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Neurology Today:
doi: 10.1097/01.NT.0000335588.81278.8a
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The Drachmans at Work: A Twin Century of Neurology

AVITZUR, ORLY MD

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When David A. Drachman, MD, and his twin brother Daniel B. Drachman, MD, were interns in 1956, they made the joint decision to choose the specialty of neurology because they believed that “at the time, it could be mastered entirely.” They had been inspired, in part, by having spent 100 hours building a model brain together at New York University Medical School in a course taught by Louis Hausman, MD. This year marks their aggregate 100 years of membership at the AAN.

The Drachman brothers, who communicate by phone twice a day (or by extrasensory perception, as Daniel jokes), have their share of entertaining twin stories and tales of mistaken identity.

On one occasion, when Daniel was having back surgery, David experienced the feeling of pre-anesthetic sedation while riding on a train to visit his twin. He wrote down the time and later confirmed that it coincided with Daniel's actual time of pre-surgical sedation — even though, unbeknownst to David, the surgery had been greatly delayed.

They each have three children, who, as they point out, are genetic half-siblings. When growing up, the cousins referred to themselves as gen-half-sis and gen-half-bro. David's son is an interventional cardiologist at Mass General, one daughter is a banker, and the other is a consultant.

One of Daniel's sons also went into medicine (hematology/oncology), and is now working for a biotech firm in Seattle; another is a cellist; and the third writes children's books.

The Drachman twins have quite a few hobbies. Daniel has been a serious clarinetist since he was thirteen. His most cherished performance was with his father-in-law, famous cellist Gregor Piatigorsky, and with renowned violinist Jascha Heifetz, playing Mozart's “Clarinet Quintet in A.” He also enjoys cycling and in 1990, along with his wife, bicycled 4,605 miles from his home in Baltimore to Seattle.

David enjoys wood sculpting and photography. His most recent sculptures used the technique of violin varnishing, which requires the use of fine brushes, and the painstaking application of ten coats of special varnishes, rubbing between each coat. It's exactly the sort of work, he admits, that should satisfy the compulsive needs of a neurologist, and gives a spectacular finish to boot!

The Drachman twins, who both enjoy fly-fishing, are planning their next outing to upper New Hampshire in August. They've taken numerous fishing expeditions together over the years. During one of those trips by seaplane, they stopped at a little airport in Minnesota on the way back from Canada. One brother, upon returning from the men's room, waved at the other, only to discover he was waving at a mirror.

Over the years since the incident, both twins have claimed ownership for the gaffe and neither will recant. But Daniel takes full credit for having grown a mustache while at a Wyoming dude ranch vacation with his family. On his return, the brothers met up at another airport in Denver, where David asked, “What have you done to our face?”

Through extraordinary careers, they've observed neurology evolve from a branch of internal medicine to a complex and broadly diverse specialty. Neurology Today asked them both to reflect on the changes they've witnessed over the years and to describe what sustains their interest and passion in the field.

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GIVEN ALL THE CHANGES IN MEDICINE OVER THE PAST 50 YEARS, WHAT SUSTAINS YOUR INTEREST AND PASSION FOR NEUROLOGY?

Daniel: The more we know about the nervous system and its diseases, the more there is to find out. It is the application of existing knowledge, and the challenge of being able to add to it, that has always sustained my enthusiasm and passion for neurology. It is both rewarding and creative. Perhaps the highest compliment I ever received was from an elementary school student whose assignment was to write to someone who was in the news. He wrote, “Congratulations for trying to cure deadly diseases. Keep up the good work.”

David: Two aspects of medicine are crucial to me: first, we have the unique opportunity to help people who need our knowledge, interest, and compassion. It's a special relationship, and perpetually rewarding. Second, the scientific aspects of neurology make it always rewarding. The changes in medicine keep it from becoming stale, repetitious, or boring. The tremendous increase in therapeutic possibilities — both current and future — adds to the value of continuing to be involved.

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WHICH CHANGES DO YOU LIKE AND DISLIKE?

Daniel: Fifty years ago, neurology was mostly descriptive, with relatively little in the way of scientific understanding, and less in terms of treatment. What has changed dramatically for the better is the ability to relate science to the clinical features, and especially the ability to treat so many of the formerly intractable neurological diseases. On the other hand, it goes without saying that the business of the health care and medical insurance industry, and its implications for neurology, are the features that are least attractive.

David: The therapeutic and scientific changes are the ones I like. Imaging advances are remarkable; the genetic testing capabilities are extraordinary. On the other hand, the tedium of dealing with too many different insurance companies; wasting time getting “prior authorizations” for procedures or medications; the multiplication of self-perpetuating bureaucracies; the decline in opportunities for NIH funding; and the intrusiveness of regulatory agencies can't be fun for anyone.

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WOULD YOU DO ANYTHING DIFFERENTLY IF YOU HAD THE CHANCE?

Daniel: In the broadest sense, I have been extremely lucky in my career in neurology. I had excellent mentors: Derek Denny-Brown, MD, from whom I learned clinical skills; Milton Shy, MD, who was one of the first to recognize and teach the importance of modern science to neurology; and Alfred J. Coulombre, PhD, who taught me scientific method and laboratory techniques. Although I discovered that botulinum toxin could be injected into a single muscle and paralyze it without being lethal in rats, in the early days, we didn't patent our discoveries. I didn't apply it to humans, but it eventually led to the use of Botox in humans. A patent could have been nice!

David: One unique “error” that I made was related to my seminal observation that cholinergic blockade mimicked the changes of aging and dementia. My only goal then was to publish the data and advance knowledge. At the time (1974), the thought of getting a use patent on the therapeutic implications of cholinergic treatments that I considered was not even on the radar.

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WHAT HAVE BEEN YOUR MOST VALUABLE LESSONS LEARNED?

Daniel: The most valuable lesson is to learn what is already “known,” but not necessarily be limited by it. Virtually all the research advances I have been able to make resulted from questioning accepted dogma, and moving beyond it.

David: I now realize that if it had indeed been possible to know all of neurology and neuroscience, it would have become boring in short order. The limitless expansion of knowledge about the nervous system, its normal function and its disorders, and the people affected, keep it fascinating.

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WHAT ADVICE WOULD YOU GIVE YOUNG NEUROLOGISTS STARTING OUT TODAY?

Daniel: For a young academic neurologist, the goal is applied — not pure basic — science. So, my advice is to find a clinical problem that is both challenging and soluble, find a mentor who is willing to help work on it, and try to ask as many questions along the way that you can!

David: For most young neurologists, there is a desire to understand more about “how the brain works” and to comprehend how the neural machinery generates thought, motion, and art. Don't lose that important goal; and never forget your responsibility to serve those who seek your help with the highest level of excellence available in the field of neurology. As Rabbi Hillel famously said (about the Golden Rule), “All the rest is commentary!”

Figure. Dr. David A....
Figure. Dr. David A....
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Figure. Dr. Daniel B...
Figure. Dr. Daniel B...
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©2008 American Academy of Neurology

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