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Leading menopause researcher talks career highlights, challenges
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Wulf H. Utian, PhD, DSc (Med), FRCOG, FACOG, FICS, executive director emeritus and honorary founding president of The North American Menopause Society, is celebrating the 28th annual meeting this week in Philadelphia.
Utian, a pioneer in menopause research, has served as the editor of Menopause and is the Arthur H. Bill professor emeritus of reproductive biology at Case Western Reserve School of Medicine and a consultant in gynecology and women’s health at the Cleveland Clinic.
He performed the world’s first surrogate in vitro fertilization procedure in 1984 in Cleveland.
Utian spoke with Endocrine Today about his vivid career and his upcoming book.
What has been the most exciting advance you’ve been a part of and how has that shaped your career?
Utian: There have been two. One, of course, has been in vitro fertilization. My team was the third successful program in the States. I was trained and grew up in South Africa and moved to the States in July 1976 on sabbatical and stayed as head of reproductive endocrinology and infertility at University Hospitals of Cleveland, Case Western Reserve. I had been interested in IVF for a long while, and we had a basic scientist who was fertilizing mouse eggs by the thousands. I asked if we could try humans, and he said, “Fine.” But when I went to the department head, he said, “Nope. It’s a gimmick. It’s never going to go anywhere. University Hospitals won’t allow you to do this.” So, I left, and I lost several years, otherwise we would have been first.
That aside, doing the actual developing, what I call the recipe for IVF, was incredibly exciting. I’m what most people describe as a clockmaker, not a time keeper, so once we got the formula running, I trained other people and moved on.
The other thing that shaped my career has been my interest in the field of menopause. That goes back to my first or second year as a resident in OB-GYN in South Africa. I was asked to review a paper by Robert A. Wilson, MD, that was called, “Estrogen Forever: From the Cradle to the Grave.” There were a lot of narrative claims about anti-aging, etc, which also led to his book in the mid-60s, Feminism Forever. So, I reviewed that and became interested in it as I felt the claims were unproven but warranted investigation . I was 25 when I finished my residency, so I didn’t want to go into private practice. I wanted an academic career and started a PhD program, and looking around for a subject, I thought, there was a lot of narrative stuff about menopause, but was there any proof to it?
I started a research clinic at Groote Schuur Hospital, the University of Cape Town teaching hospital in 1967. That year, Christiaan Neethling Barnard did the world’s first heart transplant, and with him getting all the attention and people putting money into the hospital, I was suddenly getting as much money as I wanted for research.
So, I started a menopause research clinic, which I didn’t realize at the time was the first menopause research clinic in the world. In 1970, when I was now publishing the results out of the clinic and had completed my PhD, I was invited to Geneva by the International Health Foundation. There I started an amazing friendship with Pieter van Keep, the Director General, who took me on a pub crawl around Geneva. He had done a PhD earlier on the social aspects of menopause, and mine was on the metabolic and clinical effects of menopause. We realized that we were yin and yang.
There weren’t too many people around the world doing any research on menopause, only about 15 to 20 real researchers at the time, so we started a menopause club in the early 1970s, under the auspices of the International Health Foundation. Each year we published the proceedings on the current state of researched in menopause. By 1975 to 1976 we realized that with the interest growing, we could have an international meeting, and at that meeting we decided to form the International Menopause Society. During that time, I traveled the world, helping between 25 and 30 countries start their own menopause societies, and by 1987-88 it became an embarrassment that there were menopause societies all over the world, but nothing in the U.S. I tried to get interest here, but no one was interested. So I decided to do it on my own, creating a non-profit medical organization in 1988 and had the first meeting in ’89 in partnership with the New York Academy of Sciences.
What has been the greatest challenge in your professional career?
Utian: Again, I think there are two. I started my career in apartheid South Africa, and it was very difficult working in that system. When I was a young faculty member, I had fallen out with the government and that was the reason we moved to the U.S. My confrontation with the apartheid system had hit the world press and it was very concerning to myself and to my family. I had two small children at the time and was concerned for their safety and their futures.
My second challenge was really accommodating to a different way of practicing medicine. The British/European style of medicine, when I came in to Cleveland in ’76, was an entirely different form of practice of medicine to what I found in the U.S. I would say that in British/European medicine, we practiced from the bottom up, and American medicine was being practiced from the top down. What I mean by that is that we would take a detailed history and detailed medical examination and we would write down potential differential diagnoses of what the patient had, and then based on that, we would select a very few tests. We were practicing a cost-effective medicine. When I came to the States, I discovered a lot of the practice was to run a whole battery of tests, and then if you find an abnormal result, to work down from there to what the potential diagnosis is. That was a very expensive and more cumbersome way of practicing medicine, and to me, that was a challenge. The other thing was a that I wasn’t used to the litigious atmosphere in the U.S. In fact, my liability insurance in South Africa cost me $50 a year and it was for unlimited liability, worldwide, except the U.S.
What do you think will have the greatest influence on your field in the next 10 years?
Utian: It’s not going to be the science. I think it’s going to be a couple of things. One is the anti-science, anti-women’s health attitude that is pervasive, not only among a lot of the population, but essentially, at this point of time, in the government itself. I think this narrow, unscientific, ignorant way of thinking is going to have a very negative outcome on the development of how we deliver health care to women. It’s going to have a big influence.
The other is the health insurance industry and the costs of medications and drugs and procedures. The whole costing system in our health system is completely discombobulated. There needs to be a major restructure in terms of improving on the way health insurance is delivered. I’m not speaking against Obamacare. I think Obamacare offers a lot, but the resistance of government to actually correct what was wrong with it is the problem. I don’t think we need to get rid of it, I think we need to fix it. I think people have to stop playing politics, and they have to start realizing that we’re dealing with people’s health and quality of life.
Because you have been such a prominent person in your field, what has your platform meant to you and how has it enriched your career?
Utian: It’s been fascinating because you get to a point where your name becomes well-known. People don’t know you per se, but they know your name, so you can write articles, you can write editorials, you can have a real influence on the whole system of health care. My career has really been enriched by that fact. It blows me away that starting from two guys pub crawling in 1971, and 45 years later, we’ve influenced billions of women’s lives by what we’ve put together. It’s been amazing, but it’s also been self-satisfying and mostly it’s the satisfaction of knowing that people can set their mind to things in order to enhance quality of life and health. It comes back to the previous question, in that I wish the government would realize that what they do is crucial to everyone’s health.
Another way it has really influenced my life is that by setting up these organizations around the world and traveling all over the world, I gained a lot. That’s really one of the benefits of academic medicine. During all my teaching of residents and medical students, I’ve always said to them, think seriously about an academic career because you may never make the money you would make at a private practice, but your life, your career will be so much richer because you’ll travel the world, you’ll meet people, you’ll learn new cultures, you’ll have an impact on people’s health all around the world, and most importantly, you’ll make many friends. At this point, I can say I have at least one good friend in almost every capital of the world.
What are your hobbies/interests outside of work?
Utian: They’ve obviously changed a lot. Writing is a hobby — well, it’s more than a hobby for me. When I stopped seeing patients a few years back, I got seriously into writing. I’ve written a few nonfiction books. I learned about problem-solving as a department chairman and while managing university departments, and I turned that into a book, The Utian Strategy - Is This Your Problem Or Is This My Problem? I also traced my family roots, and what I discovered was completely different than what I knew. I published that in a book called Finding the Unexpected and then, of course, I’ve done books on menopause. Now I’m currently working on a book that brings in another part of my interests. My family and I spend a few months a year in South Africa, at the absolute tip of South Africa, called the Western Cape. It’s one of the most beautiful places in the world with mountains, oceans, valleys and farmland. We’re adventurous, so we tour the little villages, and we speak to people, and we taste the local delicacies. I’ve been making notes and taking pictures, so that will be my next book. It will be about these places in the Western Cape. Hiking is my other hobby, especially in that part of the world. There are so many mountains and indigenous forests. And I suppose, finally, I’m an erratic golfer. – by Cassie Homer