Leader, Scientist, & History Buff
Arthur H. Rubenstein, MD, MBBCh, served as Executive Vice President of the University of Pennsylvania for the Health System and Dean of the University of Pennyslvania’s Perelman School of Medicine from 2001 to 2011. He is a professor in the University of Pennsylvania’s Department of Medicine’s endocrinology division. He previously served as Dean at the Mount Sinai School of Medicine in New York from 1997 to 2001. He has authored more than 350 groundbreaking papers in diabetes research, including the isolation of the pro insulin breakdown product C-peptide in 1969 together with Dr. Donald Steiner, which helped advance the medical community’s understanding of the role of insulin secretion in diabetes and translated to improved diagnostics for patients. He received the George M. Kober medal from the Association of American Physicians and the Abraham Flexner Award from the Association of American Medical Colleges for his commitment to research and medical education. Dr. Rubenstein was born in South Africa and attended the University of the Witwatersrand in Johannesburg for his medical degree, which he received in 1960 before moving to work as a researcher in England. He first came to the U.S. to work at the University of Chicago in 1967, where he worked for 30 years and also served as chair of the department of medicine.
Dr. Rubenstein gave my medical school class a fascinating lecture on the history of diabetes research, recommending many books along the way—such as Gratitude by Oliver Sacks, and The Discovery of Insulin by Michael Bliss. In fact, he referenced William Osler in telling us that great budding physicians should read some non-medical material for at least half an hour each day. It was exciting to see such an innovative researcher and leader also reference the importance of literature and history. I sat down with Dr. Rubenstein to ask him more about his career in research and leadership, what he reads outside of medicine, and the advice he has for people who want to be creative in research, leadership, or other aspects of medicine.
VV: What made you interested in medicine growing up?
Dr. Rubenstein: I grew up in South Africa. My father was an immigrant from Poland, my mother’s family from Lithuania. My father was a pharmacist; he had always wanted to be a physician, but he didn’t have enough money. He had worked during the day and went to pharmacy school at night. When I grew old enough, I would help him in his pharmacy, and he would talk to me about becoming a physician. To be truthful, I think I did it to please him. I was a good student at high school, and in South Africa you go directly from high school to medical school. There’s no college, and medical school is six years. I didn’t really have a passion for it at the time, but once I started medical school I loved it, so he was right— he knew me well. I loved clinical medicine.
VV: How did you specifically become interested in endocrinology and diabetes?
Dr. Rubenstein: I became interested in a diabetic patient when I was a junior medical student. This patient had terrible low blood sugars and hypoglycemic seizures. I spent weeks and months trying to work out what caused this problem and eventually I made a discovery as a student that he was lacking some catalyst that facilitated insulin’s action. It got written up in the Lancet and Nature and so on, and that made me quite famous as a student and diabetologist.
VV: What led you, as a young student, to that discovery?
Dr. Rubenstein: The patient told me that he was drinking an extract of a grass called Lucerne to control his blood sugar. It is a kind of a wheat extract that people usually didn’t eat; it was actually fed to animals. He had for some reason tried a variety of things to treat his diabetes because he was interested in herbs and natural foods. Everyone had ignored him and said it wasn’t true, that it wasn’t possible that you could drink this stuff and regulate your blood sugar. But I listened to him. I went to the zoo, I got this grass, and brought it back to the hospital. He and I worked together to make an extract, and he drank it, and his blood fell to a low level. So, it was extremely exciting.
VV: Did you have a mentor who encouraged you?
Dr. Rubenstein: Yes, I had several mentors including somebody who helped me in the lab to work out the basic principles of this. I then became very interested in clinical research, especially diabetes. But at that time in South Africa it took three weeks for journals to arrive. They came by ship! So I used to wait for the Lancet or BMJ or JAMA to come, and it would usually come one month later. Believe you me, it’s a different era now!
VV: When did you decide to leave South Africa, and why?
Dr. Rubenstein: I hated apartheid. I actually got married to another physician at that time, my wife, Denise. I’m still married to her 54 years later; she’s a wonderful woman. We decided we couldn’t live in South Africa because apartheid was so painful. I had African colleagues and students and they were being harassed by police, some even put in jail. Many people were going to study in England, which was the great mecca of medical knowledge for South Africans. One day there was a visiting endocrinology professor from a famous hospital medical school in London called Hammersmith hospital, and I asked him if I could come and work for him. He said, “If you get a scholarship—I have no money, but I have a place for you.” So I wrote thirty or forty applications and I got a grant, and then my wife and I and our first son, Jeffrey, went to London, and it was fantastic. In England, there was more tolerance, diversity, openness in society, and free speech. It made us sure we wouldn’t go back to South Africa. We had another son there named Errol: Then my scholarship finished, and we didn’t know where to go. I looked for a lot of jobs, but I couldn’t get a position in England, nor in Australia or Canada. A friend of mine at the University of Chicago suggested applying for an NIH grant and working at the University of Chicago. We looked at the map, where Chicago was, and my wife’s father said it’s very cold there in winter! In August 1967 we arrived there for the first time.
VV: How did your move first to England and then the University of Chicago influence your career?
Dr. Rubenstein: I stayed at the University of Chicago for thirty years, and it was fantastic. It’s such a gorgeous university, with beautiful buildings and quadrangles, and great scientists and physicians. I met Don Steiner, who was a great scientist, and he discovered how insulin was made through a precursor called proinsulin. It was one of the great discoveries in diabetes of all time, following the discoveries of great people like Sanger, Berson, and Yalow, Dorothy Hodgkin, and Banting and Best. He’s in that category, so it was a privilege to work with him. He worked out how proinsulin was made, and then we measured c-peptide (connecting peptide), interpreted diabetic patients’ beta cell failure, and worked on many publications together. I eventually became vice chairman of the department of medicine and then I was chairman for fifteen years and it was incredible. I loved teaching students and residents, and I learned all kind of leadership skills.
VV: I haven’t encountered many professors in medical school yet who talk and know so much about the history of medicine. I was curious what you think the importance is of knowing that history. I know you personally are really interested in it, but do you think it also has played a role in how you approach research and leadership in your career?
Dr. Rubenstein: I’m always inspired by remarkable people in history. I just reread The Citadel, by A.J. Cronin. It’s an incredible book. Cronin was a physician, and he wrote about the medical problems resulting from coal mining in England in the early 20th century. He saw that coal dust was hurting people, giving them silicosis and other illnesses, and pointed out the lack of concern about safety for mine workers. When he wrote this novel, some people tried to suppress it at the time. But he pointed the issue out. How can you not be proud of medicine if there are people like that around? It’s inspiring. If you don’t know about them, it’s like you’re missing something. You can live in the present, but it’s not the whole world, right?
VV: You’ve told our medical school class to read something outside of medicine for thirty minutes every day. What are your favorite books or articles?
Dr. Rubenstein: People always ask that and I’m not sure. I mean, my wife and I love Shakespeare. I read different things at different times. I read things by various mystery writers, I enjoy those too. I read the book on the Lusitania, the luxury liner that was sunk in the first world war—called Dead Wake—that’s a really good book. I read what I have time to and what’s around. I do look at what the New York Times says about books. I read Stephen King’s Mr. Mercedes; it’s scary but he’s a great writer.
VV: When you came to the University of Pennsylvania, people say the hospital system was in a bad state, and considering selling to a private third-party. You had to make a lot of important decisions to turn the situation around. As a leader, how did you make those decisions when you joined Penn? Who did you listen to and talk to?
Dr. Rubenstein: Penn Med had lost a lot of money, and it was impacting the university as a whole. So the possibility of selling the hospital to a for-profit hospital chain was contemplated. It would have been a disaster because our faculty wouldn’t have put up with it, and for-profit organizations don’t worry as much about education and research. I said I wouldn’t come if they did that—I was at Mount Sinai in New York at that time. They said they’d delay doing it for a year or so, and see if we could turn it around. So I said okay, I’d come and give it a shot. I built a team of really great people. We had to let a lot of people go, it was very difficult—and we reduced some salaries. But almost nobody left. Great students still came, faculty said we’ll hang in there with you, and after a couple of years, it all turned around. We got more patients, more grants, we cut our expenses, and gradually righted the ship.
VV: When you had moments of doubt how did you deal with it? How did you choose these team members—what qualities do you look for in a good leader?
Dr. Rubenstein: Being a 250-year-old medical school, you don’t want to be responsible for damaging it. So I felt very responsible and challenged by the situation, and I think everyone felt the same. I tried to get as much advice as possible from colleagues. I like the term “servant leaders”—people who put the institution first, not their own egos, and have a skill set that can contribute in a very special way to making an organization better. It was never about us, it was about what we could do to make the place better. Each person was key, and the whole was so much bigger than the parts.
VV: What are you working on these days that you’re passionate about?
Dr. Rubenstein: I mentor a lot of people, so I see them often and we learn from each other. I have a group of other deans that I’m very close to and we go around the country doing strategic planning and troubleshooting and helping places that are not doing well. And I spend lots of time with my wife and family. I’m very busy, but I love it!
VV: Who are the deans you are close to?
Dr. Rubenstein: Two deans I’m really close to are Phil Pizzo, he was the dean at Stanford Med, and Tom Lawley, former dean at Emory Med. We all stepped down around the same time and we formed this little group. We go around to medical centers, mainly, who want our opinion. We spend several days there interviewing faculty and students and leaders, and then we write reports and try to help them.
VV: Does the group have a name?
Dr. Rubenstein (grinning): Yeah! It’s called ATP—Arthur, Tom, and Phil! It is now the Academic Advisory Council affiliated with a healthcare company called Merritt-Hawkins.