Profiles in Rheumatology: Dr. David Wofsy

A career in medicine snuck up on Dr. David Wofsy. After graduating from Harvard with a degree in mathematics in 1968, his mind was occupied by the large moral issues of the day.

As the son of a labor-organizer father and social-worker mother who were hounded by the late Sen. Joseph R. McCarthy and the House on Un-American Activities Committee, Dr. Wofsy knew that one’s stand on important social matter might come at a price. And he paid it.

Inspired by the teachings and writings of the Rev. Dr. Martin Luther King, Dr. Wofsy applied for and was granted conscientious objector status during the time of the American involvement in Vietnam. Medicine’s appeal became clearer to him while he was performing his alternative service in the emergency room at the Los Angles County Hospital.

After graduating from medical school at the University of California at San Diego, Dr. Wofsy was a resident in internal medicine at the University of California at San Francisco, where he encountered what turned into his life’s work, he said in an interview.

"I was deeply moved by several young patients whom I met during my residency, who were dealing with life-threatening autoimmune diseases, especially systemic lupus. I also believed that the rapid pace of progress in immunology and biotechnology were likely to lead to exciting advances in rheumatology during the course of my career. I wanted to be part of that excitement."

That promise of impending clinical breakthroughs stayed with Dr. Wofsy through his rheumatology fellowship. Yet the frustrations with the clinical realities remained.

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them. When things are going well in our research, the excitement of discovery is all the motivation we need. However, when things are going poorly, it is the memory of those patients that compels us to keep trying."

Dr. Wofsy has remained at the UCSF, where he now holds the George A. Zimmermann Distinguished Professorship and is professor of medicine and microbiology and immunology. He was director of the rheumatology training program there from 1992-2006.

Dr. Betty Diamond, his long-time colleague, "I have known David well for 15 or more years, been a friend and collaborator. Our current clinical trial is one that we conceived in 2000, wrote a proposal for in 2001 and enrolled our first patient in 2007, so he certainly has patience.

"He is an avid Giants fan (the San Francisco Giants, not the New York Giants) and uses Barry Bonds to exemplify the concept of biomarkers (biceps for steroids). He is deeply committed to training, patient care, and integrity," said Dr. Diamond, professor of medicine and microbiology at the Feinstein Institute for Medical Research in New York, speaking in an interview.

According to one of his former fellows, Dr. Maria Dall’Era, happening upon him in the course of her training shaped her career.

"I joined the rheumatology fellowship program at UCSF in 2001 and began working closely with Dr. Wofsy as his mentee in 2002. Dr. Wofsy has been my mentor ever since, and it is because of his guidance, support, and leadership that I have been able to pursue a career in academic rheumatology at UCSF. I am currently associate professor of medicine at UCSF and I am director of the UCSF Lupus Clinic and [Rheumatology] Clinical Research Center. I can honestly say that I would not have achieved my success at UCSF if it were not for Dr. Wofsy."

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them," said Dr. Wofsy.

Asked about his own place in lupus research after decades at the task, Dr. Wofsy reflected that: "Within the lupus world, there are better basic scientists than I ever will be; there are better clinical scientists than I ever will be; there are better clinicians than I ever will be; and there are better teachers than I ever will be. To the extent that I have been able to contribute, it may be primarily as a translator in an era of translational research. Because I spent years doing bench research before devoting myself fully to clinical research, I speak both languages. That turns out to be an important niche that helps to make the most of the hard work and accomplishments of others."

While Dr. Wofsy may be modest about his own contributions to lupus research, those who have spent time with him beg to differ.

Dr. Dall’Era noted that "Dr. Wofsy is the quintessential physician/scientist who excels in every aspect of his work. He has an extensive knowledge of basic immunology from his years in the lab working with murine models of lupus, and he has become a leading international figure in the design and execution of clinical trials in lupus. His vision and creativity were critical in the development of the [UCSF] division of rheumatology clinical trials center in which several important clinical trials of novel agents for the treatment of autoimmune diseases were conducted. His knowledge of basic science and clinical rheumatology enables him to design clinical trials that serve to address clinical questions of efficacy as well as more basic questions about the mechanism of action of the drug being studied," Dr. Dall’Era said.

"Most important, Dr. Wofsy is a compassionate and caring person who always places other people’s interests in front of his own. He is an extremely generous mentor who has given me every opportunity to be the lead author on manuscripts and to participate in various projects and clinical trials in a leadership position. In his humble manner, he is always quick to give me credit for work and downplay the work and skills that were needed on his part to create the opportunity for me in the first place," according to Dr. Dall’Era.

Dr. Wofsy credits his own fellowship director with having a great influence. "Bill Seaman was my fellowship director. I still aspire to match the qualities that Bill modeled for his fellows – intellectual honesty, modesty, compassion, and selflessness. The two lessons I learned from Bill that have always mattered most to me are: the most important quality a physician can have is to be a good human being; and it is always OK to say ‘I don’t know’ as long as the next sentence is ‘Let’s find out.’ Words to live by."

While president of the American College of Rheumatology from 2003-2004, Dr. Wofsy continued work begun by earlier ACR leaders to increase the supply of rheumatologists to meet an anticipated shortage. In addition, Dr. Wofsy’s presidency placed emphasis on "establishment of principles and strengthening of procedures designed to ensure that the ACR set the standard among professional societies for integrity and freedom from conflict of interest. It is an appropriate source of pride for the organization that its leadership in this area is widely recognized."

Rheumatology is in the midst of a demographic sea change. "A remarkable thing is about to happen in our subspecialty. In the course of a single generation, the profession will go from being overwhelmingly male to being predominantly female," he said. "We all have a responsibility to insure that that change is reflected at all levels of the profession, including especially in the leadership of our academic programs and our professional society. The ACR has been successful in the past at seeing the future and getting ahead of it. This kind of dramatic social transformation is probably the greatest challenge yet. The ACR needs to be proactive in this area by developing a strategy to insure that there are rewarding career paths available to women in rheumatology and that women have a leadership role in preparing for this future. A simple first step would be to set some goals regarding division and ACR leadership and then to monitor success in achieving these goals."

When asked what inspires him these days, Dr. Wofsy cited the applications for UCSF medical school that he reads in his position as associate dean for admissions. "Reading the applications from the next generation of physicians, and meeting the new students each year, is very inspiring. I recommend this role to everyone. It is the best way to remain inspired and optimistic about the future. Having children – I have three – helps, too."

Sally Koch Kubetin is managing editor of Rheumatology News. You may contact her at rhnews@elsevier.com.

A career in medicine snuck up on Dr. David Wofsy. After graduating from Harvard with a degree in mathematics in 1968, his mind was occupied by the large moral issues of the day.

As the son of a labor-organizer father and social-worker mother who were hounded by the late Sen. Joseph R. McCarthy and the House on Un-American Activities Committee, Dr. Wofsy knew that one’s stand on important social matter might come at a price. And he paid it.

Inspired by the teachings and writings of the Rev. Dr. Martin Luther King, Dr. Wofsy applied for and was granted conscientious objector status during the time of the American involvement in Vietnam. Medicine’s appeal became clearer to him while he was performing his alternative service in the emergency room at the Los Angles County Hospital.

After graduating from medical school at the University of California at San Diego, Dr. Wofsy was a resident in internal medicine at the University of California at San Francisco, where he encountered what turned into his life’s work, he said in an interview.

"I was deeply moved by several young patients whom I met during my residency, who were dealing with life-threatening autoimmune diseases, especially systemic lupus. I also believed that the rapid pace of progress in immunology and biotechnology were likely to lead to exciting advances in rheumatology during the course of my career. I wanted to be part of that excitement."

That promise of impending clinical breakthroughs stayed with Dr. Wofsy through his rheumatology fellowship. Yet the frustrations with the clinical realities remained.

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them. When things are going well in our research, the excitement of discovery is all the motivation we need. However, when things are going poorly, it is the memory of those patients that compels us to keep trying."

Dr. Wofsy has remained at the UCSF, where he now holds the George A. Zimmermann Distinguished Professorship and is professor of medicine and microbiology and immunology. He was director of the rheumatology training program there from 1992-2006.

Dr. Betty Diamond, his long-time colleague, "I have known David well for 15 or more years, been a friend and collaborator. Our current clinical trial is one that we conceived in 2000, wrote a proposal for in 2001 and enrolled our first patient in 2007, so he certainly has patience.

"He is an avid Giants fan (the San Francisco Giants, not the New York Giants) and uses Barry Bonds to exemplify the concept of biomarkers (biceps for steroids). He is deeply committed to training, patient care, and integrity," said Dr. Diamond, professor of medicine and microbiology at the Feinstein Institute for Medical Research in New York, speaking in an interview.

According to one of his former fellows, Dr. Maria Dall’Era, happening upon him in the course of her training shaped her career.

"I joined the rheumatology fellowship program at UCSF in 2001 and began working closely with Dr. Wofsy as his mentee in 2002. Dr. Wofsy has been my mentor ever since, and it is because of his guidance, support, and leadership that I have been able to pursue a career in academic rheumatology at UCSF. I am currently associate professor of medicine at UCSF and I am director of the UCSF Lupus Clinic and [Rheumatology] Clinical Research Center. I can honestly say that I would not have achieved my success at UCSF if it were not for Dr. Wofsy."

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them," said Dr. Wofsy.

Asked about his own place in lupus research after decades at the task, Dr. Wofsy reflected that: "Within the lupus world, there are better basic scientists than I ever will be; there are better clinical scientists than I ever will be; there are better clinicians than I ever will be; and there are better teachers than I ever will be. To the extent that I have been able to contribute, it may be primarily as a translator in an era of translational research. Because I spent years doing bench research before devoting myself fully to clinical research, I speak both languages. That turns out to be an important niche that helps to make the most of the hard work and accomplishments of others."

While Dr. Wofsy may be modest about his own contributions to lupus research, those who have spent time with him beg to differ.

Dr. Dall’Era noted that "Dr. Wofsy is the quintessential physician/scientist who excels in every aspect of his work. He has an extensive knowledge of basic immunology from his years in the lab working with murine models of lupus, and he has become a leading international figure in the design and execution of clinical trials in lupus. His vision and creativity were critical in the development of the [UCSF] division of rheumatology clinical trials center in which several important clinical trials of novel agents for the treatment of autoimmune diseases were conducted. His knowledge of basic science and clinical rheumatology enables him to design clinical trials that serve to address clinical questions of efficacy as well as more basic questions about the mechanism of action of the drug being studied," Dr. Dall’Era said.

"Most important, Dr. Wofsy is a compassionate and caring person who always places other people’s interests in front of his own. He is an extremely generous mentor who has given me every opportunity to be the lead author on manuscripts and to participate in various projects and clinical trials in a leadership position. In his humble manner, he is always quick to give me credit for work and downplay the work and skills that were needed on his part to create the opportunity for me in the first place," according to Dr. Dall’Era.

Dr. Wofsy credits his own fellowship director with having a great influence. "Bill Seaman was my fellowship director. I still aspire to match the qualities that Bill modeled for his fellows – intellectual honesty, modesty, compassion, and selflessness. The two lessons I learned from Bill that have always mattered most to me are: the most important quality a physician can have is to be a good human being; and it is always OK to say ‘I don’t know’ as long as the next sentence is ‘Let’s find out.’ Words to live by."

While president of the American College of Rheumatology from 2003-2004, Dr. Wofsy continued work begun by earlier ACR leaders to increase the supply of rheumatologists to meet an anticipated shortage. In addition, Dr. Wofsy’s presidency placed emphasis on "establishment of principles and strengthening of procedures designed to ensure that the ACR set the standard among professional societies for integrity and freedom from conflict of interest. It is an appropriate source of pride for the organization that its leadership in this area is widely recognized."

Rheumatology is in the midst of a demographic sea change. "A remarkable thing is about to happen in our subspecialty. In the course of a single generation, the profession will go from being overwhelmingly male to being predominantly female," he said. "We all have a responsibility to insure that that change is reflected at all levels of the profession, including especially in the leadership of our academic programs and our professional society. The ACR has been successful in the past at seeing the future and getting ahead of it. This kind of dramatic social transformation is probably the greatest challenge yet. The ACR needs to be proactive in this area by developing a strategy to insure that there are rewarding career paths available to women in rheumatology and that women have a leadership role in preparing for this future. A simple first step would be to set some goals regarding division and ACR leadership and then to monitor success in achieving these goals."

When asked what inspires him these days, Dr. Wofsy cited the applications for UCSF medical school that he reads in his position as associate dean for admissions. "Reading the applications from the next generation of physicians, and meeting the new students each year, is very inspiring. I recommend this role to everyone. It is the best way to remain inspired and optimistic about the future. Having children – I have three – helps, too."

Sally Koch Kubetin is managing editor of Rheumatology News. You may contact her at rhnews@elsevier.com.

A career in medicine snuck up on Dr. David Wofsy. After graduating from Harvard with a degree in mathematics in 1968, his mind was occupied by the large moral issues of the day.

As the son of a labor-organizer father and social-worker mother who were hounded by the late Sen. Joseph R. McCarthy and the House on Un-American Activities Committee, Dr. Wofsy knew that one’s stand on important social matter might come at a price. And he paid it.

Inspired by the teachings and writings of the Rev. Dr. Martin Luther King, Dr. Wofsy applied for and was granted conscientious objector status during the time of the American involvement in Vietnam. Medicine’s appeal became clearer to him while he was performing his alternative service in the emergency room at the Los Angles County Hospital.

After graduating from medical school at the University of California at San Diego, Dr. Wofsy was a resident in internal medicine at the University of California at San Francisco, where he encountered what turned into his life’s work, he said in an interview.

"I was deeply moved by several young patients whom I met during my residency, who were dealing with life-threatening autoimmune diseases, especially systemic lupus. I also believed that the rapid pace of progress in immunology and biotechnology were likely to lead to exciting advances in rheumatology during the course of my career. I wanted to be part of that excitement."

That promise of impending clinical breakthroughs stayed with Dr. Wofsy through his rheumatology fellowship. Yet the frustrations with the clinical realities remained.

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them. When things are going well in our research, the excitement of discovery is all the motivation we need. However, when things are going poorly, it is the memory of those patients that compels us to keep trying."

Dr. Wofsy has remained at the UCSF, where he now holds the George A. Zimmermann Distinguished Professorship and is professor of medicine and microbiology and immunology. He was director of the rheumatology training program there from 1992-2006.

Dr. Betty Diamond, his long-time colleague, "I have known David well for 15 or more years, been a friend and collaborator. Our current clinical trial is one that we conceived in 2000, wrote a proposal for in 2001 and enrolled our first patient in 2007, so he certainly has patience.

"He is an avid Giants fan (the San Francisco Giants, not the New York Giants) and uses Barry Bonds to exemplify the concept of biomarkers (biceps for steroids). He is deeply committed to training, patient care, and integrity," said Dr. Diamond, professor of medicine and microbiology at the Feinstein Institute for Medical Research in New York, speaking in an interview.

According to one of his former fellows, Dr. Maria Dall’Era, happening upon him in the course of her training shaped her career.

"I joined the rheumatology fellowship program at UCSF in 2001 and began working closely with Dr. Wofsy as his mentee in 2002. Dr. Wofsy has been my mentor ever since, and it is because of his guidance, support, and leadership that I have been able to pursue a career in academic rheumatology at UCSF. I am currently associate professor of medicine at UCSF and I am director of the UCSF Lupus Clinic and [Rheumatology] Clinical Research Center. I can honestly say that I would not have achieved my success at UCSF if it were not for Dr. Wofsy."

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them," said Dr. Wofsy.

Asked about his own place in lupus research after decades at the task, Dr. Wofsy reflected that: "Within the lupus world, there are better basic scientists than I ever will be; there are better clinical scientists than I ever will be; there are better clinicians than I ever will be; and there are better teachers than I ever will be. To the extent that I have been able to contribute, it may be primarily as a translator in an era of translational research. Because I spent years doing bench research before devoting myself fully to clinical research, I speak both languages. That turns out to be an important niche that helps to make the most of the hard work and accomplishments of others."

While Dr. Wofsy may be modest about his own contributions to lupus research, those who have spent time with him beg to differ.

Dr. Dall’Era noted that "Dr. Wofsy is the quintessential physician/scientist who excels in every aspect of his work. He has an extensive knowledge of basic immunology from his years in the lab working with murine models of lupus, and he has become a leading international figure in the design and execution of clinical trials in lupus. His vision and creativity were critical in the development of the [UCSF] division of rheumatology clinical trials center in which several important clinical trials of novel agents for the treatment of autoimmune diseases were conducted. His knowledge of basic science and clinical rheumatology enables him to design clinical trials that serve to address clinical questions of efficacy as well as more basic questions about the mechanism of action of the drug being studied," Dr. Dall’Era said.

"Most important, Dr. Wofsy is a compassionate and caring person who always places other people’s interests in front of his own. He is an extremely generous mentor who has given me every opportunity to be the lead author on manuscripts and to participate in various projects and clinical trials in a leadership position. In his humble manner, he is always quick to give me credit for work and downplay the work and skills that were needed on his part to create the opportunity for me in the first place," according to Dr. Dall’Era.

Dr. Wofsy credits his own fellowship director with having a great influence. "Bill Seaman was my fellowship director. I still aspire to match the qualities that Bill modeled for his fellows – intellectual honesty, modesty, compassion, and selflessness. The two lessons I learned from Bill that have always mattered most to me are: the most important quality a physician can have is to be a good human being; and it is always OK to say ‘I don’t know’ as long as the next sentence is ‘Let’s find out.’ Words to live by."

While president of the American College of Rheumatology from 2003-2004, Dr. Wofsy continued work begun by earlier ACR leaders to increase the supply of rheumatologists to meet an anticipated shortage. In addition, Dr. Wofsy’s presidency placed emphasis on "establishment of principles and strengthening of procedures designed to ensure that the ACR set the standard among professional societies for integrity and freedom from conflict of interest. It is an appropriate source of pride for the organization that its leadership in this area is widely recognized."

Rheumatology is in the midst of a demographic sea change. "A remarkable thing is about to happen in our subspecialty. In the course of a single generation, the profession will go from being overwhelmingly male to being predominantly female," he said. "We all have a responsibility to insure that that change is reflected at all levels of the profession, including especially in the leadership of our academic programs and our professional society. The ACR has been successful in the past at seeing the future and getting ahead of it. This kind of dramatic social transformation is probably the greatest challenge yet. The ACR needs to be proactive in this area by developing a strategy to insure that there are rewarding career paths available to women in rheumatology and that women have a leadership role in preparing for this future. A simple first step would be to set some goals regarding division and ACR leadership and then to monitor success in achieving these goals."

When asked what inspires him these days, Dr. Wofsy cited the applications for UCSF medical school that he reads in his position as associate dean for admissions. "Reading the applications from the next generation of physicians, and meeting the new students each year, is very inspiring. I recommend this role to everyone. It is the best way to remain inspired and optimistic about the future. Having children – I have three – helps, too."

Sally Koch Kubetin is managing editor of Rheumatology News. You may contact her at rhnews@elsevier.com.