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Ode to a fallen giant
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Ernie Beutler is dead, and hematologists and oncologists have lost a very special voice in our discipline. Even a recent thoughtful New York Times obituary could not fully encompass Ernie’s major contributions to clinical science, and certainly was unable to capture the man’s generous and compassionate persona. So let me add some additional thoughts about his clinical good works while providing a few personal comments about him and his family.
The NY Times piece, although thorough, neglected at least three of Ernie’s early contributions. The first I refer to regularly in my rounds with medical students, residents and even hematology/oncology fellows. I was hardly out of fellowship myself when I learned of his simple but seminal study of “tired women.” This work — a pioneer endeavor in blinded randomized trials — demonstrated that the provision of iron supplements to easily fatigued yet nonanemic women significantly improved their symptoms as compared to untreated matched individuals. These results, generated well before accurate assessments of body iron deficits were available, have guided hematologists’ advice to millions of haggard mothers in the past half-century.
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I also emphasize Ernie’s absolute primacy in unraveling the Primaquine-mediated hemolysis suffered by black-American soldiers during the Korean “police action.” Jim Jandl and my interest in red cell sulfhydryl metabolism was fostered by Ernie’s insightful, and well published, march from Heinz bodies, to glutathione instability, to global G6PD-mutations. But my most vivid recollection of his scientific contributions — that were always validated by rigorous science and superbly presented at national meetings — involved one of his presentations at the Atlantic City meetings about 40 years ago. Hardly any of the roughly two thousand clinical scientists at that year’s plenary session knew a thing about the “Lyon Hypothesis.” Within 15 minutes we understood it and reveled at the aesthetically pleasing proof of its validity; a proof projected by a simple (noncomputer-generated) lantern slide. No question about it: Roughly half of oxidant-exposed red cells from a G6PD hemizygotic mother of a “Primaquine-sensitive” son were filled with methemoglobin (assessed by the K/B stain), while the other half had resisted oxidation.
It is distressing to recall that Ernie’s last plenary session contribution was given just 11 months ago at our ASH Annual Meeting. Because of his illness, his coauthor and son, Bruce, gave the paper — a paper, yet again superbly presented — elucidating the most intricate pathways that regulate hepcidin synthesis, an elucidation that generates exciting new insights into clinical states such as hemochromatosis and inflammation-mediated anemia.
Speaking of Bruce Beutler, the legacy of Ernie’s science is only eclipsed by his and Bonnie’s success in the parenting of Bruce (and presumably their other children). Bruce was recently elected to the National Academy of Sciences, thereby providing the Academy with a unique father-son tag team of spectacular scientific accomplishment. Bruce shares his father’s humility, generosity of spirit and genius. I have been privileged to have counted Ernie, Bonnie and Bruce as friends and join all hematologists in sending our thanks to the family for sharing Ernest Beutler with us, albeit for too short a time.