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Pulling Back the Curtain: Janis L. Abkowitz, MD

March 31, 2022

April 2022

In this edition, Janis L. Abkowitz, MD, discusses her passions for mathematics and international travel, and her attraction to medicine for its intersection of scientific logic with anthropology and the social sciences.

Jill Sederstrom

Jill Sederstrom is a journalist based in Kansas City.

Janis L. Abkowitz, MDJanis L. Abkowitz, MD, is the Clement A. Finch Professor of Medicine, head of the Division of Hematology, and adjunct professor of genome sciences at the University of Washington in Seattle. She also served as the 2013 president of ASH.

Tell us about your childhood and upbringing.

I grew up in Lexington, Massachusetts, which was both a historic town and a farm town. My early memories included things like sledding on Belfry Hill, where the bells rang in 1775 to mark the start of the first battle of the American Revolution. It was a reasonably conservative town, but if you needed to do something creative or novel, all you had to say was “this is revolutionary.”

The neighborhood where I lived was adjacent to a swamp, so I am an expert at catching frogs. I collected frogs, toads, garter snakes, and turtles and observed their habits. That was my first introduction to biology. I saved money to buy a textbook on zoology, which I still have and read at times.

In first grade, I had difficulty in school because I couldn’t read aloud. I was sent to a remedial classroom located in a basement that I can still visualize today. I sat quietly in the back and secretly read the Nancy Drew books that were on an adjacent shelf. After a few months, when the teacher realized that I could read well above my grade level and only struggled when reading to others, I was returned to the regular classroom. Because of this, as well as her inquisitiveness, Nancy Drew was an early hero.

In high school, I played three varsity sports – softball, field hockey, and basketball – but what I enjoyed most was mathematics. Our math team won state and tri-state competitions, and I was the league high scorer. I also placed fifth in the nation in the Mathematics Association of America exam; at the time, that was the highest score a woman had earned in the exam’s roughly 20-year history. There was a lot of hype around this, but rather than being proud, I was embarrassed. Yes, I was the only girl on the math team and a rarity in the Massachusetts math league, but I didn’t understand why gender was relevant.

Where did you go to college?

I was an undergraduate at Harvard University and majored in biochemical sciences, but I hated my first experiences in the lab. It was like using a cookbook and being required to precisely follow the recipe. In place of a research thesis, I took graduate seminars in mathematics, specifically in number theory and Gödel logic. This is somewhat ironic, since my laboratory research has been continually funded by the National Institutes of Health and my major contributions to the American Society of Hematology (ASH) focus on science research.

At the time, I wasn’t thinking about medicine as a career. It was during the Vietnam War, and final exams were canceled my freshman and sophomore years because of protests. It was a time of political and social challenges. Our discontent, idealism, and hope for a better future propelled us to become doctors, lawyers, and reporters or to join the Peace Corps.

What led you to medicine?

As a junior in college, I decided I wanted to become a doctor because it combined scientific logic with my evolving interest in anthropology and social sciences. This was solidified by advice from a thoughtful mentor, Maurice Pechet, MD, and a summer I spent in Saskatoon, a city in Saskatchewan, Canada, investigating how socialized medicine optimized rural health care delivery.

Upon graduation, I won a Frederick Sheldon Traveling Fellowship, which became the most defining experience of my career. I was appointed as a Traveling Fellow of Harvard University and received funding for a year of exploration. The award required that I spend at least nine months outside the U.S. and no more than three months in one place. Being nominated and selected for this award was a total surprise since it, like most awards at Harvard, had been restricted to men.

I spent a year from 1972-1973 traveling around the world. I spent a month with Belgian pediatricians at a nutrition clinic in eastern Zaire, now the Democratic Republic of the Congo, and traveled overland through Africa and by cargo ship from Cape Town to Bombay, now Mumbai. I also worked on medical projects in Kashmir, spent time with a typhoid fever epidemic team north of Bangkok, and spent three months in the highlands of Papua New Guinea with missionary physicians. I saw children die from kwashiorkor (malnutrition associated with a lack of protein) and it was as though it was an accepted inevitability. There were also uniquely memorable experiences, like helping to set the fractured leg of a cassowary bird so it would still be acceptable as a bride prize. Although I was 21 years old, that year remains just as vibrant and impactful to me today as it was then.

What drew you to hematology?

I became interested in hematology because of the hematology course I took during my second year as a medical student at Harvard. Stephen Robinson, MD, the course’s chair, was an important and inspiring role model. I was also intrigued by how easily accessible blood and marrow were for clinical evaluation and study.

After clinical training as a hematology/oncology fellow at the University of Washington and Fred Hutchinson Cancer Research Center, I joined the laboratory of John Adamson, MD, another important mentor. Although I initially thought that I would study eosinophils, given my prior experience with tropical medicine, I became fascinated by an animal model of erythropoiesis, feline leukemia virus subgroup C–induced pure red cell aplasia (PRCA), one of few naturally occurring models of failed differentiation. Understanding why red cells, and only red cells, could not mature was a puzzle that, like math puzzles, intrigued me.

Which topics have you pursued in the lab?

I quickly discovered that feline PRCA was not an immunologically mediated event like human PRCA, but rather that it was due to the virus’ ability to downregulate expression of its cell surface receptor. The next step was to identify this receptor, but retroviral expression libraries – the technology that was needed – weren’t developed yet, and I needed to change my research direction entirely. I pivoted and used a G6PD-heterozygous cat model to track clonal contributions following limiting-dilution autologous transplantation and showed that clonal succession maintains blood cell production. This started a 25-year collaboration with Peter Guttorp, PhD, a professor of statistics at the University of Washington, focused on stochastic modeling of hematopoietic stem cell differentiation. Although I had not thought about mathematics since college, my conceptual understanding of probability – and thus my lack of fear – made for a fantastic collaboration.

Later when the appropriate technologies emerged, my lab cloned the FeLV-C cell surface receptor (FLVCR). We showed, surprisingly, that it exported heme. We used this, and still do today, to study how red cells mature and to define new targets for the therapy of anemia.

What do you enjoy most about your job?

I think that everyone’s career path is circuitous. What I love about academic medicine is having the opportunity to follow wherever the science leads and to define the path that is right for you.

All along, I’ve also been a practicing physician seeing patients with hematologic problems, predominantly including marrow failure, myeloproliferative disorders, and myelodysplastic syndromes. I love the ongoing interpersonal relationships and how observations in patients can guide laboratory studies, and vice versa.

Dr. Abkowitz visits with chinstrap penguins in Antarctica in 2011.
Dr. Abkowitz visits with chinstrap penguins in Antarctica in 2011.

Being a division head has a fair bit of administrative responsibility that has been especially challenging during COVID. The thing I like most about this part of my job, even more than my science and clinical work, is advocating for faculty and mentoring trainees. What I find most exciting in science and in patient care is creative problem solving, and I’ve found that this is a major component of effective administration.

You served as ASH president in 2013 and have held numerous leadership positions over the years. What have been some of your biggest contributions to the Society?

I’ve been able to help ASH strengthen its translational and basic science mission because my scientific journey involved three distinct communities – red cells, hematopoietic stem cells, and iron and heme. I was the first chair of the ASH Scientific Committee on Stem Cells and Regenerative Medicine, currently serve on the ASH Scientific Committee on Iron and Heme, and am co-leading this year’s ASH-EHA Translational Research Training in Hematology (TRTH) program. I initiated the ASH Bridge Grant program alongside Robert Hromas, MD, PhD. Developing its unique selection criteria was one of my most fond memories. Through ASH, I also set up a program with the Japanese Society of Hematology to help selected trainees with scientific presentation in English.

Dr. Abkowitz lets loose in Bagan, Myanmar, in 2016 while motorbiking between temples.
Dr. Abkowitz lets loose in Bagan, Myanmar, in 2016 while motorbiking between temples.

One of the exciting things about being an ASH leader is that you get involved in things you wouldn’t normally. A good example of that was a meeting that 2018 ASH President Alexis Thompson, MD, MPH, and I had in Indianapolis with National Collegiate Athletic Association officials to explain why it was neither useful nor ethical to require that college athletes be tested for sickle cell trait.

What do you enjoy doing when you’re not at work?

I am happiest when hiking, camping, or just hanging out with my family.

I have two grown children, Jeslyn and Evan, and two grandchildren, ages 5 and 3. They are fantastic.

Our family has always put vacation times together to allow for three- to four-week trips every few years, and we’ve traveled together extensively around the world. I love being “off the grid.”

Probably the most remarkable trip we went on was the three months that we spent traveling overland between Kyrgyzstan and Sri Lanka when my daughter was 16 and my son was 12. This included a 42-hour bus ride from Golmud in western China to Lhasa, Tibet, and lots of exploring.

Dr. Abkowitz holds her granddaughter, Sierra.
Dr. Abkowitz holds her granddaughter, Sierra.

My husband, Richard Miller, MD, an infectious disease specialist, and I spent three weeks in Guatemala this past November, beginning in San Martín Jilotepeque where we had worked as fourth year medical students, one year after a devastating earthquake and just before the height of the civil war. During the war, the town was burned, destroying all records. We decided to go back as a COVID-delayed 40th wedding anniversary present to each other, and the few pictures we brought with us from our first trip were welcomed treasures. While we were there, the city public relations office video-interviewed us about our remembrances for the city’s historical records. We also traveled to remote Mayan ruins and national parks that were not accessible in 1977, especially not by bus or hitchhiking.

We are also big-time campers and backpackers and have done lots of hiking in the western U.S. Some of our favorite sites are Olympic National Park and the Goat Rocks Wilderness area of Washington state, along with the Escalante in Utah. A few years ago, we graduated to car camping and bought a tent that we could stand up in and an inflatable queen-sized mattress. I also enjoy gardening and photography.

Over the years, how did you balance your career and family life?

A wonderful husband and a lot of juggling!

. Abkowitz and her husband, Rich, at Uluru, also known as Ayers Rock, in Australia.
Dr. Abkowitz and her husband, Rich, at Uluru, also known as Ayers Rock, in Australia.

 

 

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