Former Harold Amos Scholar Evolves from Basic Diabetes Research to Fighting Health Disparities

    • August 20, 2014

Summary: Errol D. Crook, MD, began his career in academic medicine studying the causes of complications of diabetes in the laboratory. His experiences as a Harold Amos Medical Faculty Development Program scholar changed his career, broadening his focus to fighting health disparities.

“When I cut my teeth as a basic science investigator,” Crook recalled, “it was having those opportunities through RWJF to make connections and collaborations that have allowed me to now be in a position to be an investigator for both sciences and health disparities.” Today, Crook is director of the University of South Alabama Center for Healthy Communities, which leads the university’s efforts to fight health disparities and provide health care for underserved populations.

Background. Crook and his sister grew up in Monroeville, Ala., with parents who were teachers and emphasized education. “For my sister and me, it was, ‘Where are you going to college?’ not if we were going.” He had two uncles who were physicians—a neurologist in Detroit and a surgeon in San Francisco. “So although I was from a small rural town in lower Alabama, I knew the opportunity was there.”

During the summer before his senior year at Yale University, where he studied chemical engineering and played football, Crook decided to become a physician and to focus on academic medicine. He chose the Columbia University College of Physicians and Surgeons for medical school, graduating in 1989. A year later, Crook returned to his native Alabama for an internship and residency in internal medicine at the University of Alabama Hospital in Birmingham.

Connecting with Harold Amos, PhD, and RWJF. During his residency, Crook heard about the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program (then called the Minority Medical Faculty Development Program), which provides four-year awards for postdoctoral research to physicians and dentists from historically underrepresented groups who are committed to developing careers in academic medicine and dentistry. (See the Program Results Report for more information about the program.)

As his residency came to an end in 1992, Crook decided to apply. Not long after he submitted his application, Crook received a telephone call from the director of the program, Harold Amos, PhD, professor of microbiology and molecular genetics at Harvard Medical School and the school’s first African-American department chair. A tireless recruiter and mentor of minority and disadvantaged students in medicine and science, Amos served on the RWJF program’s inaugural advisory committee and directed the program from 1989 to 1993. After his death in 2004, the program was renamed in his honor.

Remembers Crook, “Dr. Amos was wonderful. I was so impressed that he picked up the phone and found me personally. He was very encouraging and very sincere about what he was doing and the mission of the program. And the advice he gave me was that it wasn’t quite the time for me to apply, that I was too young. But if I kept doing what I was doing, I was a reasonable candidate for the program.”

Based on Amos’ advice, Crook accepted a two-year nephrology fellowship at the University of Alabama at Birmingham in 1992, and reapplied for the RWJF program as the fellowship ended in 1993. As Amos predicted, this time Crook was accepted into the program, and started in January 1994.

Research opportunities and a mentor. For the next four years, Crook received funding for his basic research, and worked with mentor Donald A. McClain, MD, PhD. (James R. Gavin III, MD, PhD, was Crook’s national advisory committee mentor.) Crook’s research explored how excess glucose (blood sugar) leads to complications of diabetes, such as diabetic nephropathy (kidney disease or damage), the leading cause of chronic kidney disease in the United States. Crook zeroed in on how the body metabolizes glucose to try to determine if a certain pathway (the hexosamine biosynthesis pathway) led to these complications.

“I was a very young investigator at that point,” says Crook, who published the first of many articles about his RWJF-supported research in Diabetes in 1995, followed by articles in Endocrinology in 2000 and again in Diabetes in 2001. In each article, Crook and his co-authors presented their findings from a complex series of experiments that examined the hexosamine biosynthesis pathway and its complicated impact on glucose, metabolism, glucose sensitivity, and a host of other reactions in insulin-dependent or insulin-resistant diabetic patients.

They concluded that the hexosamine biosynthesis pathway does contribute to complications such as diabetic nephropathy and that further research into this could facilitate the development of new treatments for patients with diabetic nephropathy.

McClain, a University of Alabama endocrinologist, became a life-long mentor to Crook, and helped him expand his focus. “I looked at things from a metabolism viewpoint rather than just what was happening in the kidney. For diabetes research ... that was critical,” he said.

After working with McClain for six months at the University of Alabama, Crook followed McClain to the University of Mississippi Medical Center in July 1994, taking his RWJF fellowship with him. Acknowledging that “having a mentor and being an RWJF fellow [made me] very attractive,” Crook was named an assistant professor of physiology and biophysics and an assistant professor of medicine in the university’s division of nephrology while continuing his research with McClain.

“Dr. McClain allowed me to have autonomy to make decisions on my research,” said Crook. He was very forthright in letting me know what the challenges would be, what would be necessary to be successful, and that I had to face that gauntlet of funding and be competitive. Though we remained partners, he pushed me towards independence.”

An expanded professional pathway. Three years into his RWJF fellowship, Crook was named an investigator on the Jackson Heart Study in Jackson, Miss., a National Institutes of Health (NIH) project that is considered the largest study to date of factors that contribute to heart disease in African-Americans. The opportunity exposed Crook to additional mentors and epidemiological investigators, and led to a new research interest: eliminating health disparities.

Before long, Crook would describe himself not only as a science investigator but also as a health disparities investigator. After leaving Mississippi in 2001 and spending four years at Wayne State University School of Medicine in Detroit, Crook returned to Alabama in 2005. He joined the University of South Alabama College of Medicine in Mobile as Abraham Mitchell Endowed Chair and professor of medicine and co-director of the university’s Center for Healthy Communities.

A National Institutes of Health Center of Excellence, the Center for Healthy Communities fights health disparities through community education, research, and public service, and provides health care for underserved populations. Through the Center, Crook began working with a group of investigators who studied “everything from genetics to basic sciences to social-educational policy issues,” he said.

In 2009, Crook was named director of the Center for Healthy Communities. He now serves as both department chief and Center director, and he sits on the genetics subcommittee of the Jackson Heart Study.

Grantee perspective. According to Crook, everything in his career was impacted by his experience in the Harold Amos Medical Faculty Development program.

“It provided the protected time that was necessary for me to learn the lessons and the techniques I needed to learn to do the research I was doing and to develop my skills to be a faculty member long term,” he said.

Crook’s ties with RWJF continued after his fellowship. In 2005, Crook attended a RWJF-sponsored workshop for Harold Amos alumni about turning research into policy. After Hurricane Katrina, Crook put what he learned from the workshop into practice when he used research by the Center for Healthy Communities to try to impact policies to care for people with chronic diseases after natural disasters. “This was early in my time of leadership for the Center, and it was critical because we hope to turn what we are doing into policy, particularly locally.”

In 2008, a project with which Crook is involved received a grant from RWJF’s Finding Answers: Disparities Research for Change program to investigate telephone monitoring of blood sugar as a diabetes management strategy in primary care clinics (Grant ID# 64257).

RWJF perspective. The Harold Amos Medical Faculty Development Program is a four-year postdoctoral fellowship launched by RWJF in 1983. Its purpose is to increase the number of faculty from minority and other historically disadvantaged backgrounds who achieve senior rank in academic medicine and dentistry. A commitment to eliminating health disparities is among the selection criteria. Read the Program Results Report for more information.

The program supports one of RWJF’s major objectives: To increase diversification of the medical and dental professions and, as a consequence, improve the health care received by the nation’s underserved populations.

Of Amos program scholars, RWJF senior program officer David M. Krol, MD, MPH, says:

“Ultimately, we would like to see these individuals from disadvantaged backgrounds becoming full professors at prestigious institutions, putting out important, valuable work, looking at a variety of different issues—including how to decrease the disparities between rich and poor, majority and minority—while climbing the academic ladder. The measure of the success of the program is the success of the individuals who participate in it and their contributions to building a culture of health.”

Errol D. Crook, MD

Errol D. Crook, MD

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Post Katrina, Errol Crook studied how to shape health policies re chronic disease after natural disasters