Abstract
Fletcher H. McDowell, MD, 1923-2017
Fletcher H. McDowell, MD, passed away at his home in New York City on April 23, 2017. He was 93 years old.
Dr McDowell commenced his remarkable and influential career with his medical training at Cornell Medical College in 1945. Following graduation in 1947, he began an internship in internal medicine at Cornell, and then went on to a medical residency at Stanford. He returned to Cornell as a resident in Medicine (Neurology) in 1950. After a 2-year stint in the US Army Medical Corps and a year as a Clinical Clerk in Neurology at Queen Square, he came back once again to New York Hospital/Cornell, where he was to spend the remainder of his career. From 1956 to 1967 Dr McDowell was the Physician-In-Charge of the Cornell Neurological Service at Bellevue Hospital in Manhattan. In 1973, Dr McDowell was named Chief Executive Officer and Medial Director of the Burke Rehabilitation Hospital in White Plains, New York (then affiliated with New York Hospital and Cornell). In assuming this role, he brought rigor and high clinical standards to that institution and to the entire field of physical medicine and rehabilitation. In 1975, he was named Winifred Masterson Burke Professor of Rehabilitative Medicine and Associate Dean of Cornell University Medical College.
Dr McDowell saw that having scientists and clinicians work in close proximity to patients in an intimate, integrated setting would fuel the translation of science into treatment. He created the Burke Medical Research Institute, attracting leaders in neurology and rehabilitation research to White Plains to establish their basic neuroscience research labs at Burke. In addition, Dr McDowell helped found the American Society for Neurorehabilitation in order to advance scientific knowledge of how to best aid recovery in neurological disease, His contributions to that organization are memorialized in an award given to outstanding young investigators each year.
Dr McDowell was a quiet, almost unassuming and practical man. His passion was for the care of patients and helping them live as best they could in the face of their neurological disabilities. His pioneering vision and his confident and calm leadership in several areas of neurology encouraged multiple generations of neurologists to follow in his footsteps. He encouraged his students, mentees, and colleagues to innovate and follow their own passions in the service of patients with neurological disability. A compassionate, caring, and personal physician, he made house calls when his aging and severely impaired Parkinson patients were home bound.
Dr McDowell recognized immediately the significance of George Cotzias’ observation that slowly titrating oral levodopa dosage allowed patients to tolerate sufficient doses of medication to ameliorate their Parkinsonian symptoms. He and his group executed and published one of the first clinical trials with levodopa. Perhaps most important, he and a succession of colleagues at Cornell, carefully tracked the progress of the initial cohort of levodopa-treated Parkinson patients, and collaborating with centers from across the country demonstrated the positive effects of levodopa treatment on the natural history of Parkinson’s disease. His group’s landmark 1972 article demonstrated that cognitive impairment was not only common, but a near universal clinical aspect of the clinical course of Parkinson’s disease.
Parkinson’s disease was not Dr McDowell’s only major contribution to neurology and medicine. He was an early promoter of the concept that more attention should be paid to stroke. He was a founder of the journal Stroke and served in editorial roles from 1970 to 1981. He formulated consensus positions for the diagnosis and treatment of stroke. And, significantly, in the relatively new arena of the active treatment of patients with chronic stroke, he waved off the passive protocols requiring patients with stroke be treated with rest, quiet, and only passive movement of the affected limbs. He could never understand why patients spent so much time lying in bed. In the era when regulations imposed a maximum of 3 hours of therapy per day, he advocated for intensive motor training protocols.
Dr McDowell’s passion for the prevention of stroke and improving patient’s ability to function with their disability, led him to encourage a number of young clinical investigators and neurologists from Cornell Medical School to join him in the awareness that newly discovered neural recovery phenomena could potentially be leveraged to aid in recovery from stroke. Several of these early trainees built solid careers of accomplishment, no doubt a reflection of Dr McDowell’s ethic of straight-forward preparation and hard work for the difficult problems of treating brain disease, and his realization that apparently small improvements could lead to significant effects on real-world outcome for the patient.
In an era when neurologists believed “diagnosis was destiny” for people with damage to the brain resulting in limb paralysis, Dr McDowell challenged the prevailing view. Dr McDowell sparked yet another revolution in neurorecovery when he led the first efforts to test the hypothesis that intensive task-specific practice could lead to greater motor recovery. Experiments in animals had demonstrated that intensive training could alter the brain map underlying movement. Dr McDowell encouraged expanding this work through his pioneering foundation, the National Stroke Association. By 2010, the group at Burke, with support of The Department of Veterans Affairs, executed a definitive multisite trial showing that intensive training with these robotic devices effectively improved upper limb function in patients with chronic stroke, resulting in the first ever rehabilitation article to be published in the New England Journal of Medicine. That seminal article changed the landscape of neurological rehabilitation.
When Dr McDowell retired from Burke and Cornell he continued to participate in the National Stroke Association and a number of official Board positions, including United Cerebral Palsy Research, to encourage others to move forward in research and clinical endeavors to improve treatments for brain injury.
Dr McDowell was a generous man. He was generous with his time, letting students and trainees grow into new understanding of the problems they encountered with patients or in their research. He was generous with credit that would accrue to others as projects progressed. Generations of Cornell neurology residents remember the parties at his house, and the trips they took with him, often accompanied by his gracious wife, Electra, who passed away prematurely at age 55 in 1989. Her loss affected him profoundly. He is survived by his daughters, Electra, Laura, Linn, and their families.
Dr McDowell made a mark on all who had the pleasure of his friendship. His honest, direct, and quiet leadership have forever enhanced the discipline of neurology. Those who worked closely with him have been indelibly influenced by his core vision: that care of the patient with chronic neurological disability is core to the role of the neurologist, whether that care entails medication management of patients with Parkinson’s disease, prevention of stroke, or rehabilitation of patients with stroke, spinal cord injury, or other underlying disorders.
We thank the many colleagues who submitted comments about Fletcher, including George Wittenberg, Hermano Krebs, Bruce Dobkin, Mike Reding, Dave Good, and Alex Dromerick.
We had the honor of meeting Fletcher McDowell during our formative years in Residency at The New York Hospital, working for him at Burke, and alongside him in numerous clinical, research, and community service endeavors.