One of the enduring tragedies of fair Ireland, beset by recurring economic woes, is that it loses many of its best and brightest, who, in search of opportunity, emigrate, most often to the United States.
A sterling example of this brain drain is Garret FitzGerald, who was born in Dublin, and came here the first time at age 18 to take a summer job driving a Coca-Cola truck.
Since then, he has risen fast and far. After earning his medical degree at University College in Dublin, FitzGerald eventually returned to the United States and during the 1980s ran the clinical pharmacology division at Vanderbilt University. He now chairs the department of pharmacology and directs the Institute for Translational Medicine & Therapeutics at the University of Pennsylvania.
He and his fellow researchers were the first to show how aspirin acts to prevent platelets from accumulating and clogging blood vessels. This led to recommending low-dose aspirin as a tool for preventing heart disease. His group also predicted and explained the cardiovascular hazard of nonsteroidal anti-inflammatory drugs, such as Vioxx and Celebrex. And his team discovered a molecular clock in the cardiovascular system and how it and various tissues connect to the brain to regulate the heart and metabolism.
FitzGerald, 62, is one of the premier biomedical researchers in the city, if not the nation. He is also an enthusiastic runner who has completed 25 marathons, including three Bostons (best time: 3:07). After being sidelined by a series of ailments and injuries (a Morton's neuroma in his left foot; vertical tears in both Achilles' tendons), FitzGerald planned to enter this year's New York Marathon (ultimately canceled by Hurricane Sandy) but was deterred by severe bronchitis.
In his youth, FitzGerald was interested in sports but came late to running. In high school, he played rugby, and in college, he played squash, losing his two front teeth when he got smacked in the mouth with a racket just before his academic finals, which added a degree of difficulty to his oral exams.
In medical school and especially when he became an intern and resident, FitzGerald was working brutal hours, grazing and eating constantly. He stopped exercising and began thickening around the middle. His conversion came when he watched the marathon at the 1984 Los Angeles Olympics. Ireland's John Treacy, 27, came in second. Even more impressive was the winner, Carlos Lopes of Portugal. He was 37.
"I was 37," FitzGerald recalls thinking. "If this guy can win a gold medal, surely I can run a marathon."
While visiting another aspirin researcher, Carlo Patrono, on the island of Elba, off the Tuscany, coast FitzGerald laced on some old tennis shoes and went for a three-mile run. Afterward, he was exhausted, "a broken man," but Patrono was encouraging. "You have a marathon man inside you, waiting to emerge," he predicted.
He was right. Within 11 months, FitzGerald showed up at the starting line for the Rocket City Marathon in Huntsville, Ala. The temperature was in the 20s, the course was flat. FitzGerald finished. "I felt wonderful," he says. "I found that I enjoyed running." He adopted the running lifestyle and joined running coworkers, fostering "a culture of running" in the lab. Better yet, his newfound pastime was backed by science. At about the same time, FitzGerald read a paper in the New England Journal of Medicine that found that people who are physically active, especially regular runners, live longer.
The other day, I visited FitzGerald at his office, with large windows offering a magnificent view of the city. I had an agenda. Heart disease runs in the family. My father had open-heart surgery twice and died, at age 71, after surgery for peripheral vascular disease, including the amputation of a foot. To nullify those genes, I exercise in some form (running, biking, weightlifting) about every day. For years, I've also taken two fish-oil capsules twice a day, as well as a multivitamin, and a full-dose aspirin.
Is this doing any good? I asked FitzGerald.
His answer: No.
"Aspirin is the most cost-effective drug on the planet if you've had a heart attack or stroke," he said. "It reduces your chance of another by one-quarter, which is a huge effect for any drug."
But if you haven't had a heart attack or stroke, and you're free of other risk factors such as smoking, high blood pressure and high cholesterol, "there's no evidence of impact on mortality," he said. Any benefit is offset on a one-to-one basis by the frequency of intestinal bleeds.
As for fish-oil capsules, Fitzgerald was even more emphatic. "There's no compelling reason whatsoever to take them for cardiovascular health. (He later sent me the results of a recent study that made the same point.) People who eat a diet rich in fish may enjoy better cardiovascular health simply because they're not eating red meat and fatty food, he speculated, and are more conscientious about engaging in salubrious activities, such as exercise.
As for vitamin supplements: "You're wasting your money," he declared. "If you're not malnourished, if you live in an affluent society and have a reasonable diet, by taking supplements, you're merely enriching the vitamin output of your urine."
For the record, FitzGerald practices what he preaches. He does not take aspirin, fish-oil capsules, or vitamin supplements. One thing he does do - and which is conducive to cardiovascular health - is run, three or four days a week, usually at lunchtime.
The other day I accompanied him. We crossed the South Street Bridge and circled Rittenhouse Square, then returned to the Penn campus via the Walnut Street Bridge and a path traversing gorgeous Penn Park. FitzGerald, who weighs 168 pounds (about 20 pounds more than his ideal racing weight), moved at a brisk, seemingly effortless pace. I had trouble keeping up, mainly because I forgot my running gear and was wearing loose-fitting tasseled loafers.
No problem there. The sun was out, the air was bracingly chilly, and we were running fast enough to work up a sweat. Besides, running is primarily about mind over matter. In fact, during our wide-ranging conversation, FitzGerald mentioned a study of a broad cross-section of British citizens, in a variety of occupations, that showed the principal factor in feeling a sense of well-being and exhibiting cardiovascular health is the perception of autonomy.