when one of his mentors Dr. Harold Jeghers, who was Professor of Medicine at Georgetown University, asked him to spend a year at Saint Michael’s Medical Center in Newark, N.J. Almost 50 years later, Dr. Smith is still there. Established by the Franciscan Sisters of the Poor in 1867, Saint Michael’s Medical Center is a 357-bed regional tertiary-care, teaching, and research center in the heart of Newark’s business and educational district. Saint Michael’s Medical Center is a member of Catholic Health East. Based in Newtown Square, Pa., Catholic Health East is one of the nation’s largest nonprofit health systems, with 34 hospitals in 11 states. Dr. Smith says he has always had a missionary zeal. In fact, he lived with a priest while studying at Georgetown and gave serious thought to joining the clergy himself. “That’s until I went to a retreat; immediately after I proposed to my wife,” he says. But this didn’t for one minute detract from his strong Catholic beliefs. In fact, he says his wife, Margaret, is more devout than he is. He says he took his wife to a leprosarium for their honeymoon, a true test of love in any marriage. Being married to a nurse meant medicine was a family affair; the couple set up a free clinic in a Newark church basement in 1963. “We got a couple of other doctors to volunteer, solicited free samples, and we went to work,” he says. The couple loved what they were doing, but times changed and Dr. Smith got roughed up during the riots at a gas station. “My wife said we have five kids, you’re taking a big chance, so we moved our clinic back to Saint Michael’s and the people followed us there,” he says. Through one unpleasant incident, he learned that he was also liked and respected by the people of the community, though it didn’t seem like it at the time. One night after closing the clinical, Dr. Smith’s car wouldn’t start. Upon opening the hood, he saw the battery had been stolen. “I was so angry because I was taking care of the people in the community and they stole my battery,” he says. He called Monsignor Cary, the local priest whom Dr. Smith had come to know and respect enormously. “He said ‘they like you — they didn’t cut your cables’,” Dr. Smith recalls. “That put it in perspective — the people in the neighborhood were hungry, they needed money, so they stole my battery, but they liked me enough to leave the cable intact.” Few doctors will go out of their way for their patients to the extent that Dr. Smith will. He likes to use the “whole world” — the Mayo clinic, Harvard, Hopkins, all the big centers with all of the top people in the world — when he gets stuck. He sincerely believes people deserve the best care possible. For example, Dr. Smith has a wonderful young patient, an electrician, who had chronic sinusitis. He diagnosed Wegener’s granulomatosis. “I couldn’t prove it, a biopsy couldn’t prove it, so before we started treating him, I sent him to the Mayo clinic and they confirmed Wegener’s,” he says. Dr. Smith then turned to Dr. Robert Speira in New York, who has experience with Wegener’s and started the patient on treatment, and when that didn’t work they started the patient on a new treatment called Raptiva. “This poor man has four children and has suffered so much,” Dr. Smith says. “I call him every day to see how he’s doing.” F Throughout his life, Leon Smith, M.D., has been led by a calling to help others. It’s what drove him to study medicine, to become an expert in infectious diseases, and to devote his life to helping patients least able to help themselves. Foundations: 1982 – 1985. Co-founder of Northern New Jersey Chapter Physicians for Social Responsibility 1982 – 1985. Founder of nonprofit New Jersey Infectious Disease Foundation to sponsor education and research in infectious diseases 1977 – 1987. Established Nosocomial Laboratory of New Jersey 1977. Updated V.D. clinic of Newark with the recruitment of Dr. Ira Gouterman from Yale University School of Medicine 1978-1979. New Jersey-Saudi Arabia medical advisor and liaison committee 1977. Established Saint Michael’s Medical Center Visiting Sabbaticalship of Infectious Diseases; first recipient, Dr. Jacques Acar 1976. Established Host Defense Laboratory with the recruitment of the director 1975-Present. Co-founder with Dr. Louria, Dr. Armstrong, and Dr. Grieco of Intercity Rounds New York and New Jersey Infectious Disease Rounds 1972. Established first N.J. Pediatric Infectious Disease Department with the recruitment of personnel 1972. First regional viral diagnostic laboratory of New Jersey and First Viral, Chlamydia diagnostic laboratories of New Jersey 1970 – Present. Co-founder with Dr. Louria, New Jersey Infectious Disease Society Visiting professorships: 1992 and 1978. Grenada, West Indies 1979. Jordan 1979. Puerto Rico 1979. France 1969. Austria 1969. Russia Committees: 1990 – 1991. Committee of Legislation & Political Action, Essex County Medical Society 1985 – 1975. Council of American College of Physicians 1982. U.S. Swimming Committee, Colorado Springs 1980 – 1981. Venereal Disease Control Committee, Essex County 1977 – 1979. Member — New Jersey Health Science Council 1973 – 1975. Member of Admission Committee, New Jersey Medical School 1972 – 1975. Chairman, Hospital Research Committee, Saint Michael’s Medical Center; Chairman, Intern and Resident Committee, Saint Michael’s Medical Center 1968 – 1969. Director of Education Task Force, New Jersey Regional Medical Program