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Robertson leaves lasting legacy in clinical research

Nov. 30, 2017, 9:00 AM

David Robertson, MD, gets a hug from lab manager Charlene Finney during a recent reception honoring Robertson’s distinguished career at Vanderbilt. (photo by Joe Howell)

When David Robertson, MD, sorted through 39 years’ worth of textbooks, journals and framed photographs in Vanderbilt University Medical Center’s (VUMC) Clinical Research Center (CRC) recently as he prepared for retirement, the memory that brought him to tears was a 30-year-old embroidery piece by his daughter, Rose Robertson Pink.

It shows Rose standing by a small tree and Robertson standing by a large one — a nod to both the bond between father and daughter and to one of his longtime passions — growing rare trees.

“Rosie spent so much time in this office. She would come here as soon as school was out. She’d sit here and do her homework,” he said. “She sewed that picture when she was about 5. Of all the things I’ve looked through, that’s the one I shed tears on.”

Robertson, Elton Yates Professor of Autonomic Disorders, professor of Medicine, Neurology and Pharmacology and director of the General Clinical Research Center, retired from active faculty service last month. Kevin Niswender, MD, PhD, associate professor of Medicine, will serve as the new director of the CRC.

Robertson is best known nationally and internationally for his own clinical research into the autonomic nervous system and how it affects circulation and blood pressure regulation.

Robertson’s career at Vanderbilt was multi-faceted. He is well known for his work managing the selection and support of the training of many young physician-scientists through the Medical Scientist Training Program. As director, he oversaw scores of clinical research trials on the third floor of Medical Center North in the CRC. But what he’s best known for nationally and internationally is his own clinical research into the autonomic nervous system and how it affects circulation and blood pressure regulation.

“Dr. Robertson’s contributions to our understanding of complex autonomic disorders have brought worldwide attention to Vanderbilt. His career is one of numerous highlights, such as being among an elite group of scientists to have a NASA-sponsored research project on Neurolab, a space shuttle mission that probed how the autonomic nervous system functions in microgravity,” said Jeff Balser, MD, PhD, President and CEO of VUMC and Dean of the School of Medicine.

“Accompanying these enormous achievements, David has always been a kind and humble colleague to those of us who have been fortunate to learn from him. I want to express my sincere appreciation for all he has done for Vanderbilt.”

Robertson and a core group of investigators formed the Vanderbilt University Autonomic Dysfunction Center in 1978 to treat and study patients with orthostatic hypotension (a fall in blood pressure while standing) and other disorders of the autonomic nervous system.

“I was drawn to studying the autonomic nervous system because when I was an undergraduate, I met (Vanderbilt’s) John Oates, an international expert on high blood pressure. And high blood pressure was such a big deal. But sometimes it’s an advantage to go to the other end where there are new things that can be found,” he said. And it led to the discovery of new diseases and new treatments.

Robertson and his Vanderbilt colleagues linked a genetic defect resulting in absence of the enzyme dopamine beta-hydroxylase and thus of norepinephrine to very severe orthostatic hypotension, a rare condition in which those affected could only walk 20-40 feet at a time before having to sit down.

“This really forced a change in our thinking,” Robertson said. “Before this, most of us wouldn’t have believed you could survive without norepinephrine. It was quite a surprise. And we were so pleased that we were able to find an effective treatment.

“One patient called me several years ago and wanted to run the New Orleans Marathon. I told her I didn’t know if that would be possible, but she was on her new treatment and was willing to work up to it. Determination wasn’t part of her genetic problem,” he laughed.

“I got several colleagues in the New Orleans area, stationed about 1 mile apart on the marathon route, just to keep an eye on her. She was able to compete and finish!” Robertson said.

Disorders of the autonomic nervous system can cause very high or very low heart rates or blood pressures. The most common of these disorders is the debilitating syndrome of orthostatic intolerance — “POTS” — characterized by an increase in heart rate (at least 30 beats per minute) on standing. For someone who suffers from orthostatic intolerance, the simple act of standing causes a racing heart, nausea, headache, dizziness, and even fainting. The disorder affects more than 500,000 people in the United States. A few of these patients suffer from another rare genetic problem uncovered by Robertson and his group, norepinephrine transporter deficiency.

David has had an enormous impact on our understanding of autonomic function. He has helped so many patients who had otherwise lost hope of functioning.

“David has had an enormous impact on our understanding of autonomic function,” said Nancy Brown, MD, Hugh J. Morgan Professor of Medicine and chair of the department. “He has helped so many patients who had otherwise lost hope of functioning. Although David is retiring from active faculty service, we look forward to his continuing involvement at Vanderbilt. For many of us, he has been a role model and guide and will continue to be so.”

Robertson is married to Rose Marie Robertson, MD, adjunct professor of Medicine, who is now chief science and medical officer of the American Heart Association. “High blood pressure and low blood pressure, we have it covered,” Robertson said, smiling.

He became director of VUMC’s CRC in 1989, and helped make it among the best in the nation, said Gordon Bernard, MD, Executive Vice President for Clinical Research at VUMC. “David has provided consistent organizational and intellectual input into the operations of the Clinical Research Center, making it one of the most successful and prominent programs of its kind in the nation. Further, the quality of the center has allowed for the conduct of some of the most delicate and complex human research conducted anywhere,” Bernard said.

Robertson grew up in the tiny rural community of Sylvia in Dickson County where his family has lived for generations and where many of his relatives still live.

He graduated from Vanderbilt University in 1969 with a BA in Germanic and Slavic Languages and became interested in medicine during his undergraduate years, when he worked in a Clinical Pharmacology lab and the Clinical Research Center to help develop an assay for renin, important in high blood pressure.

After graduating from Vanderbilt he attended the Arnamagnaen Institute in Copenhagen, Denmark, pursuing his interest in the Icelandic language, but then returned to Vanderbilt University School of Medicine, where he received his medical degree in 1973.

“I’m sure my family thought that going to medical school made a lot more sense than studying Germanic and Slavic languages, including Russian,” Robertson said.

“But the Russian connection later made it possible to spend time in Moscow and work with distinguished faculty there, and I came to appreciate how outstanding many of their faculty were. This relationship fostered our subsequent research in the new field of space physiology, giving us the opportunity eventually to study human subjects in the weightlessness of space. Oleg Otkov, who was a faculty member at the Moscow Institute and had spent more than 200 days in space, visited us in Nashville, and gave outstanding presentations about his life in space.”

Robertson completed his internship and residency at Johns Hopkins Hospital and was a postdoctoral fellow in Clinical Pharmacology at Vanderbilt for two years before accepting a position as assistant chief of Service in Medicine and instructor in medicine at Johns Hopkins in 1977.

Once recruited back to the faculty at Vanderbilt, Robertson proved his ability to lead. In addition to serving as the director of the CRC, in 1993 he became director of the Medical Scientist Training Program and served as director of the Division of Movement Disorders in the Department of Neurology until 2000.

Robertson said he is looking forward to having time to focus more on travelling with his family, gardening and growing rare trees, and visiting his family farm in Dickson County. “I like to garden and grow rare things — gourds, pumpkins, vegetables of all varieties, unusual plants and trees that don’t normally grow in this area,” he said.

“Vanderbilt has been a wonderful place for me. It has been so supportive of seeking new discoveries and training the next generation. I’m looking forward to watching it continue to progress.”

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