ARTICLE IN BRIEF
Twin brother and fellow neurologist Daniel Drachman and colleagues of David Drachman recall a man who made pivotal discoveries in Alzheimer's disease, helped found the Alzheimer's Association, and inspired generations of future neurologists.
David A. Drachman, MD, FAAN, entered the hospital in the last week of his life with a freshly revised copy of his latest study, an analysis of the cause of dementia in Down's syndrome that he was finishing up to submit for publication. At 84, he was still writing, still seeing patients, and still thinking about the puzzles of Alzheimer's and dizziness, his two lifelong clinical passions. The neurologist had been diagnosed with chronic lymphocytic leukemia (CLL), ordinarily a rather slow chronic disorder, but he was surprised that it was progressing so quickly. He thought he had the CLL in check.
After all, David Drachman was a fix-it guy. Everyone knew that. He even took his doctor's bag on family vacation trips, complete with duct tape (for whatever ails you), a transcutaneous electrical nerve stimulation unit that worked surprisingly well against insect bites, and chisels and mallets in case of thirst (to open coconuts). He never packed light in life, but he was always prepared for anything.
And on this day, he was staring up at his identical twin brother, Daniel, a neurologist as famous in name and deeds, reciting a child's Thanksgiving Day poem that had been published in The New Yorker in 1955, and recited every Thanksgiving by the Drachman family. Daniel knew the words would make his brother laugh.
Together they took turns reciting ten more lines, and they laughed and they cried. David Drachman died a few days later on December 5, leaving behind a legacy of life at the bench and at the bedside, and with his family at home and in the world of neurology.
David used to say that he wanted to be a “desert island doc.” Give him a penknife, a bottle of iodine and aspirin, and he could make the world a healthier place. It was during medical school at New York University that he became interested in neurology, called Columbia University's most famous neurologist, Houston Merritt, MD, and convinced him to accept two third-year medical students who were anxious to learn about the field. (Both Drachman men went to college and medical school together.)
It was 1955, and they watched Dr. Merritt — the chair of neurology who co-discovered Dilantin for the treatment of epilepsy and had just published a classic textbook on neurology — during grand rounds pronounce a diagnosis of Creutzfeldt-Jakob disease with a tap of the knee and a scratch of the foot.
The next year, the brothers added another outside neurology elective to their resumes in the capable hands of Morris Bender, MD, another famed neurologist at Mount Sinai. Dr. Bender was also the department chair, and he instilled in the medical students the importance of clinical research in understanding neurologic disease.
During their internships, the brothers first separated: David went to Duke University School of Medicine, and Daniel to Beth Israel in Boston. It was during one fateful weekend visit that the brothers got to talking about their futures in medicine and realized there was too much to know in the entire field of internal medicine; in neurology, it was possible to learn everything that was then known.
“That's why we decided to become neurologists,” said Daniel. The next year, Daniel was at Boston City Hospital and his brother was at Massachusetts General Hospital. David worked with Ray Adams, chair of the neurology department and one of the great thinkers in modern neurology. There was a year of neuropathology, and David was excited by holding brains shrunken by Alzheimer's and seeing the same amyloid stains that were first described by Alois Alzheimer at the turn of the century.
“He still had no idea he would be spending the rest of his career studying Alzheimer's disease and treating dementia patients,” said Paul McHugh, MD, a fellow resident who went on to become a leading figure in psychiatry. During those years, Ray Adams was debunking the idea that hardening of the arteries was causing dementia. David was drawn into the mysteries and possibilities of treating the disease.
The Drachman brothers went on to spend three years at the National Institutes of Health (NIH) in lieu of military service. There, they studied with Milton Shy, MD, a neurologist interested in neuromuscular diseases. Dr. Shy brought modern scientific scrutiny to neurologic diseases, and it is during that time that David's interest in memory and dementia was confirmed.
After the NIH, he moved to Northwestern University. He'd read a study on twilight sleep and memory impairment in surgical patients treated with scopolamine and decided to do a bit of experimenting, giving doses of that anticholinergic drug to some of his students and testing their memory. “They developed transient memory impairment,” his brother recounted.
He studied all the known neurotransmitters of the time and was intrigued by the effects of the anticholinergic drugs. In the mid-1970s, he published the first evidence that the brain's cholinergic system could be involved in Alzheimer's disease. He was at the forefront of research as the field came of age in the 1970s and 1980s.
In 1977, David became chair of the first neurology department at the University of Massachusetts Medical School. Over the next few years, he worked closely with other neurologists to create the Alzheimer's Association.
“He was also instrumental in establishing criteria for the diagnosis of Alzheimer's,” said John H. Growdon, MD, FAAN, professor of neurology at Massachusetts General Hospital. “He helped stimulate the NIH to establish focused research programs in Alzheimer's disease that continue to this day. David joined me in establishing the Massachusetts Alzheimer's Disease Research Center, the first of 30 centers that were inspired by his vision. He is a true pioneer in Alzheimer's research.”
He taught future generations of neurologists, and by the early 1990s he was disputing the growing theory that amyloid was the key trigger for Alzheimer's. He emphasized that amyloid-beta is a marker of some other pathological process, and not the cause of Alzheimer's disease.
In 2014, he published a carefully reasoned and documented paper in the journal Alzheimer's & Dementia: “The amyloid hypothesis, time to move on: Amyloid is the downstream result, not the cause, of Alzheimer's disease.”
“He was always clear about what he thought,” said Daniel. His theory is that the vulnerable aging brain suffers impaired microvascular function, resulting primarily from decreased Notch-related angiogenesis. He thought that therapeutic strategies should focus on supporting normal angiogenesis.
“One of his favorite topics in the cafeteria was the hole in the amyloid hypothesis,” said Robert H. Brown, MD, chair of neurology at University of Massachusetts. “He had immense knowledge and dignity, and made lasting contributions in Alzheimer's.”
Earlier this year, David was working on a clinical trial of a drug cocktail that he had tested in patients with AD, the results of which were also in his briefcase when he died.
Daniel said that he and his brother spoke at least twice on most days over the course of a lifetime together. They had that extrasensory perception shared by identical twins. Daniel told a story about having an irresistible desire to whistle after being separated from David for a month when they were camp counselors. They shared a unique summoning whistle. When he called his brother at a different camp in another town, David said that he had had an identical experience three hours earlier. Based on the time and the distance, they calculated that the speed of their whistle was about 33 miles per hour.
It is with this wit, intelligence, and compassion that David took care of his dementia patients and those who arrived at his office for an answer to their dizzy spells. His teachings were filled with the same ingredients. For years, he taught a course at the annual AAN meetings. He called it “Doctor, I'm Dizzy.” There was nothing that made him happier than to maneuver a patient's neck and head to reposition the structures of the inner ear and voila! – the dizziness was gone. (His son Douglas Drachman, an interventional cardiologist in Boston, said that he's tried it, and it works.)
“He was my lifelong mentor,” his son said. “I always saw him as someone who can fix anything. He was always focused on leaving things better than when he found them. He would always have an expression that came in handy.”
On writing: “Ideas not words, tell a story, point of view; think it through.”
On diligence and organization: “Get them before they get you.”
David Chad, MD, met his mentor in 1982 when he was hired to develop a neuromuscular division at University of Massachusetts. He was drawn to David's intellect and enthusiasm. “He was open-hearted and open-minded,” he said of his friend and colleague. Dr. Chad stayed until 2008 and now works at Massachusetts General Hospital. “He was my neurology father figure,” he added. That expression was shared by many. “Even his initials spell DAD,” his son reminds us.
David was also a photographer, bird lover, fly-fisherman, and sculptor. His medium was wood. He was married for 57 years and has three children and six grandchildren.
In September, he was given the Chancellor's Medal for Clinical Excellence at the University of Massachusetts, where he remained chair for 25 years and continued his research, teaching and caring for patients until the last weeks of his life
The poem “Octogenarian Twins” by David Drachman describes the lifetime of shared experiences and memories of the syngeneic Drachmans.
By David Drachman
There are not a lot of people -
None, I should say,
Whose remembered worlds
So nearly match one's own.
Womb-mates, room-mates, classmates-
Four score years of life
Dually perceived, cross-calibrated
Have shaped a congruent memory.
Those worlds are gone, of course,
Lost images of a past; yet made real
By hours beyond number sharing, talking
Now replayed, like any memories - but confirmed!
Un-twins too have worlds
But to whom could they ever turn
To re-run those ancient recollected scrolls
From zygote, to maturity, to age?