Health Sciences Report Summer 2006

This Pediatrician Is a Coach
With a Winning Strategy

By Susan Sample
Photos By Steve Leitch

Edward B. Clark, M.D.

Even the Tooth Fairy is a team player on his roster of researchers. But then Edward B. Clark, M.D., is a passionate recruiter for the National Children's Study (NCS).

Baby teeth will be collected from 100,000 children in the nation's most comprehensive study of how the interaction between genetics and the environment affects their health and well-being. "Metals children have been exposed to are deposited in the layers of enamel that make up teeth," explained the pediatrician, who is lead investigator for the NCS at the University of Utah. "We'll have a scientific role for the Tooth Fairy."

"We can read hair shafts like rings on a tree," continued Clark, referring to other biological samples that will include hair, blood, urine, and placentas. "Women's nails during pregnancy absorb and preserve substances they're exposed to. We'll preserve and archive these samples, so multiple questions can be answered now and in the future. It's our responsibility to make sure the data is accessible and valuable to scientists in 100 years."

Just six years ago, legislation created the task force charged to develop the NCS. Clark, chair of the U Department of Pediatrics and medical director of Primary Children's Medical Center, was invited to the first national meeting of the group focusing on birth defects. His involvement with issues at the core of the NCS, however, dates back much further: "It's been on my radar screen for 20 years: how environmental factors affect birth defects."

"I had a concept of this study when I interviewed here 11 years ago," said the former director of research and division chief of pediatric cardiology at the University of Rochester Medical Center."This was one of the reasons I came to Utah. I could do the study here."

A physician with a flair for telling stories and historical footnotes, Clark specializes in teratology: "It's derived from teras, the Greek word for monsters. It's the scientific study of biological monstrosities and malformations."

He's pioneered research in the developmental biology and biomechanics of the cardiovascular system, and the genetics of cardiovascular malformations at medical schools in New York, Iowa, and Nebraska, and at Johns Hopkins University, where he was inducted last year into the Society of Scholars. In the 1980s, he was co-principal investigator on a family study of congenital cardiovascular malformations, which identified a single-gene defect responsible for several leftheart obstructive defects.

"Errors in development" is how the pediatric cardiologist terms it these days. As he builds consensus in Utah communities for the NCS, he uses engineering analogies. "For years, we've focused on reductionist biology. Now we need the skills of engineering to look at how biological systems integrate and operate," said Clark, who is adjunct professor of bioengineering and holds the Wilma T. Gibson Presidential Endowed Chair at the U.

He likens the human genome, the identification and sequencing of all 100,000 genes in the human body, to "a complicated set of house plans that we've been given without a hammer and nails." The NCS, as Clark sees it, is the next page in the blueprint. "It's difficult to slice and splice: to change the genetic environment. But if we can find critical genetic/ environmental interactions, then we can change the environment."

Clark points to spina bifida as an example. When pregnant women take multi-vitamins with folic acid, they prevent the often crippling congenital defect in their infants. "Once we begin to understand interactions and disease," he noted, "then we as pediatricians can do what we do best: prevent."

Clark's enthusiasm is contagious as he switches from hard hat to baseball cap. "All I am is the coach for the NCS team here," he claims. But he's got a winning strategy: "First, you need ideas. Second, tools. Third, teams that are able to use the tools to link the ideas.

"I'm fascinated with teams," he admitted. His second-most valuable class (pre-med topped the list) as an undergraduate at Union College in Schenectady, New York, was sociology; it focused on how people interact. "If you get people together in unique combinations, they'll come up with unique results that were never expected. I'm a strong believer in serendipity.

"That's the power of the NCS: the sum of people who are coming together is more than the numbers. It's creating a huge sense of excitement that is going down a generation. It's creating new opportunities and new scientists."

Nurturing the next generation of scientists is essential to Clark, who turns 62 this summer. "I'm certainly reaching the point in my life and my career where I put aside my own agenda to consider who will follow us and take advantage of our successes. There's a history of gains that have not been sustainable, because people weren't there to carry on."

The concept of generativity, a stage of middle adulthood in which psychologist Erik Erikson theorized that individuals look beyond themselves in order to leave a legacy, is implicit in the NCS, according to Clark. He regularly schedules NCS Interest Group meetings for graduate students and faculty from colleges across the U campus, encouraging them to pilot their own innovative research projects using the NCS infrastructure.

"To a young person, it's important to receive validation early in one's career," he said in an experienced voice. Forty-one years ago, as a student at Albany Medical College, Clark received $600 from the local chapter of the American Heart Association for a summer project. He's been researching ever since.

"If this study goes 100 years, we'll need three generations of researchers," predicts Clark. Some will be specialists we can't even imagine, though he didn't turn down an opportunity to try. "Pediatric pharmaco-geneticists? Specialists in pre-disease identification with strategies to prevent disease? Maybe we'll be immunizing children against adult cardiovascular disease or substance abuse."

As a Vivaldi concerto played in the background of his pediatric office, Clark thought about his response to a final question: Would he like to live 100 more years to know the results from the NCS? "I'd love to see it," he said.

Then he leaned back in his chair, propped his elbows on the armrests, and narrowed one eye. "I'd like to live 25 more years. This study is the next step in understanding the evolution of health."

"Is it big? Yes."

"Is it complicated? Yes."

"Will things go wrong? Yes."

"Will it make life better?" Clark was unequivocal: "Yes, generation after generation."

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