Hooked on Rheum with Karen H. Costenbader, MD, MPH
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The apple doesn’t fall far from the tree. My dad was an orthopedist and my mom was an academic psychologist. If you cross those two, you get a rheumatologist.
I was always attracted to biology, but when I arrived at medical school, I became really fascinated by immunology. I recall my first case of a young woman with lupus. The idea of autoimmunity intrigued and horrified me at the same time. How does this happen to a young person like this, where suddenly her immune system turns on her? It had a profound impact on me because I was about the same age as the patient at that time. It made me wonder whether there are things some of us have been exposed to that might precipitate this condition. I also started to wonder if there was a way to intercept the immune system before the disease took off.
I was also very interested in renal pathophysiology and, after medical school, I spent a year in a laboratory doing nephrology basic research. The idea of doing basic science attracted me, but when I actually started doing it, I did not have the patience for it. My podocytes in sterile culture kept getting infected and I had to restart my experiments several times! It was a bit frustrating.
At that point, I decided I would try clinical research. I went into rheumatology after my residency at Massachusetts General Hospital and found that I was still interested in all of those questions, particularly about lupus. Why does it happen to young women? Why does it happen to non-white, non-European women? As I continued to explore these questions, I was introduced to epidemiology as well as clinical and translational research.
A great thing about rheumatology is that it has allowed me a combination of asking clinical research questions and seeing patients who prompt these questions, which brings me to another reason I love the specialty: I have a fantastic patient population. I have been doing rheumatology long enough that I have grown up with many of my patients. I’ve seen many of the same people for years, and gotten to know about their families — and they know about mine. This is a wonderful aspect of rheumatology. I’ve also been able to volunteer for the Lupus Foundation of America, and meet and work with patients, scientists, clinicians and advocates across the country, which has been a great experience.
Finally, I would like to mention and thank a number of mentors along the way. Abul Abbas, MD, taught immunology at medical school and sparked an interest in that subject. Julian Seifter, MD, was my nephrology professor in medical school and is still at Brigham and Women’s Hospital, and still a fantastic teacher. Hasan Bazari, MD, was a mentor during medical residency and Karen Atkinson, MD, was a mentor during my rheumatology fellowship. Matt Liang, MD, Beth Karlson, MD, and Michael Weinblatt, MD, were wonderful mentors in Brigham rheumatology — they have since become great colleagues.
Karen Costenbader, MD, MPH
Director, Lupus Program
Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital
Professor of Medicine, Harvard Medical School
Chair, Medical and Scientific Advisory Council, Lupus Foundation of America