In memoriam: Burton Combes, M.D.
Authors: Steven Schenker
Journal: Hepatology (2014)

I report with great sorrow that Dr. Burton Combes (Fig. 1) passed away unexpectedly in Dallas, Texas, on November 23, 2013. He was 86 and had retired from active clinical work in 2009 as professor emeritus of internal medicine at the University of Texas (UT) Southwestern School of Medicine in Dallas. He joined the UT Southwestern faculty in 1957 and spent his entire academic career there. Dr. Combes is generally considered one of the guiding forces of U.S. hepatology. He was known for his intellect, wise counsel, clinical skills, scholarship, and teaching of many young physicians. I was privileged to be among them, will forever be grateful to him, and will miss him. Dr. Combes was born in 1927 in New York City. He earned a bachelor's degree from Columbia University in 1947 and his medical degree from Columbia University College of Physicians and Surgeons in 1951. After completing an internship and residency at the prestigious New York Presbyterian Hospital, he became a research fellow of the American Heart Association under the tutelage of the eminent scientist, Dr. Stanley Bradley. Later, he continued his initial scientific studies at University College Hospital Medical School in London. Not all activities in New York focused on medicine. While there, he met and married a medical student, Mollie Allensworth, from San Antonio, Texas. Mollie was his devoted partner for life, became a practicing pediatrician, and preceded him in death by approximately 13 months. Burt and Mollie settled in Dallas, where Burt joined the emerging UT Southwestern Medical School under the leadership of Dr. Donald Seldin. At UT Southwestern, Burt established and directed the liver unit for more than 40 years. He seamlessly coordinated patient care and teaching of hepatology with that of the gastroenterology program under the direction of Dr. John Fordtran and then of Dr. John Dietschy. Burt was a superb clinician deeply devoted to the ill. He epitomized the famous dictum of George Peabody that “the secret of taking care of the patient, is to care for the patient.” His teaching method was characteristically soft spoken, erudite, logical, and very persuasive. Burton Combes was a scholar. His initial studies dealt with the metabolism and transport of various forms of bromosulfophtalein (BSP) as a marker of membrane transport. His more clinical studies were to define prognostic factors in acute liver failure, describing various hepatic disorders observed in pregnancy and as principal investigator of multicenter National Institutes of Health (NIH) clinical trials of various therapies for primary biliary cirrhosis. He received a research career development award from the U.S. Public Health Service in 1962. In recognition for his various research accomplishments, he was elected to the American Society for Clinical Investigation and to the Association of American Physicians. On the national scene, Burt was instrumental in developing the guiding principles for collaboration between the academic community and interested lay public in promoting research in liver disease. This group, The American Liver Foundation, owes much to the efforts of Dr. Burton Combes. In 1984, he received the Distinguished Service Award of the American Association for the Study of Liver Disease and served as its president in 1971. He was a frequent reviewer of grants and manuscripts for the NIH and various medical journals. Locally, Dr. Combes served as president of the UT Southwestern Faculty Senate from 1972 to 1974 and as chairman of the Promotions and Tenure Committee for UT Southwestern Medical School from 1982 to 2007, overseeing more than 1,500 promotions to researchers and clinicians during his service. In 2002, he was named an Ashbel Smith Professor, one of the highest honors bestowed by the UT System Board of Regents for excellence in teaching and scholarship. When he retired in 2009, friends, colleagues, and former students created the Dr. Burton Combes Lecture Series in Hepatology in his honor. Willis Maddrey, a clinical colleague of Burt's for many years, called Burt Combes a “gentle giant and a go to clinician who inspired respect for his accurate assessment of complex issues. His love for hepatology and his dedication to UT Southwestern, his friends, and his family were well known to all.” He was honored to have known Burt, a feeling shared by many. On a personal note, I first met Dr. Combes on the Boardwalk at Atlantic City at a “Young Turks” meeting. Having just finished a study of placental transport of bilirubin in guinea pigs in vivo, I was anxious to extend these studies to BSP transfer, benefiting from his experience with that drug. During a short time in his laboratory as a visiting scientist, he asked me to take an entering medical student at UT Southwestern under my wing. And, thus, I met Dr. Joseph Goldstein, who, with Dr. Combes and me, subsequently published two articles on fetal and neonatal guinea pig metabolism and transport of BSP in the American Journal of Physiology. Dr. Goldstein (with Dr. Michael Brown) subsequently won the Nobel Prize in Medicine for their work on cholesterol leading to statins. Dr. Goldstein shared the following vignette: “I was introduced to the excitement and fun of science as a medical student working in Burt Combes' laboratory in the summer of 1963 (between my first and second years of medical school). Burt challenged me to develop a rapid assay to measure the activity of the enzyme that attaches glutathione to BSP. Within several months, I came up with a spectrophotometric assay that replaced the time-consuming prior method that involved thin-layer chromatography. This was my first scientific discovery, and I became hooked on the thrill of scientific research.” Doctors Goldstein and Combes (and I) remained friends thereafter and have often reminisced about this initial chance encounter. Dr. Combes is survived by two sons and a daughter, all in Dallas. He was deeply committed to his family. Burt and Mollie loved music and especially opera. One of the great joys of their retirement were the summer visits to Santa Barbara and involvement in that cultural milieu. It is said that those who are fondly remembered never die. Dr. Combes will live on in our good memories. Steven Schenker, M.D. Emeritus Professor of Medicine University of Texas Medical School at San Antonio San Antonio, TX