John Kurtzke

Abstract

Pioneering neuroepidemiologist who studied multiple sclerosis. Born on Sept 14, 1926, in Brooklyn, NY, USA, he died from a stroke on Dec 1, 2015, in Falls Church, VA, USA, aged 89 years. “It may seem unlikely to many that one could even hope to learn the causes of things such as diseases by means of that discipline labelled epidemiology”, John Kurtzke wrote in a chapter of Multiple Sclerosis: A Critical Conspectus published in 1977. But for Kurtzke, who was the chief of the neurology service at the Veterans Administration Hospital in Washington, DC, USA, for more than 30 years, studying the incidence of multiple sclerosis and its progression in populations throughout the world revealed environmental factors that influence a person's risk for the disease. “John was passionate about understanding MS and using the power of epidemiology to do so”, says Mitchell Wallin, Clinical Associate Director of the Multiple Sclerosis Center of Excellence-East at the US Department of Veterans Affairs, who worked with Kurtzke for decades. In the 1970s, Kurtzke began to study a multiple sclerosis outbreak in the Faroe Islands. He found there were no cases of the disease between 1900 and 1943, but that 24 people were diagnosed between 1943 and 1960 and then one person again in 1970. The residents with multiple sclerosis were in contact with British troops who occupied the islands during World War 2, leading him to postulate that an infectious agent that came and went with the soldiers might have caused or precipitated multiple sclerosis in susceptible individuals. He argued, up until 2 weeks before his death in an address at the National Institutes of Health, that the epidemiological evidence suggested an infectious agent spread via the gastrointestinal tract might have initiated the disease. “He had a very observant eye for where the disease occurred and why. He was a sort of detective”, says Ahmed Obeidat, a Clinical Instructor in the Department of Neurology and Rehabilitative Medicine at the University of Cincinnati College of Medicine. Throughout his career, Kurtzke studied the environmental risk factors for multiple sclerosis, often in large military cohorts. He and Wallin examined two populations of veterans who served in World War 2 and the Korean War, and the Vietnam War. Grouping the veterans with multiple sclerosis by their place of birth and where they lived when they entered service, they found that the risk for the disease was higher in people from the northern USA than those from the south but that the relative risk associated with geographical differences decreased between the World War 2 and Vietnam veteran populations. “Such marked changes in geography, sex, and race in such a short interval strongly imply a primary environmental factor in the cause or precipitation of this disease”, they wrote in 2004. They went on to study veterans who served in the Persian Gulf and found the risk of developing the disease was increasing for African Americans and women over time. In 1955, he published a clinical scale used for measuring the severity of multiple sclerosis and evaluating the progression of the disease in patients. The Kurtzke Disability Status Scale was expanded in the 1980s and is still commonly used today. “It was a clever way of taking the traditional neurological examination dating back to the 19th century and earlier, applying sentinel aspects of the neurological exam and translating it to a single number”, says Nicholas LaRocca, Vice President of Health Care Delivery and Policy Research at the National Multiple Sclerosis Society. “This benchmark saw widespread use in clinical trials and in economic analyses of the disease where it helped to illuminate the varying health-care needs of this population as the disease progresses.” Kurtzke graduated from St John's University in New York City and received his medical degree from Cornell Medical School in 1952. He served in the US Navy medical corps in World War 2 and remained in the Naval Reserves until he retired in 1986 as a two-star admiral. From 1956 to 1963, he was Chief of the neurology service at the Coatesville Veterans Affairs Medical Center; he held the same position at the Veterans Administration Hospital in Washington, DC from 1963 to 1995. “He was very focused, relentless and not deterred by sceptics. But he was also humble and approachable. As a result, he was able to work with a wide variety of people”, says LaRocca. Kurtzke is survived by his wife, Peggy; six children; 21 grandchildren; and nine great-grandchildren. Two children predeceased him.