Lives of the fellows

David Rabin

b.25 January 1934 d.26 October 1984
MB BCh Wits(1956) MRCP(1959) MRCPE(1959) MD(1963) FRCP(1979) FACP(1979)

David Rabin was born in Zastron, Republic of South Africa. He displayed scholastic and scientific brilliance early in his career; when he graduated from Aliwal North High School he won an award for the best chemistry student in South Africa. He held an unparalleled record as a medical student at the University of Witwatersrand Medical School in Johannesburg, and graduated with the highest cumulative grade average ever attained by a student there. He married Pauline Aron, a medical school classmate, in 1956. Their children, Michael, Roni, Dana and Keora, witnessed a marriage and family life unsurpassed in warmth, humour, liveliness, and close friendships made wherever they went.

After two house staff years in Johannesburg, and subsequent postgraduate training with Russell Fraser at the Postgraduate Medical School in London, Rabin moved to Johns Hopkins Medical School where he became one of the most productive investigators in the field of endocrinology in the USA. His work with Kenneth Zierler, using catheters to study the effects of insulin on the metabolism of adipose tissue and muscle in the forearm, was a classical contribution to the understanding of hormone-fuel relationships in humans. He next turned his attention to growth hormone secretion. Collaborating with Tom Merimee, David Rimoin and Victor McCusick, Rabin studied insulin and growth hormone secretion and action in patients with isolated growth hormone deficiency, and the resistence to growth hormone action in the African pygmy. While at Hopkins he contributed seven chapters in the textbook The Principles and practice of medicine, 17th ed.,edited by A McGehee Harvey, Appleton-Century Crofts, New York, c.1968. After nine years at Johns Hopkins University, during which he served successively as a fellow, instructor, and assistant professor of medicine, Rabin and his family moved to Jerusalem. From 1968-73 he served as associate professor of medicine at Hebrew University, Hadassah Medical School, and head of the department of chemical endocrinology at Hadassah University Hospital, where he began studies in reproductive endocrinology, focussed on gonadotropins. He was credited with documenting the first cases of hereditary FSH deficiency in women.

Rabin returned to the United States in 1973 as a visiting scientist at the National Institutes of Health, where he worked with Jesse Roth. He became chief of the division of endocrinology at Vanderbilt University Medical School in Nashville, Tennessee, in 1975, succeeding Grant W Liddle who had been appointed to the chair of the department of medicine. He continued his contributions to the field of reproductive physiology and concentrated on the use of LHRH analogues as a male contraceptive. While at Vanderbilt he also played a crucial role in collaborative investigation into intermediary metabolism, which resulted in a series of landmark papers on the hepatic roles of insulin and glucagon in controlling glucose homeostasis. Altogether, he contributed some 206 original articles to medical journals and as chapters in textbooks.

At the height of his investigative career, in 1979, he noted the onset of symptoms of amyotrophic lateral sclerosis (motor neurone disease). This condition progressively deprived him of his power to walk and the use of his upper extremities, and finally reduced him to a state in which he could only move his eyelids. Over a difficult five-year period his slight frame gradually withered away, but his intellect, courage, humour and production never diminished. It was not long before he was unable to go to work at Vanderbilt, where he was the Alexander Heard distinguished service professor in the departments of medicine, obstetrics and gynaecology, as well as director of the division of endocrinology. He carried on at home, where his devoted family cared for his physical problems. When he could no longer speak he learned to operate a computer word processor, using a switch controlled by his eyebrow. He continued to direct his research activities, and to write scientific articles and letters to his friends and colleagues. His encyclopaedic knowledge of endocrinology and the broad scope of his interests and expertise were reflected in the textbook which he co-authored with Joseph McKenna, Clinical Endocrinolgy and metabolism: principles and practice, New York, London, Grune and Stratton, c.1982.

David’s love of music, and his enthusiasm for people, issues and politics, continued. Musicians from the Blair Academy of Music frequently performed in the Rabin home for the family and their friends. Using the eyebrow switch to operate his word processor, he wrote an article for the Nashville Tennessean encouraging support for a public radio station that played classical music and, with his daughter Dana, wrote an article calling attention to the physical dangers inherent in the sport of boxing.

His own experiences as a patient increased his interest in the care of the patient with incurable disease. Sensing that his own experiences were likely to be shared by others in similar circumstances, he published his concern about the attitudes of many physicians and their inability to deal with chronic or terminal illness in an article entitled ‘Compounding the ordeal of ALS: isolation from my fellow physicians’, New England Journal of Medicine, 1984,304,699-701. Written with his wife Pauline and his daughter Roni, the paper concluded: ‘...bear in mind that the absence of a magic potion against the disease does not render the physician impotent. There are many avenues that can be helpful for the victim and his family. I am often surprised and moved by the acts of kindness and affection that people perform. Fundamentally, what the family needs is the sense that people care. No one else can assume the burden, but knowing that you are not forgotten does ease the pain.’

The growing concern of David and Pauline with the attitude displayed by society and physicians towards persons with progressive or terminal illness, dementia and mental illness, culminated in the publication of a book which they co-edited: To provide safe passage: the humanistic aspects of medicine, New York, Philosophical Library Inc., 1985, a collection of essays devoted to the role of the physician in the face of incurable illness, and containing guidelines to help patients deal with grief, chronic physical disability, intractable pain and terminal illness. Their daughter Roni wrote an eloquent and inspiring book: Six parts love - one family's battle with Lou Gehrig's disease, New York, Charles Scribner’s Sons, 1985, chronicling the struggle of the Rabin family in coping with ALS.

David Rabin was widely respected and admired for his broad knowledge, his exciting lectures, and his courage in the face of a ravaging illness. His colleagues at Vanderbilt established an annual David Rabin Lectureship in endocrinology in his honour. But above all, he will be remembered for the warmth of his personality and the twinkle in his eye.

AL Graber

(Volume VIII, page 400)

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