The “privilege of trying to help”–
Cardiologist Casscells applies all his skills to service of country
For some people, to be a life-saving cardiologist, a flu pandemic expert and a cutting-edge biotechnology executive would be enough.
But for S. Ward Casscells III, M.D., vice president for biotechnology at The University of Texas Health Science Center at Houston, two events would propel him into doing even more.
The first was in 2004, when he became the first civilian to receive the General Maxwell Reid Thurman Award for his work in using new technologies including telemedicine to improve emergency medical care.
S. Ward Casscells III, M.D.
The second event was the discovery while cleaning out a closet of his father’s World War II uniform and letters of commendation and three bronze stars. His father was a surgeon with Gen. George S. Patton’s army groups for four years.
These events prompted Casscells, then 53, to knock at the door of an Army recruiter. Casscells thought he was a fine candidate, joking later that “I didn’t have any parking tickets.” But an Army sergeant practically laughed him out of the office.
Last summer, three waivers later - for age, hearing loss and a history of cancer - Casscells was commissioned in the U.S. Army Reserve as a lieutenant colonel in the Medical Corps.
As odd as it seems, his two worlds fit together almost seamlessly. The things that mark his career - such as cardiology advances, ground-breaking emergency medicine, pandemic influenza research and nanotechnology - have been or will be put to use in the military field.
“Being in the Army in general has been like being a doctor in the sense of having the privilege of trying to help,” said Casscells, who expects to be deployed to Iraq soon. “But mostly it’s been the privilege of learning from the determination and grace and courage of people who are going through tougher things that you’re going through.”
Casscells has already been deployed to Asia and the Middle East to study the avian flu and assess the possibility of a world-wide pandemic. As a result of his work as the U.S. Army Medical Command’s senior medical advisor for avian influenza and pandemic influenza, Casscells was awarded the U. S. Army’s Meritorious Service Medal.
Casscells began studying influenza seven years ago after he saw a connection between heart attacks and recent bouts of flu or colds in his cardiac patients.
“One third or so of our heart attack patients said they recently had the flu or a cold so we began to urge them to get flu vaccinations. The medical residents asked me to prove the link so by 1999 we had data that flu shots reduced the risk of heart attack or stroke,” Casscells said. “We’ve had a hard time getting people to understand the importance of vaccination but we just keep at it. We’ve just been stubborn about it.”
Col. Ward Casscells inspects his sidearm during officer basic training at Camp Bullis, Texas. (Photo courtesy of U.S. Army News Svc.)
Casscells was one of the principal architects of the Army’s DREAMS (Disaster Relief and Emergency Medical Services) program, which uses technology and real-time video imaging to link remote medical experts with trauma and disaster victims. It can save lives in the case of combat injuries or help reduce the severity of a flu pandemic.
“A typical (military) company doesn’t have a doctor. They have medics, who are incredible heroes - and we’ve lost a lot of them - but a lot of soldiers have no doctor nearby and telemedicine fills that gap,” Casscells said. “In the same way, if you have influenza sweeping the country, you’ve got to care for people by telephone and video camera. People will not want to go to the doctor or to work if they think they could get the flu.”
Casscells goes back to World War I and the 1918 avian flu pandemic to explain why the military is so passionate about containing the newest round of avian flu before it kills millions of people.
“We lost more soldiers to the flu than to combat in World War I,” Casscells said. “Service men were crowded together in ships, malnourished and stressed and many times by the time they reached shore, half were dead.”
A virulent strain of flu can kill 55 percent of infected humans, he said. In the past, flu strains have simply run their course through a population and all susceptible people die. Typically a flu pandemic affects 20 to 25 percent of the world’s population, half of which will die. That could be a billion people, he said.
“No one can get their mind around those numbers. International business could grind to a halt. Borders could close. There could be product shortages. People may develop a distrust of government, leading to unrest. Absenteeism could shoot up to 30 or 40 percent and most businesses or governments can’t function that way,” Casscells said. “Most scenarios looking 1 to 5 years down the road say 10 to 100 million people could die during a six-month period.”
But researchers are rushing to try to make sure that doesn‘t happen.
“No one knows for sure when this avian flu will hit humans. Right now it’s missing a couple of mutations,” he said. “The problem is that it goes so deep in the lungs that it doesn’t produce a cough, which is the body’s way of protecting itself. Most experts think that if we work hard in the next few years that the next pandemic could be mild, particularly if the mutation makes it milder. If we can prevent a pandemic, it will be the first time in history.”
Casscells said he is working on developing antiviral drugs and the surveillance needed to detect the outbreak at the first available opportunity in order to contain it quickly. Isolation, masks, sanitation and antiviral drugs are key. Plants and fruits with antiviral properties, including the star anise plant from which Tamiflu comes, may be the answer, he said.
Building on 2001‘s DREAMS is the Texas Training and Technology for Trauma and Terrorism program (T5), which seeks ideas to improve trauma care and reacting to biological threats. On the research side, it works to develop new imaging techniques and the education and training to support them. The operational component includes having teams packed and ready to go at any time.
Casscells has been responding to disasters since the Oklahoma City bombing and was one of the first American doctors to reach Phuket in the wake of the 2004 Asian tsunami.
Last month, the Department of Defense awarded $5.7 million in federal funds for a new pandemic influenza preparedness and response program based at UT under Casscells’ direction. Called “Texas Science, Humanitarian Intervention, Education and Leadership in Disasters” (TexSHIELD), the multi-disciplinary program conducts research on public health interventions for battling a potential flu pandemic on a global scope.
“Once the flu is behind us, we will refocus on other humanitarian efforts such as natural disasters,” Casscells said.
Another of Casscells’ interests, nanotechnology, also has military and civilian uses. Nanotechnology is the science of taking common chemical elements such as carbon and making them very, very small, which can lead to the elements acquiring different properties. In 2004, Casscells helped launch the Alliance for NanoHealth, now a coalition of seven Houston-area research institutions.
“You can take carbon and when you make it small, you can make shapes out of it and they’re strong,” he explained. “We may be able to make body armor more flexible and lighter for areas that are still exposed such as the arms, face and hands. We think we can use nanotechnology to make solar power more economical, which could make us less reliant on oil. It could change the world.”
During much of this productive time, Casscells was waging a five-year battle of his own against prostate cancer beginning in 2001. He jokes now that he is the only vegetarian in the U.S. Army, a result of a phone call from a former student, the now-famous nutritionist Dean Ornish.
“He said I was kind to him when he was an intern at Harvard and that I had to change my diet. So I went on this crazy diet five years ago and I think that‘s part of why I‘m still alive,” Casscells said.
The bout with cancer was another factor in his decision to join the Army. Now he is inspired by others, as well as being an inspiration to them.
“I shake my head in wonderment that there are those people who sacrifice for others, particularly in this all-about-me generation,” Casscells said. “It has brought me closer to my father. To wear the same uniform means a lot to me. I never put it on without thinking of him.”
Fittingly, it has also made him grow closer to his own sons, now 13 and 10 (he also has an 8-year-old daughter).
“When I first put on the uniform (the day he was commissioned) and came downstairs, they were playing basketball in the yard and there was dead silence,” he said. “Their arms fell to their sides and their jaws dropped. I‘ll never forget that."
By Deborah M. Lake