David Streeten Memorial Lecture presented at the 24th International Symposium on the Autonomic nervous System

I am deeply honored to have been invited to give this annual David Streeten lecture, and to follow such distinguished past speakers such as Wouter Wieling, who, you may recall, took you on a tour of the autonomic nervous system in only 30 s. That must have been quite a trip and a lot of fun! Well done, Wouter. Or Frank Abboud discussing sensory signals in the development of neurogenic hypertension. That was almost certainly extraordinarily erudite and scholarly, or David Goldstein speaking on Catecholamines 101. Knowing David it was clearly not an ordinary 101 type lecture. Well, this talk will not deal with the facts, hypotheses, discoveries and challenges of a particular aspect of autonomic science, but instead, will, I hope, tell a tale of what medical scientists have done right in the past and, unfortunately, what, in my opinion, they may have done wrong. But first, I must tell those of you who do not happen to know very much about David Streeten, a little bit about him. He was a good friend, and a superb colleague to many of us. An extraordinary scientist, he was brilliant, gifted, stubborn, self confident and selfless, all at the same time. He told me an interesting, and instructive story about his career at The University of Michigan that demonstrates the sort of selfless person he was. He was in Ann Arbor working as a young faculty member in the laboratory of a famous endocrinologist, who, as you will see, needs to remain nameless in this presentation. One day, David, upon reviewing his records realized that he had accumulated a group of patients, each of whom had severe hypertension resistant to treatment, were hypokalemic and each with markedly elevated levels of aldosterone. He further discovered that the majority of this cohort had clearly detectable apparent adrenal masses on imaging. Excited, he told his boss about these findings, but, unfortunately, heard nothing from him subsequently. He later discovered that his mentor had published a summary of these patients, without either including Streeten’s name as a coauthor or even acknowledging his important participation. Thus, was primary hyperaldosteronism first described. Such may be the fate of some younger investigators, even today, but David took this in stride with a maturity and wisdom most of us would find to be surprising for his age. I paraphrase David ‘‘Oh, well, he was an egomaniac and in the end I made a valuable contribution to the field of endocrine hypertension’’. Such was David Streeten, and I am proud to give this lecture in his honor. I believe that every one of us is born with an innate sense of goodness, which subsequently evolves into knowing what is right and what is wrong; as you have matured into your professional lives it is expressed as a bioethical imperative: to do no harm to your patients. We all try to live up to that––but we recognize that working long hours and suffering the bone numbing fatigue that we all must endure, makes adhering to this concept difficult. This vital credo of not doing any harm to our patients likely becomes battered and bruised and driven out of our sensibilities during the harrowing years of our medical education. Unfortunately, what most often happens is that as we mature into young trainees patients are no longer called patients, they evolve into cases, which then become diagnoses: Mrs. Jones is no longer the very pleasant elderly gray haired lady in room 420, but is now the CA of the lung with wide spread metastases, or even worse, and please I. Schatz (&) University of Hawaii School of Medicine Honolulu, Honolulu, Hawaii e-mail: Schatzi@hawaii.edu