New Column—Ed Mason at Large

This ongoing column is dedicated to sharing with readers the life and experiences of Dr. Edward Mason.

Welcome from Column Editor
Tracy Martinez, RN, BSN, CBN
It is with great honor and delight to coordinate this new column “Ed Mason at Large.” For those who know Dr Mason, it will be enlightening to learn more about him and his vast contribution to the specialty of obesity research and bariatric surgery. For those who are in this field and do not know him, it will be a gift.

Knowing the history of our specialty will help all of us move forward in our contribution and care of our patients. Dr Mason is often described as the “grandfather of bariatric surgery.” I believe we owe him enormous gratitude for his vision and foundation of our society as well as the acceptance of surgical treatment of this disease. The following are some questions I asked Dr. Mason to learn about the early years of his life, career in medicine, and the beginning of bariatric surgery. Each month he will talk to us more about what he has learned over the years in his medical career and personal experiences. I think you will find his words inspirational.

Please participate by emailing us questions you may have.

Sincerely,
Tracy Martinez, RN, BSN, CBN
Program Director
Wittgrove Bariatric Center
La Jolla, California

Where were you born and raised? What can you tell us about your parents and siblings?

Dr. Mason: I was born October 16, 1920, in Boise, Idaho, going around the corner of 16th and State in the back seat of a taxi. My grandmother caught me. My dad was riding shotgun. My dad took us to Moscow, Idaho, when I was a year old. A web search helped me learn that my father, Edward Files Mason, was in the English Department and started a program in Journalism at the University of Idaho. We moved to Iowa City when I was nine. Dad started the first course in pictorial journalism at the University of Iowa. He used to edit some of the papers I wrote.

My mother attended Lewiston Normal in Idaho and taught first grade (I was in her class) while we lived in Moscow. She obtained a BA from the University of Idaho and an MS in sculpture at the University of Iowa. She lectured all over the United States, modeling someone from the audience while reviewing the history of sculpture. She modeled Nile Kinnick in our living room in 1939 while he was studying. He had missed an examination in international law when he was receiving the Heisman trophy and had to make this up after returning to Iowa City. He would read a few pages and then look up and think about what he had read—a perfect opportunity for Mother to obtain an excellent likeness in two hours. Nile brought his fraternity brothers over that evening to see the bust. They liked it!

My wife, Dordana, and I are both the only children in our families. We attended some classes together when Dordana was working on her thesis in nutrition. She obtained an MS and an MD at the same time at the University of Iowa—I was the MD. We lived at the State Tuberculosis Sanatorium in Oakdale, Iowa, during my senior year in medical school. Dordana was in charge of nutrition and I took night call, learning how to draw blood from arms of patients with obesity for sedimentation rates.

What made you realize you wanted to go into medicine? What were the deciding factors to specialize in surgery?

Dr. Mason: I had a grade-school classmate whose father, Milford Barnes, had been a missionary in Siam. Barnes was Chairman of Preventive Medicine in the College of Medicine. Another classmate’s father taught pediatrics and another taught biochemistry. My mother took a course in anatomy and had a friend who was secretary to the Chairman of Surgery at University of Iowa Hospitals and Clinics. Another boyhood friend’s father ran the University of Iowa Hospital Transportation of Patients from all over the state to our hospital and home again after treatment. These were indigent patients. The counties paid the bills. The department chairmen had private patients and not enough time for teaching and research.

At the beginning of our second year in medical school in a course called Introduction to Clinical Medicine, Elmer DeGowin lectured to us about peptic ulcers and mentioned papers about finding the best operation for peptic ulcers from Owen H. Wangensteen’s research laboratory. I read these papers and decided I wanted to participate in that type of research. I also asked H. P. Smith, Chairman of Pathology, where to apply for academic surgery training. He recommended Owen H. Wangensteen and Lester Dragstedt. H.P. Smith also advised 1) that if I did not like what I was doing to get out immediately and 2) continuity of effort was important for success. This turned out to be excellent advice. I chose Wangensteen at the University of Minnesota in Minneapolis and wrote him a letter. He invited me to visit him, and I spent a day following him around, after which he told me he would have a place for me and that he had never had anyone apply so early.

Bariatric surgery was not popular (maybe not even described) nor understood in the beginning. Thanks to you and your leadership, many individuals who suffer from this disease now have a second chance for longevity and disease resolution. What made you focus and give so much of your academic career to the disease of morbid obesity?

Dr. Mason: I have hay fever, and I would often leave Iowa City in October to either portage in the canoe country with my swim-age children or study in Canada. In 1965, I spent two weeks living in an empty (fall vacation time) student dormitory, reading papers on stomach physiology and swimming in their pool. I attended a meeting on gastric physiology at the end of my retreat and came home with a plan for research on gastric bypass, which was a copy of Billroth II gastrectomy from 1885, but leaving the bypassed stomach in place. I was not thinking about what the operation might be used for at the time but knew it might be used for treating peptic ulcer.

Chikashi Ito from Sopporo, Japan, had arranged, through a Japanese heart surgeon who had trained at the University of Minnesota and with Robert Tidrick, Chairman of Surgery at the University of Iowa, to spend three years working in the Iowa Animal Research Laboratory. These arrangements were a wonderful surprise to me. Ito arrived in Iowa City at the same time I returned from Canada. He did not have a plan for research so I told him about my plans to determine the effects of gastric bypass upon gastrin and acid secretion in causing peptic ulcers.

Ito wanted to live in the United States with his wife and two daughters for three years and learn our language and our way of life while working in our laboratory. Ito had been practicing general surgery. Within a year, we were satisfied that gastric bypass would decrease gastrin and acid secretion and would be safe for use in humans. Treatment of patients with peptic ulcer was an obvious choice. Poor maintenance of weight had been an undesirable complication in gastrectomy for treatment of peptic ulcer. We could turn this into an advantage for the severely obese. Treating obesity was a second choice. Only one of the eight patients with peptic ulcer remained free of symptoms. That patient was also obese and lost weight. After a year, I dropped the peptic ulcer study but continued treating severe obesity with gastric bypass. We also continued the related animal research.

Can you share how the early bariatric meetings for bariatric surgery in Iowa came about?

Dr. Mason: I received an invitation to help start an obesity society in Japan in 1953. I had been thinking about starting a society in the United States and decided that if Japan needed such an organization, we certainly should have one for obesity surgery. I asked Thomas Blommers, who was helping us with our obesity program, to help me with the details. We had been running an obesity surgery post-graduate course for six years. We incorporated the Society for Bariatric Surgery in Iowa and held the first meeting in the spring of 1953. We added scientific and commercial exhibits and continued giving credits for post-graduate education. We had a welcome reception in our backyard at 5 Melrose Circle with a big canopy set up in case of rain. We invited a speaker for the dinner at our meeting place in the University Memorial Union. On two separate occasions, our speaker was Richard Hornberger, who wrote M.A.S.H. under the pseudonym, Richard Hooker. One of his Roux-en-Y gastric bypass (RYGB) patients worked for the highway and referred patients with obesity from the roadside. The Hornbergers lived in New England on Richard’s parent’s ocean-side farm. Dordana and I were taken along the coast to see the many lobster traps when I was invited there by Hornberger to lecture.

Can you share some stories about the patients you cared for early on and why they were chosen for bariatric surgery?

Dr. Mason: In 1953, when I became an Assistant Professor of Surgery at the University of Iowa, I asked the Patient Records department for a list of patients with a diagnosis of inoperable hernia. Nineteen of these patients agreed to come in for pneumoperitoneum (air injections for a few weeks) to restore abdominal domain, followed by hernia repair. When a cross-table lateral radiograph showed only air above the supine abdomen, the hernia was repaired with normal tension. Two of the patients began excessive eating and their hernias recurred. I presented this experience in Minneapolis, and Arnold Kremin, whose research as a resident had led to treating obesity with intestinal bypass, suggested I use that operation to control weight. In 1954, our first patient was studied before and after intestinal bypass in our clinical research center. We could not detect any change in her ability to gain weight. A second patient had a more extensive intestinal bypass and I had to operate again to add to the functioning bowel. I decided not to perform any more of those operations. I admit that my study of intestinal bypass was inadequate to make such a decision. The laboratory research leading to gastric bypass did not begin until 1965.

In 1966, we used the indications for gastric bypass that had been established for intestinal bypass. Intestinal bypass had been in use for 12 years, so patients came to us knowing that surgical operations could decrease obesity. There were not so many to choose from before the epidemic began. Most patients were referred by relatives or friends who had obesity surgery. When referrals from physicians began, it was because of pressure from patients and frustration of both patients and referring physicians. As Hornberger said, it was with a plea to “do something” because nothing else worked. When complications of intestinal bypass became overwhelming, a patient was again referred with the request “do something.” There are now two epidemics that need resolution—obesity and type 2 diabetes (T2D). We are helping less than one percent of the people who could benefit from obesity surgery. Surgery’s greatest contribution may be the elimination of the need for surgical procedures. I believe that is occurring for T2D, when the body mass index (BMI) is less than 40kg/m2. I cannot obtain the glucose mimetic I would like to try for my age-related T2D. I could use the readers’ help but you would need to learn the mechanism and teach it to others until we can establish a new paradigm. We could reduce the cost of medical care while saving limbs and lives. Maybe the readers can learn how to eliminate the need for obesity surgery as we learn more about mechanisms. In 1885, Billroth provided us with an operation that prevents and cures T2D. He just did not know about the disease and the mechanism of dumping for diabetes.

Category: Ed Mason at Large, Past Articles