Being one of ten children, he had to learn to focus. Fortunately for those suffering from bone cancer, Dr. Denis Clohisy, Chair of the Department of Orthopedic Surgery at the University of Minnesota, has brought his pinpoint vision and insight to the lab.
Born in Evanston, Illinois, Dr. Clohisy is philosophical about his upbringing. “Being one of ten kids was a wonderful experience, and I think, has helped me better understand the variety of personalities, talents and dreams that are out there. As for my parents, they just expected that we do our best.”
Denis Clohisy took this expectation and, well, magnified it. “In high school I developed a fondness for chemistry, then went on to major in that field at Knox College in Galesburg, Illinois. I was able to do an independent study using the electron microscope and was fascinated because it could take you down into the cells…it was like driving around in the cell. That’s when I realized I wanted to both pursue a career in research—and be a doctor.”
Training for the Lab and the Hospital
Setting his sights high, the modest Dr. Clohisy says he then bumped up against a few people higher up on the intellectual mountain.
I attended Northwestern for medical school, in part because I already had a connection there—during college I was a research fellow at Northwestern through the American Heart Association. One of the main things medical school taught me? That there are a lot of people out there who are smarter than I am…a good life lesson.
But he was certainly savvy enough to negotiate for what he wanted. “In 1983 I began an orthopedic residency at the University of Minnesota—this is after ensuring that they would give me enough time to explore research opportunities inherent in orthopedics. In all, the program took seven years because I spent two years doing full time research at Washington University in St. Louis. While there I worked with a world expert in bone disease, Dr. Steve Teitlebaum, who taught me that I should always have a vision of achieving something great. Also critical to my professional life was Dr. Zvi Bar-Shavit, an Israeli scientist who taught me how to conduct top notch research, imparting the helpful wisdom that a researcher should focus his efforts on one thing and do it exceptionally well. Then there was Dr. David Lacey, who possessed a unique talent and enthusiasm for applying science to medicine.”
Returning to Minnesota for three years, Dr. Clohisy then made a strategic decision. “I knew that in order to do the research I wanted to do, I would have to be at a major medical center. I knew I would have that freedom within the world of orthopedic oncology because most of this work occurs at such institutions. There was also the dawning realization that I really liked taking care of pediatric oncology patients.”
The wisdom of other prominent orthopedists also helped him find his path. “In 1990 I began a fellowship at Harvard in musculoskeletal oncology, something which held a significant amount of responsibility. Fellows oversaw the clinical program, including the residents, patients, surgical scheduling, ordering implants, etc. The preeminent academic surgeon, Dr. Henry Mankin, guided me through much of this. His love of orthopedics and medicine was impressive, as was his tendency to ask ‘the why’s’ of orthopedics. Dr. Dempsey Springfield taught his clinical mastery by example, and Dr. Mark Gephart gave me a wonderful experience in dealing with children who had cancer. In particular, he set a helpful example of how to work with families.”
Researching Cancer and its Treatment
Looking back over 22 years of continuous NIH funding, Dr. Clohisy reflects, “Early on we discovered that osteoclasts destroy bone at the sites of the tumor, in contrast to the long-held belief that tumors ate at bone. While we weren’t the only ones pursuing this line of research, I am proud to say that our work helped change things such that we now treat osteoclasts in addition to treating the cancer.”
But ultimately, of course, they are treating a human being who has bone cancer pain. And, says Dr. Clohisy, if they can determine the exact mechanism of pain, then they can better treat those tormented by this condition. “One part of the pain is caused by the osteoclasts stimulating the nerves. Other pain is caused by weakening of the bone. I collaborated with Dr. Patrick Mantyh, a neuroscientist, on this work. I understand bone cancer and he understands pain and neuroscience, so it was a good fit. Working with Dr. Mantyh was a once in a lifetime opportunity and an adventure. We formed a great team, which was driven primarily by his energy and wonderful commitment to discovery. It was a rare thrill to be the first group to discover many of the ways that bone cancer causes pain.”
The American Academy of Orthopaedic Surgeons (AAOS) chose Dr. Clohisy to Chair the research development committee. Dr. Clohisy, who has a particular interest in the development of orthopedic clinician scientists, notes, “The greatest thing about this role is working with people on the committee. The variety of talents comes from the Orthopaedic Research Society, the Orthopaedic Research and Education Foundation, AAOS Leadership Fellows, etc. We also have resident representative from AAOS who work on the clinician scientist development program, attend NIH discussions, and meet congressional leaders.”
Advice for Aspiring Clinician Scientists
In terms of what residents need to become clinician scientists, Dr. Clohisy states, “There are a couple of obstacles to this, the most significant being the debt that many residents have from educational loans. This is an especially heavy burden because clinician scientists have lower salaries and don’t enter the workforce until later because of the extra time required for scientific training. In addition, for the past five or six years, there has been an increasingly competitive funding environment at NIH. There has been a bit of relief from the stimulus package, however. Another issue is that residents often have limited training in grant writing. That is being corrected to a certain extent as we now have grant writing training programs through the Bone and Joint Decade, as well as several programs through the specialty societies.”
Then there are the cultural issues: 1) lab versus OR; and 2) How does young Dr. Smith advocate for her superiors to understand the importance of lab time? An adamant Dr. Clohisy says,
Residents must have protected time to do their research. Most of these young surgeons are understandably excited about their surgical skills, and that tends to draw them away from using the protected time for lab work. Also, the orthopedic leadership in the departments may not fully understand the protected time needs that they have. This is not always part of the institutional culture, particularly in the surgical disciplines. But how else will our field advance?
In this time of shoestring funding, it is especially important to drive home the importance of research. Dr. Clohisy reports: “With the support of AAOS, we go to ‘The Hill’ to deliver our message. Patient advocates and physicians hold ‘Capitol Hill’ days in which we advocate for research funding. There is also an educational program for the patients, physicians and scientists, followed by a dinner with a speaker who discusses the need for musculoskeletal research. The next day the patients go to Capitol Hill where they are divided into geographic districts—then they go see their congressional representatives from their districts. Everyone makes important contacts and follows up with their representatives later on reporting the status of musculoskeletal research.”
When he comes down from the hill and the lab, Dr. Clohisy meets a bevy of children—not ten, mind you, but a few. “My overall happiness is a reflection of my family. They are highly supportive of my work needs and my responsibilities. I have three children, two boys and a girl—all teenagers. I get involved in their sports, and watch my daughter dance—her passion. When we get away as a family, I make sure it is to anyplace warmer than Minnesota and usually go fishing.”
