November 19, 2010

VUMC Reporter profile: Sharp mind, humble heart help drive Brown’s success

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Nancy Brown, M.D., was recently named chair of Vanderbilt’s Department of Medicine. (photo by Joe Howell)

VUMC Reporter profile: Sharp mind, humble heart help drive Brown’s success

Clinical pharmacologist Nancy Brown, M.D., relaxes in her chair, leans on an elbow and gives each speaker her utmost concentration.

A dozen or so biomedical scientists attend Brown's weekly research meetings, held in a small conference room tucked amid laboratories high in the Robinson Research Building. Five or six young researchers take turns reporting out lab activity and presenting their latest data, as Brown listens and asks questions.

One young lab member is describing a stint of productive but intense work with a study's human subjects.

“I go home exhausted every night,” she says resignedly, wrapping up her report.

“Excellent!” Brown replies, with spot-on comic timing and a gleeful mercilessness that is just right.

It gets some laughs. Brown may have an unfailing sense of humor, and she may be the opposite of dour, but she hardly appears to be the effusive sort either. Her way of saying things is measured, concise, matter-of-fact.

Responding to interview questions, she is consistently open and candid, but you don't picture her closing her letters with little X’s and O’s, nor is it likely that slapping backs and jiggling ice cubes was ever really her thing.

Nancy Brown, M.D., shares a laugh with Matt Luther, M.D., and other colleagues during a recent lab meeting in the Robinson Research Building. (photo by Joe Howell)

Nancy Brown, M.D., shares a laugh with Matt Luther, M.D., and other colleagues during a recent lab meeting in the Robinson Research Building. (photo by Joe Howell)

“She has a quiet warmth, she's not a hail fellow well met,” said Lisa Guay-Woodford, M.D., a colleague and friend who directs the University of Alabama at Birmingham Center of Clinical and Translational Science. “She's not in your face, not obtrusive, but very genuine.”

On Nov. 1, Brown took over as the Hugh J. Morgan Professor and Chair of Vanderbilt's Department of Medicine, the first woman to hold the post.

The department's total annual research funding stands at $169 million and Brown is responsible for some 625 faculty members in 13 divisions, who are joined by 416 residents and fellows. As part of the legacy of her predecessor, Eric Neilson, M.D., she inherits a department that has risen to sixth in the nation in funding from the National Institutes of Health.


True to science

Colleagues say Brown's clarity of mind in the laboratory is something to behold. The committee tasked with search for a new chair of Medicine considered a number of highly qualified physician-scientists, but what helped set Brown apart was a rare capacity for recognizing and nurturing scientific talent in others and her passion for science itself.

“She's inspirational in her thought process,” said Robert Carey, M.D., Emeritus dean of the University of Virginia School of Medicine.

A colleague at Harvard, Gordon Williams, M.D., said, “She formulates ideas consistent with the data. She poses very clear hypotheses, which can be tested effectively” — a sort of basic grant requirement, one might think. But it's clear that Williams is talking about something far richer. “I think that's a unique talent,” he said.

Brown's research team studies vascular biology in humans, with emphasis on blood pressure regulating systems and their various interactions with clotting systems and with inflammation. Health implications of these interactions range from stroke and heart attack to atherosclerosis and diabetes.

I try nudging Brown into contrasting her work with someone else's in terms of the validity and promise of their respective approaches. I even try painting an example, from elsewhere in current biology, of what look like disagreements over guiding concepts and methodology.

There must be some investigators who share Brown's general area of inquiry but who happen to have opposed outlooks, mustn't there?
Brown isn't buying it.

“It's not that one approach is more valid. It's that we need to remain agnostic to the answer when we do research or see patients,” she said.

“I think we always have to question dogma. If we frame objective hypotheses and then we look at the data without bias as best we can — because we're all human — and we pay attention to outliers and ask the question 'what's different about this outlier?' then we will see new patterns that we might have missed and we'll ask new questions.”


Learning to adapt

Don and Joan Brown's three children were Air Force brats. A Canadian immigrant, Don Brown joined the service upon graduation from Columbia University and retired 32 years later at the rank of Major General.

Growing up, many of Nancy Brown's summers were spent moving with her family.

“I think that it made me flexible and versatile in a way that living in one place all my life would not have. If you move a lot and you have a supportive family, it's a positive thing; one can acclimate quickly to new situations.”

As a freshman at Yale, Brown became fascinated while sitting in on introductory biology lectures by a pair of Nobel Laureates, and she wound up majoring in molecular biophysics and biochemistry.

“Even as a child I liked reading books about science. I was just really interested in how things work. I'd read very dry stuff, like how a thermometer worked, at a young age, and I remember being fascinated by it.”

After a one-year, less-than-gratifying stint as a consultant for an alternative energy company, Brown opted for medical school, “for all the usual reasons.” After earning her M.D. at Harvard, she moved with her husband, Andrew May, to his native Nashville.

Brown reviews a patient’s case with S. Scheaffer Spires, M.D., during clinic rounds. (photo by Daniel Dubois)

Brown reviews a patient’s case with S. Scheaffer Spires, M.D., during clinic rounds. (photo by Daniel Dubois)

They had met as students at Yale. May, an ex-Marine and a Harvard MBA, has spent his career as a securities analyst specializing in health care services companies; he recently became chief financial officer at Nashville Bank & Trust. The couple has three sons: Dan, a senior at Princeton; Ike, a senior at University School of Nashville; and Sam, an eighth-grader, also at USN.

May and Brown have both been active in the Nashville Jewish community, and Brown has taught Hebrew at their synagogue.
Isn't there a tension between the call to faith and the demand in science for rationality?

The question appears to leave Brown mildly amused.

“It's not a tension at all, actually. I don't find that the rational and the spiritual are mutually exclusive.”

Brown, who once rowed for Yale, keeps in shape with jogging and sessions on a stationary rower. She is musical, but no longer finds time for piano or flute. The boys each play music and participate in athletics.

Everyone likes camping and they've taken a number of far-flung backpacking trips together.

In the summer of 2008, Brown, her husband and her husband's brother joined 10,000 other cyclists for the week-long RAGBRAI — Register's Annual Great Bicycle Ride Across Iowa — billed as the world's largest bicycle touring event.

“I thought RAGBRAI was a good metaphor for life. You ride 70 miles to get to the next town. Pretty soon you figure out it's the riding that's the thing — not the destination.”


Consummate mentor

Brown began her medical residency at Vanderbilt in 1986 and has never left. She was the 1991-92 Hugh J. Morgan Chief Medical Resident. In the late '90s, with Tom Hazinski, M.D., she developed and led Vanderbilt's Master of Science in Clinical Investigation; in 2006 she was named associate dean for physician scientist development; in 2009 she became chief of the Division of Clinical Pharmacology.

“She always keeps the careers of her protégés foremost in her mind. She's a consummate mentor. She knows how to lift you up — and push you from behind a little bit,” said Annis Marney, M.D., who studied with Brown for three years and is now a faculty member at the University of Vermont.

Brown has nurtured trainees and junior faculty, “really placing that high on her agenda. Not all successful scientists are as good at that,” said John Oates, M.D., a mentor of Brown's (and chair of Medicine from 1983 to 1996).

Alastair J.J. Wood, M.B., Ch.B., is another mentor. “She will be a terrific chair because everyone who works with her will quickly recognize that she is absolutely straightforward and honest — she means what she says, and delivers what she says she will do,” Wood said.

Gordon Williams has his own take on Brown's leadership skills. Both science and clinical work are becoming far more collaborative than in the past, he observes.

“If it were 20 years ago I'd say she doesn't fit the mold. If you looked at the typical chair of medicine or surgery over the last century, she would be quite atypical. But if you look at what's needed in the 21st century — clear thinkers, listening to others, suppressing the ego, less dictatorial — she's it.

"From my perspective, she's somewhat unique in academic medicine, where most of us have big egos and tend to show that more than we should. She's much more open to ideas and thoughts that come from other people. She's much more oriented to serving than to having others serve her,” Williams said.

Brown, center, was honored at a special reception last week hosted by Jeff Balser, M.D., Ph.D., left. (photo by Joe Howell)

Brown, center, was honored at a special reception last week hosted by Jeff Balser, M.D., Ph.D., left. (photo by Joe Howell)

As Brown's 75-minute-long lab meeting draws on, she asks a young lab member a series of insistent questions.

She tells him, “It's too easy to do a bunch of experiments and lose track of what it is you're asking.” She isn't chiding or scoring points, she is scrutinizing and guiding.

Near the end of the meeting the discussion, for once, briefly veers entirely off track — to Louisiana, the home state of one of the medicos. Brown listens along as, playing off one another, these young life scientists hypothesize a relationship among the Pelican State's sky-high rankings in self-reported happiness, obesity, and availability of drive-thru alcohol.

The room erupts. And Brown slowly claps her hands as she is reduced to rocking in soundless laughter.