OM SHARMA: THE RENAISSANCE MAN, INTERNATIONALLY ACCLAIMED SPECIALIST IN SARCOIDOSIS
A gentle giant of learning and inspiration has peacefully passed away on 19 August 2012 at home in Los Angeles, at the age of 76 years. Om's academic accomplishments speak for themselves. But they do not convey the gleam that was always in his eye, nor his infectious smile. He only had positive things to say and was always encouraging. He was a great man, whose profound learning, humility, and gentle approach to others will be a lifelong source of inspiration to those who knew him. The entire sarcoidosis community is mourning the passing of a true friend and academic teacher. For those of us lucky enough to know him, his passing is very sad news. For those of you who had not yet met him, you have missed a great opportunity. Om always spoke with a calm reassurance, yet he was very passionate about many things. Many of us have our favorite Om stories, but they mostly center about how he encouraged us. Om Sharma was truly a great clinician and teacher who not only added new knowledge to the mysteries of sarcoidosis, but also kept news of this disease important for patients and physicians outside the field. His persona embodied the best qualities of a mentor, and of a wonderful and generous friend. In addition to his professional merits, we would like to stress Om Sharma's outstanding commitment toward his patients. As Editor of this journal, he was able to lead Current Opinion in Pulmonary Medicine to an all-time high impact factor of 3.075. As we take on the leadership of the journal, we realize we will have a big task keeping up with what he has done (Fig. 1).
OM SHARMA: PIONEER IN SARCOIDOSIS PATIENT CARE, RESEARCH AND TEACHER
Professor Sharma was a well known and internationally respected physician, clinical scientist, teacher, medical historian, and humanist. He was born in India, where he graduated from Victoria College and attended G.R. Medical College in Gwalior. Afterwards, he worked in India, Scotland, England, and the USA. In 1969, Dr Sharma was appointed as an assistant professor and in 1983 promoted to full professor of medicine at the Keck School of Medicine, University of Southern California, Los Angeles, USA. Professor Sharma's academic and professional background encompasses many areas of pulmonary medicine, but he has mainly dedicated himself to the study of sarcoidosis. During his career that embraces 50 years of clinical and research experience, he has produced outstandingly clear, concise, and informative books and monographs on sarcoidosis, general pulmonary medicine, and tropical medicine, and has written about 400 articles and short papers. In addition, he has written several books and articles about other important scientists in medicine, including Samuel Johnson, Sheila Sherlock, and his close friend Gerry James. He delivered a great contribution to the educational, clinical, and translational research areas of respiratory and critical care medicine. Just to mention one: in 1983, he and his group contributed to solve the puzzle of hypercalcemia in sarcoidosis by showing that alveolar macrophages are able to produce calcitriol, the active form of vitamin D3 (see Fig. 2).
IT IS ALL A MATTER OF VIEWPOINT
Professor Sharma always used parables in his presentations. One of his favorites was one of a poem by American poet John Godfrey Saxe (1816–1887) based on the famous Ancient Indian parable (Fig. 3).
‘Oh how they cling and wrangle, some who claim for preacher and monk the honored name! For quarrelling, each to his view, they cling. Such folk see only one side of the thing’. We all see things in very different ways, mainly because we tend to be restricted by our own viewpoint. The Buddha used a parable about six blind men and an elephant to explain how the differing views have come by. Each man has a different idea of what the elephant is, each being able to touch a different part of the animal.
OM SHARMA: CHALLENGER OF COOPERATION AND FOUNDING MEMBER OF WORLD ASSOCIATION OF SARCOIDOSIS AND OTHER GRANULOMATOUS DISORDERS
Professor Sharma encouraged multidisciplinary, multicentric, national, and international cooperation in caring for patients with interstitial lung diseases, especially sarcoidosis. He participated in several studies comparing the clinical manifestations of sarcoidosis in America to those in Europe and Japan. Professsor Sharma's interest and achievements in sarcoidosis in particular led to his presidency of the World Association of Sarcoidosis and other Granulomatous Disorders (WASOG) from 1999 till 2008 (Fig. 4).
During his tenure as president, he worked with Dr Geraint James and Gianfranco Rizzato as they helped standardize the sarcoidosis definition throughout the world. He was part of the first ERS/ATS/WASOG statement regarding sarcoidosis. Professor Sharma's insights into the various clinical manifestations of the disease led to a large clinic in Los Angeles. For decades, his work has attracted chest disease specialists as well as general physicians interested in sarcoidosis, immunological lung disease, and granulomatous lung disorders. His devotion to investigating the cause of sarcoidosis has resulted in national and international educational and research collaborations. He shared his fascination for the disease with many people and introduced them into the sarcoidosis world, and made the international sarcoidosis family grow.
UNRAVEL THE PUZZLE TOGETHER WITH THE PATIENT
Sarcoidosis is a fickle disorder. Professor Sharma called sarcoidosis ‘a chameleon-like disease’ and stressed that patients should always be taken seriously. In order to find out what is wrong with someone, and how a certain disorder can develop, it is of essential importance to acquire adequate information about everything the person has done. You cannot make do with a brief case history. An extensive inventory of possible contacts and exposure is necessary. The doctor has to be persistent and dogged. Asking the right questions and being a good listener can help. In practice, this quite often suffers from lack of time, which can curtail the perseverance and forbearance of the caregiver. The right dose of curiosity is essential, bearing in mind the fact that the potential cause of diffuse lung diseases may be any particles or substances that have been present in the air inhaled or in the blood. Creativity is a precondition to identify possible ‘triggers’ with the patient. The approach is comparable with that of a detective. Sherlock Holmes made use of what is known as the deduction method. Arthur Conan Doyle, the creator of Sherlock Holmes, was an ophthalmologist. He described the disease of a family with multisystem disease presenting with uveitis, skin lesions, and arthritis as gout . Om Sharma pointed out that this clinical manifestation strongly suggested sarcoidosis and not gout . Jonathan Hutchinson who was the first to describe the skin lesions of sarcoidosis was a consultant in the hospital where Arthur Conan Doyle worked in London. It is likely that Jonathan Hutchinson's interests, lectures, and publications greatly influenced Conan Doyle. Indeed, skin disease became basic ingredients of the plots of many of Sherlock Holmes adventures.
THERAPY OF SARCOIDOSIS
Professor Sharma investigated several types of treatment for sarcoidosis. His reports span the currently available treatment options for sarcoidosis. He performed one of the original studies of the utility of glucocorticoids versus placebo for pulmonary sarcoidosis . He was a strong advocate of the use of antimalarial agents for various aspects of the disease, including hypercalcemia. He and Dr James were one of the early proponents of the use of azathioprine for sarcoidosis . He was also one of the first to report on the effectiveness of infliximab in treating advanced sarcoidosis .
FATIGUE IN SARCOIDOSIS AND SOCIAL IMPACT FOR THE PATIENTS
Fatigue in association with a systemic illness like sarcoidosis can be ominous. Although interest in understanding the pathogenesis of fatigue is of relatively recent onset, the symptom has been with us forever. Management of the patient with fatigue requires more than prescribing drugs. Professor Sharma always stressed that it is important that the physician listens to the patient; it is wise to believe what the patient says. In addition, patients should be encouraged to avoid physical or emotional stress and to pace their activities. They should also be instructed to lead as active and involved a life as possible.
‘In the morning a man walks with his whole body in the evening only with his legs.’ (Emerson).
Professor Sharma was the first to describe that four types of fatigue can be recognized in sarcoidosis .
- Early-morning fatigue, in which the patient either is not able to arise or arises with feelings of inadequate sleep. This type of fatigue is also seen in patients with autoimmune diseases and may reflect troublesome muscle or joint pains or sleep disorders including sleep apnea syndrome.
- Intermittent fatigue, in which the patient wakes up normally but after a few hours of activity, feels tired and exhausted. After a short rest of an hour or so, the patient is able to resume activity, only to succumb soon after to another episode of fatigue.
- Afternoon fatigue, in which the patient arises in the morning with adequate energy but ‘runs out of gas’ or ‘feels washed up’ in the early afternoon. These patients compare their fatigue to ‘having a flu-like syndrome’.
- Postsarcoidosis chronic fatigue syndrome. This occurs in about 5% of patients who seemingly have recovered from active sarcoidosis. The phenomenon has attracted many synonyms, including post viral fatigue syndrome, Royal Free disease, myalgic encephalomyelitis, fibromyalgia, and others. The persistent symptoms are widespread myalgia, incapacitating fatigue, and depression. Physical signs are absent.
In 2011 a study was published by de Kleijn et al. in cooperation with Professor Sharma's department entitled ‘Types of fatigue in sarcoidosis patients’ [8▪]. The objective of this study was to examine whether the types of fatigue (early morning fatigue, intermittent fatigue, and afternoon fatigue) described by Om Sharma previously can be identified in sarcoidosis. Latent cluster analysis revealed three clusters:
- Mild fatigue: patients with mild or no complaints of fatigue.
- Intermittent fatigue: patients with complaints of fatigue that varied during the day.
- All day fatigue: patients who felt tired the whole day.
The three patient clusters differed regarding clinical, psychological, and demographical characteristics, with all day fatigue patients reporting the most complaints. Careful consideration to categorize patients with sarcoidosis into the three types of fatigue will help healthcare providers to understand the challenges these patients encounter.
This observation and others of Professor Om Sharma are of major social importance in view of the fact that sarcoidosis is generally seen among relatively young people. Understanding of a patient's surroundings and above all recognition of the problem is very important for the healing process. In addition, it is important that patients themselves learn to cope with being ill and learn to accept their limitations [9▪▪]. These also are lessons we have learned from Professor Sharma.
CARE AND ITS PROVISION: LESSONS FROM PROFESSOR OM SHARMA
The complexity of the medical sciences makes it necessary to introduce increasing specialization. Doctors are more or less forced to restrict themselves to their own special fields. This does not mean literally that the doctor cannot or should not stray far from home as it were. Knowledge of each other's ability and cooperation is needed to interpret certain observations. Taking care of sarcoidosis patients implies that you should not focus too much. ‘There's no such word as can’t’. That is a lesson to be always remembered when striving for answers, not to give up too soon. It is important that integral and generalistic thought should continue to be integrated in specialist actions and approach to each patient. In addition to teaching us these lessons, Professor Sharma was one of the first physicians with a website of his own, in which patients could find information such frequently asked questions (FAQs), presentations, and articles on sarcoidosis.
Just one reaction of a patient is described as follows, of which you can find more on the website (http://www.wasog.org/sharma-condolence.htm):
Dr Sharma saved my life. Had it not been for his genius, inquisitive nature, and inability to jump to conclusions, I would not be alive and living the quality of life that I am now able to enjoy. He was a man of integrity, empathy and showed concern for his patients that should be emulated by all doctors. I will miss him and I will never forget how he spent time teaching me about the condition that I will have for the rest of my life. He even took time to help my children understand what they could and should expect and how to support me. He was a good man and doctor.
As doctors, we have a wonderful profession. We are the detectives of the healthcare system. We have to be patient and willing – if necessary – to stray from the well beaten path. Keep striving for the right cooperation and communicate laterally: that can lead to answers you would never have thought of. Keeping this in mind, we can honor Professor Sharma (Fig. 5)!
Om Sharma embodied the best qualities of a leader, a mentor, a loyal family man, and a dependable friend. We offer our sincere condolences to his wife Maggie and his family. He will be sadly missed by those who knew him, those who loved him, and those who wished to have known him.
The authors wish to thank Maggie Sharma kindly for her help and support in perparing this In Memoriam.
REFERENCES AND RECOMMENDED READING
Papers of particular interest, published within the annual period of review, have been highlighted as:
- ▪ of special interest
- ▪▪ of outstanding interest