Defining the Tension Between Physician, Researcher

Whether it’s caring for an ICU patient at Barnes-Jewish Hospital, helping to define and interpret the rules that protect human research subjects, or traveling across the world to treat underserved populations, Jonathan Green, MD, is focused on how his wor

authors Lucy Schultze

A physician directing care for a patient may be guided solely by what’s in that patient’s best interest. But when that same physician deals with patients in randomized clinical trials, an entirely separate set of goals is in effect.

“As a researcher, your primary obligation is to get the best possible data — which is very different from making the best possible decision for one patient at one time,” said Jonathan M. Green, MD, for whom exploring that tension has become a central focus of his career.

A professor of medicine and of pathology and immunology in the Division of Pulmonary and Critical Care Medicine at Washington University School of Medicine, Green devotes a large proportion of his time to his role as associate dean for human studies and executive chair of the Institutional Review Board (IRB) at Wash U.

Additionally, he recently began a three-year term on the Secretary’s Advisory Committee on Human Research Protections (SACHRP) within the U.S. Department of Health & Human Services. In that role, he will be among 11 committee members offering guidance, as the department rewrites the set of rules governing human trials across the nation for the first time since 1981.

“It’s a particularly exciting time to be appointed to SACHRP,” Green said. “These are the rules that will govern our work as researchers for the next 20 years.”

Green’s current focus on bioethics has evolved over the years, stemming from his own experiences as a pulmonary and critical care specialist. He continues to maintain a clinical practice in the medical ICU at Barnes-Jewish Hospital.

“In the ICU, we deal with very sick and dying patients, which involves a lot of end-of-life issues,” he said. “Ultimately, ethics is about grappling with: What is the right thing to do?”

Green became involved in the hospital ethics committee in the early 2000s, and went on to chair that group from 2005-09. That experience developed his interest in research ethics alongside clinical ethics. His interest continued to grow after he joined the IRB in 2008 and became its chair two years later.

“I’ve become more and more fascinated by the physician-investigator conflict,” he said. “In research, you still have a duty to the patient, but it’s different than if you were acting just as a physician. It becomes a protective duty, and sometimes you have to be able to take the patient out of the research study in order to do what’s best for them.”

Likewise, he said, a physician is expected to tailor care to each individual, while a researcher must treat each person according to a defined protocol to get valid results. Randomizing patients and giving placebos can also be ethically challenging from a medical perspective.

“If you went to your doctor and said, ‘I’m sick,’ and they spun a wheel of fortune and that’s how they picked your treatment, you’d think they were crazy,” Green said.

Still, he said, research has to go forward in this way.

“I’m a firm believer that we have to do these things to advance care,” he said. “But when these research subjects take on the risk, the benefit very often doesn’t go to them. It goes to other people in the future. They should be as informed as possible and receive as much protection as we can offer.”

In his own basic science lab, Green and his team study the regulation of T-cell immune responses. His interest in bench science developed during his undergraduate years at the University of Michigan in Ann Arbor, where he got a job assisting in a lab. Up to that point, he had been focused on a career as a physician but had never considered academic medicine.

“I always thought I would be a regular doctor, taking care of people,” he said. “But I found I really enjoyed the lab environment as well.”

Green also worked in a professor’s lab during his first two years at Wayne State University School of Medicine in Detroit. He went on to complete his residency at Boston City Hospital, then returned to Michigan for his pulmonary fellowship. There, he had an opportunity to work in the lab of Craig B. Thompson, MD, now president and CEO of Memorial Sloan Kettering Cancer Center in New York. Green followed Thompson to the University of Chicago for an additional two-year postdoctoral fellowship. He then joined the Wash U faculty in 1996.

Over the years, Green has made a priority of taking time away to participate in medical service missions to underserved areas around the world. Most recently, he spent six weeks in Liberia this past spring, as part of the response to the Ebola outbreak.

“Last winter, the death count was still rising and they were projecting there could be up to 100,000 deaths,” he said. “I have a skillset that’s useful in that situation. I decided to go, because I couldn’t sit back and do nothing.”

Green cleared the idea both with his family and with Wash U, and identified an opportunity to go with the nonprofit Partners in Health. Ultimately, his time in Liberia focused on working with local health providers to prepare them to respond if Ebola flares up again. He also spent a week providing care in a village so remote, it took a 10-hour drive plus a five-hour walk through the jungle to get there.

“Normally, the local providers try to set up a clinic there once a month, but since the Ebola outbreak, they hadn’t been to the village for over a year,” Green said. “The whole health system in that country was overwhelmed by the impact of Ebola. In addition to the thousands of deaths, the tiny bit of health infrastructure they had just completely fell apart.”

Green has also taken part in medical missions to Southeast Asia, East Timor and Vietnam. While such endeavors require a departure from his duties at Wash U, for Green, they have an important place in the bigger picture of his work.

“I’ve been very lucky in my life in all sorts of ways,” he said. “So it’s important for me to find ways to give back and to contribute in a meaningful way – whether that’s on an individual level with a patient in the ICU or on a bigger level in taking these trips. The unifying theme for me is to try to do work that contributes positively beyond myself to society as a whole.”

On his own time, Green enjoys outdoor activities like cycling, backpacking and traveling with his family. He and his wife, Christy Auston, a teacher at the new Hawthorn Leadership School for Girls in north St. Louis, have four children ages 12-22: Michael, Lizzie, Sarah and Owen.

 

RELATED LINKS:

Washington University School of Medicine: Jonathan M. Green, MD

Secretary’s Advisory Committee on Human Research Protections

More in Clinical

Clinical  May 04

The Pill, Prescriptions, Pharmacists & Physicians

‘The Pill’ made headlines and stirred up controversy in the late 1950s and early 1960s as the nation debated whether or not women…

Clinical  Apr 21

The Bidens at AACR

On April 20, Vice President Joe Biden and Jill Biden, EdD, addressed over 4,000 attendees during the American Association for Cancer…

Clinical  Apr 12

Zika Legislation Headed to President's Desk

On April 12, Chairman Lamar Alexander (R-Tenn.) made the following statement as Senate health committee-passed legislation to spur…

Business  Apr 07

Planning for Long-Term Care

“A man who procrastinates in his choosing will inevitably have his choice made for him by circumstance.” – Hunter S. Thompson

Clinical  Apr 07

Plan to Address Mental Health Crisis

A bipartisan U.S. Senate group looks to ease the burden on Americans suffering from mental health and substance abuse disorders…

Clinical  Apr 06

Artificial Intelligence, Real Results

Developers have created a new tool that combines predictive analytics with artificial intelligence to improve outcomes and decrease…

Clinical  Apr 06

Surgeons Test Technology with Potential to Expand Lung Transplant Donor Pool

Organ transplant patient Michele Coleman receives a follow-up exam a few months after surgeons at Washington University School of Medicine in St. Louis gave her a new set of lungs.

Clinical  Mar 29

AMA on Ending Opioid Epidemic

Opioid and heroin abuse have skyrocketed in America prompting new guidelines and regulations from the CDC and FDA. The AMA weighed in…

Clinical  Mar 28

Cells Have Strategies to Get Back on Track After Replication Stress

In a recent review paper published in Nature Structural & Molecular Biology, Saint Louis University scientist Alessandro Vindigni, Ph.D., describes the strategies cells use when their DNA faces replication stress, challenges that may derail a…

Clinical  Mar 03

Findings may guide design of new drugs

Genetic errors identified in a new study led by Washington University School of Medicine in St. Louis may reduce risk of heart attacks…

Business  Feb 29

‘Trigger Tool’ Available for Hospitals and SNFs

How can ‘trigger tools’ identify adverse events?

Clinical  Feb 29

Cancer Stats & Facts

Each year the American Cancer Society releases the latest data as a litmus test of where the nation stands in the fight against cancer.

Clinical  Feb 24

Technology may improve treatment for deadly brain cancer

Using a laser probe, neurosurgeons at Washington University School of Medicine in St. Louis have opened the brain’s protective…

Clinical  Feb 23

Ending the Opioid Epidemic

Read the Feb. 22 joint statement by National Governors Association Health & Human Services Committee Chair Massachusetts Gov. Charlie Baker; Vice Chair New Hampshire Gov. Maggie Hassan; American Medical Association Chair-Elect Patrice A. Harris, MD, MA

Business  Feb 08

Challenging Population Health Management Issues

The nation’s leading forum on innovations in population health is slated for March 7-9 in Philadelphia.

Clinical  Feb 08

Prevent, Protect, Improve

Healthways and Dr. Dean Ornish have teamed up on a secondary intervention proven to not only treat heart disease but also to reverse…

Clinical  Feb 08

The 7th Character

How important is the 7th character for Medicare/Medicaid claims?

Clinical  Feb 04

Scientists More Effectively Control Pain by Targeting Nerve Cell’s Interior

New research indicates that the location of receptors that transmit pain signals IS important in how big or small a pain signal will…

Business  Jan 26

Taken for Granted: A New Era in Care – the New SSM Health Saint Louis University Hospital

Patient-centered design will enhance the new state-of-the-art academic facilities.

Clinical  Jan 26

New Outpatient Care Center Under Construction in South St. Louis County

Washington University School of Medicine in St. Louis and Barnes-Jewish Hospital (BJH) are building a new outpatient facility in south…

Clinical  Jan 26

Bhayani Named Holekamp Family Chair in Urology

Sam Bhayani, MD, who recently was appointed chief medical officer of the Faculty Practice Plan at Washington University School of Medicine in St. Louis, has been named the Holekamp Family Chair in Urology at Barnes-Jewish Hospital (BJH) and the School

  Load more content