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A profile of Richard L. Berkowitz, MD

Published:April 12, 2016DOI:https://doi.org/10.1016/j.ajog.2016.04.007
      Full interview at ajog.org: click Video under article title in Contents of this issue. Video is also temporarily posted on website home page under “Featured.”
      Related editorial, page 257.
      Dr Richard L. Berkowitz is a Professor of Obstetrics and Gynecology at the Columbia University College of Physicians and Surgeons and the former Chair of the Department of Obstetrics and Gynecology at the Mt Sinai School of Medicine in New York City. His multiple contributions through the years qualify him for inclusion in this series of “Giants of Obstetrics and Gynecology.”
      Early in his career while working with Dr Terence Rafferty, a critical care anesthesiologist, Dr Berkowitz pioneered the use of Swan-Ganz catheters to study the central hemodynamic changes in women with severe preeclampsia, and he edited the first textbook devoted exclusively to the treatment of critically ill pregnant women. During his years at Yale, he and his partner Dr John Hobbins were among the first obstetricians in the United States to recognize the enormous potential of the use of diagnostic ultrasound imaging to study the development of fetuses in utero and to detect morphologic congenital anomalies. Their innovative studies, performed with that rapidly improving technology platform, led to many further refinements in the unparalleled growth of diagnostic obstetrical ultrasound imaging. Dr Berkowitz has also been a true pioneer in the development of invasive fetal diagnosis and therapy. After learning how to perform existing invasive fetal procedures (such as fetoscopy for the early diagnosis of thalassemia in utero and intraperitoneal transfusions under fluoroscopic guidance), he went on to develop ultrasonically guided techniques that led to his performing the world’s first percutaneous placement of a fetal pleuroamniotic shunt, the first percutaneous intravascular intrauterine transfusion for the treatment of severe fetal anemia, and the first multifetal pregnancy reduction in the United States. He is also widely recognized for his seminal work in the assessment and treatment of alloimmune thrombocytopenia. Dr Berkowitz and his colleague, Dr James Bussel of the Weill-Cornell Medical College, earned international recognition for their work on that disorder, sharing the prestigious King Faisal International Prize for Medicine in 2012.
      Richard's first mentor was his father, an internist and “a true humanist.” The elder Berkowitz conveyed to his son a passion for helping people that inspired him to pursue medical studies.
      A graduate of the New York University College of Medicine, Richard then completed a year of postgraduate training in internal medicine at Kings County Hospital in Brooklyn, where he met his second mentor, Dr Ludwig Eichna, a no-nonsense physician who demanded the best from every one of his trainees “even if you didn’t think you were capable of doing any better,” he recalled.
      World events dictated the next step in Dr Berkowitz's professional development. Richard was accepted into the newly created Peace Corps and took on an assignment as a Peace Corps Physician in West Africa. It was the fulfillment of a dream; he had been fascinated with Africa since childhood. His two-year commitment was an “extraordinary experience” that left him in awe of the resourcefulness of physicians who work with only extremely rudimentary equipment and diagnostic tools in isolated rural clinics.
      “I learned from that experience that we can do a lot more than we think we can and certainly more than we’ve been told we can do by some of the people who have trained us,” he said.
      Returning to the United States, Richard completed his residency in Obstetrics and Gynecology at New York Hospital-Cornell University Medical Center and then received a Master’s degree in Public Health from Johns Hopkins University.
      Africa beckoned once again. Dr Berkowitz embarked on a two-year adventure, transporting a Land Rover from England to India and then shipping it to East Africa where he worked as a general surgeon and obstetrician/gynecologist in a mission hospital at the foot of Mount Kenya.
      Dr Berkowitz’s preparations for his “grand tour” laid the groundwork for the next big step in his career. Before the trip, Richard volunteered at the Yale University School of Medicine to learn how to administer epidural anesthesia, a skill he anticipated needing in Africa. His proficiency caught the eye of the Chair of Obstetrics and Gynecology, Dr Nathan Kase, who offered him a job on his return. Richard took up Dr Kase on his offer, returning to Yale in 1974. It was “the best career move I ever made,” Richard said. Dr Kase proved to be an important mentor in a department brimming with talent and innovation.
      “I was privileged to be there, and that unique environment led me to a career in academic medicine,” said Dr Berkowitz, who became an Assistant Professor and then an Associate Professor and Director of High Risk Obstetrics at Yale.
      Dr Berkowitz arrived in New Haven just as technologic and research breakthroughs were transforming the field of obstetrics and gynecology. Ultrasound imaging had changed obstetrics in a fundamental way by opening up the closed world of the human uterus for evaluation of its contents in ways previously not imaginable. He credits Dr Hobbins, Head of Obstetrics at Yale and a pioneer in obstetrical ultrasound imaging, as the “driving force” behind his interest in maternal-fetal medicine, fetal imaging, and the development of invasive procedures for prenatal diagnosis and management of fetal disorders in utero.
      After an extraordinary career at Yale, in 1982, Dr Berkowitz became Chief of Obstetrics and Head of the Division of Maternal-Fetal Medicine at the Mt Sinai School of Medicine in New York City. Dr Kase, then Chair of the Department of Obstetrics and Gynecology and subsequently Dean of the School of Medicine at Mt Sinai, made Richard one of his key recruits. Dr Berkowitz went on to succeed Dr Kase as chairman of the department, a position that he held for 18 years. Under his leadership, Mt Sinai became the go-to hospital for innovative prenatal diagnosis, the treatment of Rh disease, and the treatment of complex high-risk obstetrical cases.
      One day in the mid-1980s, Dr Berkowitz received a call that would change his research focus and, indeed, the lives of patients who are affected by a relatively rare, but devastating, alloimmune disorder. Dr Bussel, a pediatric hematologist at Weill-Cornell, asked Richard whether he would be interested in working with him in caring for women with alloimmune thrombocytopenia (AIT), the platelet equivalent of Rh disease. The major risk to the fetus in that disorder is the development of an intracranial hemorrhage in utero or during the neonatal period. Unlike Rh disease, however, severe manifestations of AIT may become manifest in the first affected pregnancy, and all subsequent pregnancies conceived by that couple will be as badly affected, or worse, if the fetus inherits the offending antigen.
      Dr Bussel had successfully treated a woman who had lost a previous newborn infant from an intracranial hemorrhage caused by AIT by empirically giving her the same medication that he used for treating thrombocytopenic infants throughout her pregnancy. He asked Richard whether he would work with him to recruit other obstetrical patients with this disorder and to use his skill in performing fetal blood sampling to study the natural history of the disease in utero and to measure the efficacy of various forms of therapy administered to the mother. During almost three decades of collaboration, this partnership led to an effective treatment for essentially eliminating the potential for intracranial hemorrhage in affected fetuses by administering intravenous gamma globulin and, in some cases, prednisone to the mother during the antepartum period. Furthermore, the therapeutic algorithms that they developed essentially did away with the need for fetal blood sampling in these cases.
      When not practicing, Richard is an avid reader and movie lover. One of his favorite books is Tolstoy’s War and Peace; his favorite movie is Casablanca. For him, the film’s best scene is the crowd at Rick’s Café drowning out the Germans with a stirring rendition of “La Marseillaise.” “I must have seen that movie 15 times,” he said. “Every time I see it (the Marseillaise scene), it brings tears to my eyes.”
      Looking back on his career, Dr Berkowitz is sorry about only one thing. “What I regret at this point in my life is that I’m not going to be around for the next 50 years because there are so many ground-breaking things being developed at the interface of genetics and our field. I’ve lived through an amazing period in the history of our specialty, but I think what is coming will be even more exciting,” he said.

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