Loren A. Laine will become the 107th president of the AGA. Our New President Loren A. Laine, MD. Growing Up. Early Education

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1 GASTROENTEROLOGY 2012;142: Our New President Loren A. Laine, MD Loren A. Laine, MD Loren A. Laine will become the 107th president of the American Gastroenterological Association () at Digestive Disease Week (DDW) 2012 in San Diego, which is a fitting location because this is the city where he completed his fellowship training. We have known Loren professionally and personally for nearly 30 years, and it is our privilege and honor to provide this introduction to the membership. Growing Up Loren was born to Lee and Norma Laine on December 1, 1954, in Los Angeles. Loren s father was reared in Brooklyn and his mother in Baltimore, but in high school each moved with their families to the West Coast. They subsequently matriculated at the University of California, Los Angeles (UCLA), where they met. Loren was the first of their 2 children and was joined 2½ years later by his sister, Susan. Throughout Loren s childhood and teenage years, his parents worked in the variety store retail business. They subsequently retired to the restaurant business, owning and managing a Caribbean-style restaurant called Cha Cha Cha from 1991 to 2006 in Encino, California. Loren, who was a co-owner of Cha Cha Cha, found the restaurant business an enjoyable diversion and occasionally served as a maître d in the restaurant s early years. Early Education Loren grew up not far from the beach in West Los Angeles. He attended Palisades High School, graduating at the tender age of 16 years (having skipped the second grade). From there he moved inland to attend Pomona

2 May College in Claremont, California. After an initial dalliance with the liberal arts, he shifted his passion to the sciences, majoring in zoology and chemistry. It will come as no surprise that Loren excelled academically, graduating in 1975 magna cum laude and Phi Beta Kappa. While at Pomona College, he lived in the dorms (perhaps developing there his ability to work with people of divergent interests), was active in the college newspaper (laying the foundation for an extensive portfolio of clear, concise writing), and played varsity tennis, lettering all four years. Summers were spent working in his family s retail stores and playing tennis. It was during this time that Loren developed an interest in medicine. Although he had no role models or mentors in the medical field, he found the thought of combining science and working with people attractive. These qualities of independence and self-initiation are trademarks of Loren s that have served him well throughout his academic career. Loren did not venture far after college, moving back to West Los Angeles for both medical school and a residency in internal medicine at UCLA. Given that the world s foremost ulcer research group, CURE, was based at the Wadsworth VA and UCLA School of Medicine, it is ironic that Loren, who would later achieve renown for his investigation of ulcer disease, had little contact during this time with these investigators. In fact, he had not yet developed an interest in clinical research but rather was attracted to internal medicine by its intellectual challenges. When not studying, caring for patients, or taking call, Loren worked on his tennis game (sometimes practicing across the street from the medical school with the UCLA women s tennis team). It was also during this time that Loren developed his interest in running, a passion he has pursued ever since. This love of running has led to frequent sightings of Loren arriving at the breakfast buffet at GI meetings around the world still in his running clothes. Choosing a Career in Gastroenterology Loren recalls that his decision to pursue gastroenterology was influenced by his desire to become expert in one organ system as well as curiosity about the emerging technologies in the field. Preferring to remain in Southern California, Loren considered his top options to be UCLA and the University of California, San Diego (UCSD) (Figure 1). He remembers a spirited fellowship interview with Alan Hoffman and a subsequent offer of a National Institutes of Health sponsored research track position at UCSD. After 7 years at UCLA, Loren shifted his horizons from the beautiful beaches of Santa Monica to the beautiful beaches of La Jolla. After packing his car with his tennis racket and running shoes, he made the long, arduous drive south through Orange County (no doubt listening to the Beach Boys on an audio cassette) to commence his UCSD fellowship training in1982. It was an exciting and Figure 1. Loren as a new fellow at UCSD. stimulating time at UCSD, given the vision and charisma of Jon Isenberg, a new chief who was intent on building a world-class division. The GI group was dynamic, blessed with outstanding senior (eg, Jon Isenberg, Alan Hoffman, Marty Kagnoff) and junior (eg, Steve Pandol, Mario Chojkier, and Kiertisin Dharmsathaphorn) faculty. Upon completion of his clinical training, Loren entered the laboratory of Mario Chojkier, his first real mentor, to pursue basic research on liver fibrosis. With time, Loren realized that he was not attracted to bench research but enjoyed asking and answering clinical questions. Perhaps recognizing Loren s latent talents, Dr Chojkier engaged him in the analysis of a GI bleeding database that he had brought from Yale. This spark would ignite a passion for clinical investigation in GI bleeding that has burned brightly throughout Loren s career. Loren quickly became enamored with the idea of pursuing an academic career in clinical investigation. By the middle of his second year of fellowship, he had accepted a clinical position at the University of Southern California (USC). At that time, the USC GI faculty consisted of only 3 members: section chief Jorge Valenzuela, Hartley Cohen, and Ian Renner. Jorge was a wonderful person and supportive chief (despite Loren sometimes driving Jorge crazy with his high energy), allowing Loren the freedom to develop his interests. Hartley Cohen helped him greatly in refining his clinical and endoscopic skills and was the person Loren would turn to when he needed a sounding board for difficult clinical or research questions. Clinical Research The stage for Loren s research in upper GI bleeding was set during internship by his first patient experience, a GI bleeder, and his later involvement with Mario s Yale GI bleeding database. Providence no doubt followed Loren to the Los Angeles County USC Medical Center, where he

3 1242 GASTROENTEROLOGY Vol. 142, No. 5 found a hospital with an enormous number of patients with acute upper GI bleeding and a GI endoscopy unit with a newly acquired bipolar generator and thermal probes. Unlike many endoscopists who were interested primarily in how new technologies worked, Loren was interested in the potential utility of these new technologies in improving clinical outcomes. Despite a lack of formal training in clinical research methodology, Loren performed a series of seminal, welldesigned studies assessing the optimal technique and efficacy of different endoscopic modalities for the treatment of nonvariceal and variceal upper GI bleeding. His first trial of multipolar electrocoagulation in the treatment of active upper GI hemorrhage resulted in a single-author lead article in the New England Journal of Medicine in 1987, less than 3 years after starting his USC faculty position. This was followed in 1989 by another single-author publication in Annals of Internal Medicine, a randomized controlled trial on the efficacy of multipolar electrocoagulation in the treatment of ulcers with nonbleeding visible vessels. These randomized trials, conducted alone by Loren at the very beginning of his career, resulted in major changes in the way we assess and manage patients with acute ulcer bleeding. These were followed by several other studies (nearly all single authored) assessing the relative efficacies and optimal application of several hemostatic techniques, including injection therapy, as well as different thermal probes and coagulation settings. The techniques he described and refined for rendering optimal therapy persist to this day. It now was abundantly clear that Loren Laine was a transformational figure in the field of ulcer-related bleeding, but his interests in ulcer disease soon expanded to include nonsteroidal anti-inflammatory drugs (NSAIDs) and the recently discovered Helicobacter pylori. Although many investigators were interested in ulcer disease, none were working concurrently on the 3 areas of bleeding, NSAIDs, and H pylori. Loren was one of the few people accepted both in endoscopic circles for work in GI bleeding and in the ulcer research community for his work in H pylori and NSAIDs. Other investigators were now interested in working with him. Fred Weinstein at UCLA asked him to collaborate on work involving mucosal injury related to NSAIDs and alcohol. Deborah Cook, who was working in critical care at Stanford, contacted Loren regarding her interest in GI bleeding. This collaboration, through which Loren developed his expertise in systematic review and metaanalysis, culminated in several publications, including a seminal meta-analysis in GASTROENTEROLOGY in 1992 on nonvariceal gastrointestinal bleeding that confirmed the benefit of endoscopic therapy and a meta-analysis in Annals of Internal Medicine in 1995 that established the superiority of band ligation over sclerotherapy for the treatment of esophageal varices. These works announced and highlighted what those of us who have had the privilege to work with Loren know so well: his remarkable ability to collaborate. He is legendary for his willingness to collaborate across institutions, disciplines, and countries. His list of collaborators is mind boggling, including Chojkier, Weinstein, Cook, Cohen, Freeman, Fennerty, McQuaid, Rabeneck, Yang, Wilcox, Fendrick, Schoenfeld, Peterson, Chey, Cave, Hawkey, Hunt, Bombardier, Abraham, Chan, Scheiman, and Jensen. These collaborations span the spectrum of many important areas of GI investigation over the past 3 decades, including all aspects of GI bleeding (variceal, nonvariceal, occult, obscure, and lower), ulcer disease (H pylori, NSAIDs, low-dose aspirin), gastroesophageal reflux disease, dyspepsia, and acquired immunodeficiency syndrome (AIDS)-related disorders. Loren has used his largely self-taught expertise to mentor many coinvestigators in trial design, statistical analyses, systematic review and meta-analysis, and the principles of evidence-based medicine. His work ethic and extraordinary professional standards are an inspiration to everyone with whom he works. Loren s prodigious body of work has been disseminated in the most respected journals. Since his very first paper, which was published in JAMA, he has hit for the cycle with publications in virtually every top-tier medical and GI journal, including New England Journal of Medicine, Annals of Internal Medicine, Lancet, and GASTROENTEROLOGY. His work has had a tremendous impact on clinical care. He has published more than 220 papers in peer-review journals and 19 book chapters, and he was an editor of the 3rd and 4th editions of Yamada s Textbook of Gastroenterology. Loren is a gifted writer and editor from whom a first draft is almost always the finished product. Involvement in the For more than 20 years, Loren has provided extraordinary service to the, most especially through his work on the Council and his impact on DDW. He served as vice-chair and chair of 2 sections: the Esophageal, Gastric and Duodenal Disorders Section ( ) and the Clinical Practice Section ( ). In recognition of his leadership and diplomacy, he was elected to serve as chair-elect and chair of the Council from 2002 to He served on the Governing Board from 2000 to 2002 and again from 2003 to Loren has had numerous other roles in the, including course director of the 1995 Postgraduate Course at DDW, Leadership Cabinet, associate editor of GASTROENTEROLOGY, the Research Task Force, the Education and Training Committee, and the Undergraduate Teaching Project. He has had a special interest in guideline development, serving on the s Guideline Development Task Force from 2006 to 2007 and again last year. Through these experiences, Loren has gained valuable perspective on the that will serve him well during his presidency. Professional Career Outside the At the USC School of Medicine, Loren was an instant success and rose through the ranks, receiving

4 May tenure in 1991 and becoming a professor of medicine in There he served as director of endoscopy (from 1990) and associate director of the Division of Gastrointestinal and Liver Diseases (from 1992) and as chief of gastroenterology at LA County USC Medical Center from In 2009 he became associate chair in the Department of Medicine of the USC School of Medicine, and in 2010 he became chief of staff of LA County USC Healthcare Network. Loren also has served as a member of the American Board of Internal Medicine Gastroenterology Subspecialty Board from 1997 to 2003 and as a GI training program reviewer for the Accreditation Council for Graduate Medical Education from 1994 to 1999, and he was active in the American Federation for Clinical Research (Western Section). Apart from his extensive work with the, Loren has also worked with the other GI societies as well. For the American Society for Gastrointestinal Endoscopy (ASGE) he served on the Technology Assessment Committee, the Scientific Program Committee, and the Budget and Finance Committee and as associate editor of Gastrointestinal Endoscopy. With the American College of Gastroenterology (ACG), he worked on the Research Committee and on the development of guidelines and consensus recommendations as well as educational programs. He has served as a grant reviewer for the National Institutes of Health, VA, and Gates Foundation. He was an Agency for Healthcare Research and Quality panel member as well as a member of the Food and Drug Administration GI Advisory Committee. Loren is known for his outstanding lectures. For the past 20 years he has been a fixture at the annual Postgraduate Course and a frequent lecturer at the ASGE and ACG postgraduate courses. He has served as a visiting professor or invited lecturer at more than 100 medical schools and has given a similar number of invited lectures at national and international scientific meetings. He has been honored with clinical research awards from the and ACG and with named lectureships at a variety of institutions and organizations, including the national meetings of the, ACG, Canadian Association of Gastroenterology, and South African Gastroenterology Society. Notwithstanding his incalculable contributions to research and education, Loren is first and foremost an outstanding clinician. As a full-time physician at the Los Angeles County Hospital for 27 years, Loren was in the trenches providing care on a daily basis to the indigent and underserved of Los Angeles. It may be said without exaggeration that Loren was an institution at USC, where he was beloved by his students, residents, fellows, and colleagues for his clinical care, his compassion, his teaching, and his mentorship. It therefore came as a surprise to everyone when, last year, Loren decided to accept a new position as professor of medicine and director of clinical research at the Yale University School of Medicine. A major impetus for Loren s move east was his desire to focus more of his time on Figure 2. Loren and Nancy at their wedding rehearsal dinner. clinical research and especially on the mentorship of others. Another reason to relocate was the wish of Loren s wife, Nancy, to return to her native East Coast. Provided this Southern California boy can adapt to the New England winters, we have no doubt his legacy as a teacher, clinical researcher, and mentor will continue to grow. Personal Life The international recognition of Loren s work led to invitations to speak and travel around the world. Although he loved the travel, the food, the exploration of new and exotic places, and the opportunity to make new friends, his greatest joy and adventure was yet to be experienced. In 1999, while sitting with one of us (M.B.F.) at dinner during a GI meeting in Switzerland, this inveterate 45-year old bachelor was introduced to Nancy Carberry, a beautiful and elegant woman who was in charge of GI research and analysis for Astra Merck. Their relationship blossomed, and in 2002 they were married (Figure 2). Nancy moved from Philadelphia to Los Angeles to work as a vice-president at Warner Brothers Studios. An animal lover, Nancy developed an interest in dog rescue, specifically German Shepherds. Hannah, their first shepherd, became such a fixture in their lives that they subsequently adopted three more who live permanently with them (Figure 3), and they have rescued and re-homed dozens more.

5 1244 GASTROENTEROLOGY Vol. 142, No. 5 Figure 3. Loren, Nancy, and the dogs. Loren as President As President, Loren is looking forward to the challenges and, we are certain, to great successes that have heretofore marked his distinguished career. He is blessed with charisma, grace, vision, integrity, and a superb organizational ability that will bring excitement, energy, and dignity to the. As a distinguished clinician, scientist, and educator, he will represent the diverse interests of the membership in a fair, thoughtful, and balanced manner. His extensive background of service within and outside the provides a strong foundation on which to build and lead. The science and practice of gastroenterology is facing an increasing number of external challenges that may reshape our profession in unforeseen and possibly undesirable ways. In facing these challenges, it is imperative that the GI societies move forward together on issues of mutual interest in patient care, practice, research, and education. Loren recognizes the importance of preparing for the impact of health care reform on gastroenterology, advocating for GI practitioners and researchers, enhancing education and training during fellowship and beyond, and developing evidence-based guidelines, clinical decision tools, and quality measures for use by physicians and payers. Loren s long record of cordial and collaborative involvement will help continue to foster and accelerate closer connections between the and the ASGE, ACG, and American Association for the Study of Liver Diseases to better serve the interests of all of us, practitioners and scientists alike. We believe there is nobody more qualified or more capable of leading this great organization. M. BRIAN FENNERTY Division of Gastroenterology Oregon Health and Science University Portland, Oregon KENNETH MCQUAID Department of Medicine University of California, San Francisco San Francisco, California Conflicts of interest The authors disclose no conflicts by the Institute /$36.00 doi: /j.gastro