Dr. John M. Carethers, recently elected to the American Society for Clinical Investigation, in discussion with a medical studentThis year, Dr. John M. Carethers, Professor of Medicine and Chief of the Division of Gastroenterology, was honored with election to the American Society of Clinical Investigation (ASCI).

ASCI membership is granted to a select number of physician-scientists who have made extraordinary contributions in patient care and research before the age of 45.“John epitomizes the ideals of the ASCI – academic scholarship, teaching and clinical medicine,” says Ken Kaushansky, M.D., Helen M. Ranney Professor and Chair of the Department of Medicine.

“He is one of the true triple threats at UCSD, and all should aspire to achieve John’s high standards and accomplishments.”Dr. Carethers is a groundbreaking cancer researcher and a highly respected educator who has won teaching awards from housestaff, fellows, and the Vice Chancellor. He is the youngest division chief in the Department of Medicine.

Since he became chief in 2004, Dr. Carethers has expanded the faculty and secured several major grants, including the division’s first NIH Center grant for a Digestive Diseases Research Development Center.

In a recent interview, he looked back to his earliest steps on the path to this fruitful career, and to the upbringing that set him in this direction.

“My parents believed in education”

John M. Carethers was raised in Detroit, third youngest of 12 children.

“My parents believed in education, and they sacrificed a lot to get us educated,” he says. “They took care of us down to their last penny.”

His father, the only African-American student in his college, graduated in 1948 with a degree in mechanical engineering. At the time, companies in Detroit did not hire African-American engineers. He took a job with the Detroit Water and Sewage Department and worked his way up through the ranks.

On a modest income, John’s parents devoted themselves to providing the structure and the opportunities that best suited each of the children, one of whom was disabled.

“We were all different,” he says. “Different personalities, different strengths.”

All of John’s siblings attended parochial school and adhered to a schedule during their hours at home. Television was reserved for weekends. There were dedicated time periods for homework and for play.

As a child, he knew he wanted to be a doctor.

It Started with an Encyclopedia

Asked when he first became interested in medicine, Dr. Carethers says promptly, “Age 7.”

This was when his parents purchased the Encyclopaedia Britannica. The new books came with a requirement for summer projects: each child must make a weekly presentation on a topic of his or her choice at the Sunday afternoon meal.

Finding himself with the “A” volume, John discovered the section that depicted the human body. He remembers the wonder he experienced as he studied the colored overlays that superimposed muscles over organs over bones.

“Anatomy,” he says, smiling broadly. “Physiology. That was it. I knew I wanted to be a doctor.”

On summer Sundays, at the family table, the children gave their presentations. One of his brothers discussed flags; a sister talked about other cultures. John Carethers, age 7, presented the organ systems of the body.

He went to parochial school until high school, when he transferred to a magnet public high school in Detroit. There, he took college preparatory courses in physics, biology, and organic and inorganic chemistry.

In his college job as a unit clerk at Detroit Children’s Hospital, he had
his first chance to see medicine from the inside.

He covered several paper routes and he tirelessly cultivated a neighborhood clientele for his lawn mowing and snow shoveling services. When he started college, he had saved three thousand dollars.

For the first two years of college, per the family rule, he took public transportation and worked his way through his college courses. Then he purchased a car – for cash.

Although he was certain he wanted to become a doctor, he couldn’t imagine himself as a physician in practice. He had never seen what that life, and the path to it, was like.

First glimpse of medical practice

Then he took a job as a unit clerk at Children’s Hospital in Detroit during college.

“For three and a half years,” he says, “I published the OR schedule, made sure the operating doctors had privileges, and recorded the post-anesthesia charts in the computer. I met pediatric surgeons and I got to watch surgeries.”

It was his first inside look at medical practice, and it equipped him to envision his own future.

Although he considered becoming a pediatric surgeon,
“the real diagnosticians are the internists.
That was what interested me.”

Initially, he thought he would become a pediatric surgeon himself. When it came time for his third-year surgery rotation in medical school, however, one of his younger brothers came home with chicken pox and infected the others.

That and a postviral syndrome kept Dr. Carethers from immersing in his surgery rotation as he might have done. He did well in it, but by the time the rotation ended, his interest had expanded to other areas of medical practice.

“I thought about it,” he said, “and I felt the real diagnosticians are the internists. That was what interested me.”

During his residency in internal medicine at Massachusetts General Hospital, he determined that he would specialize in gastroenterology. He completed his fellowship training in gastroenterology at the University of Michigan Hospitals and joined the UC San Diego faculty in 1995.

Contributions in cancer research and policy

In the last 10 years, Dr. Carethers and his collaborators have made major discoveries in colon cancer. One of their most significant findings is that patients whose tumors have lost the capacity for DNA mismatch repair are resistant to chemotherapy with 5-fluorouracil, a common anticancer drug. Three other independent research groups have confirmed these findings.

Dr. Carethers and his coworkers demonstrated that this defect is present in 20% of people who have sporadic colon cancer, and in all families who have the hereditary colon cancer that is known as Lynch syndrome.

As a member of an NIDDK commission,
he helps to set national funding priorities for gastroenterology research.

Dr. Carethers is one of 16 appointed members of the National Commission on Digestive Diseases, which was proposed by the American Gastroenterological Association (AGA) and formed by the Director of the National Institutes of Health (NIH) in 2005. The mission of the NCDD is to assess the state of GI research and map out a 10-year plan to accomplish the most promising and pressing research goals.

The Commission advises the NIH Director and Congress, and thus exerts a direct influence on the allocation of federal research funding for GI research projects.

“No one has examined this for 20-30 years,” Dr. Carethers says. The Commission’s next report is due out this summer.

He also holds a two-year position as Vice Chair of the Gastrointestinal Oncology Section of the AGA. In this capacity, he reviews abstracts submitted for the annual AGA meeting. UC San Diego will serve as a host institution as this year’s AGA meeting, known as Digestive Disease Week 2008, convenes in San Diego.

Inspiring and supporting students and trainees

Today, creating ways to inspire young, motivated students is a priority for Dr. Carethers. This has inspired him to work in support of the Preuss School, UC San Diego’s charter middle and high school.

“There are students in the Preuss School who might never have gone to college if they had gone to local schools. But they come to Preuss and see that things could be different. They’re exposed to things they never knew existed.

“We have Preuss students go on to UCSD, Harvard, and other universities,” he says. “I think that’s fantastic.”

“Some people, if they’re given an opportunity, will take the ball and run with it.”

Supporting his gastroenterology students and faculty members in their development is important to him as well. He is proud of the training grant that provides protected time for Gastroenterology trainees to do research; he is delighted that the grant has just won a 5-year renewal.

“That’s how I came along,” he said. “I wouldn’t be where I am if I hadn’t had that time to develop.”

He has also established a permanent GI Division Research and Junior Faculty Development Committee to school senior fellows and junior faculty in the UC San Diego promotion process.

“It’s designed to help them navigate the academic process more smoothly,” he says. “No one tells you this stuff.”

In 2006, he received the UC San Diego School of Medicine Vice Chancellor’s Award for Mentoring Excellence.

He speaks warmly of his own mentor, C. Richard Boland, who was Chief of Gastroenterology from 1995 to 2003. Dr. Boland is now at Baylor in Dallas.

“He’s my mentor and friend for life,” he says.

“Through education, we had opportunities”

Dr. Carethers recalls the efforts of his parents, whose values carry on in him and in his siblings.

“Through education, we had opportunities,” he says. “If someone never has the opportunity, they have no idea what they’re missing. Some people never achieve because they never got the opportunity.

“But some people, if they’re given an opportunity, will take the ball and run with it.”

Today, 11 of the 12 Carethers children are college graduates. Among them, they have 21 college degrees.

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