Sarcoidosis: A Former Harold Amos Scholar Looks at Sarcoidosis, an Idiopathic Disease
The problem. Sarcoidosis is an inflammatory disorder that can affect any organ, but most often affects the lungs. Symptoms can include shortness of breath, fatigue, and chest pain. The disease, which usually develops between the ages of 20 and 50, sometimes goes away on its own, but it can also be quite severe and occasionally fatal.
The cause remains unknown, but Wonder Puryear Drake, MD, is working hard to change that. She first encountered sarcoidosis as a resident at Johns Hopkins University Hospital in the mid-1990s, and later at a University of Alabama/Birmingham Hospital clinic. "I was amazed with the degree of devastation that this disease could cause in young people," she recalls.
Drake was particularly touched by the response of a man in his 20s when she said he was facing renal dialysis. "I saw how sad he looked. He was devastated. This disease took this man who was productive in society, had people depending on him, a wife and two children, who had been feeling fairly healthy—it stopped him in his tracks.”
"I remember thinking, 'Sarcoidosis has to have a cause. Every disease has a cause.’"
Beginnings. Wonder Drake was born in very humble circumstances in a small town in Alabama. Her parents were factory workers who did not graduate from high school, but they had high expectations for their five children. "Everyone's grades were reviewed every semester and unacceptable grades had consequences," she recalls.
Drake graduated as valedictorian of her small high school and entered the University of Alabama intending to be a science teacher. She soon switched to medicine as a career choice. "It just felt right," she says.
The summer prior to starting medical school at Vanderbilt University in 1990, she had her first taste of academic medicine, conducting a research project into the ways harmful bacteria in the digestive system can bypass the body's immune system. The project was supervised by Martin J. Blaser, MD, then division chief of infectious diseases at Vanderbilt.
"He taught me to ask good questions and design experiments to answer them," Drake says. "The lab was like a huge family with members from all over the world. I saw that academic medicine was for me."
Drake continued to conduct research throughout her four years of medical school and co-authored a paper published in Clinical Infectious Diseases (26(5), 1127–33, 1998) during her residency at Johns Hopkins. She then went into private practice in Alabama, partly "to improve my critical thinking as an internist" and partly to pay off her medical school loans.
Back to Vanderbilt, this time to stay. Drake found private practice satisfying for a while, but soon missed the stimulation she had found in research. She returned to Vanderbilt to complete a fellowship in infectious diseases, where she studied the role of infectious agents in causing sarcoidosis.
In her early work, she looked at sarcoidosis granulomas, the immune cells that cluster in lumps, and found evidence of mycobacteria that was genetically similar, yet distinct, from the mycobacteria associated with tuberculosis. A $364,612 fellowship from Robert Wood Johnson Foundation’s (RWJF) Harold Amos Medical Faculty Development Program helped her pursue the research. The program 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.)
"It was phenomenal in allowing you to get the foundation you need in academic medicine," she says.
Drake also valued the award for introducing her to so many physician/scientists from underrepresented populations. “It has been helpful to see people with similar backgrounds navigate the waters of academic medicine,” she says. "People understand what it is to be a minority in a majority institution, how you get on committees at national meetings."
Has having the Amos program on her resume helped her attract other funding? "It doesn't hurt," she said, laughing. "Other scholars have done pretty well."
The National Institutes of Health (NIH) has been an important backer, giving her a series of grants to build on her preliminary research results. "They were looking at the scientific merit of the proposals" she says. Drake has been principal investigator on NIH projects involving collaborations with research teams at Denver’s National Jewish Medical Research Center and the Cleveland Clinic.
In 2013, she was awarded an NIH grant to lead a Phase II clinical trial that involves a larger patient sample and more in-depth analysis of the role of antibiotic therapy in pulmonary sarcoidosis. Here, she will be working with researchers at the Cleveland Clinic and the University of Cincinnati medical school.
Drake received tenure in 2010 from Vanderbilt, and earned American Thoracic Society Awards for Excellence in Sarcoidosis Research in both 2010 and 2012.
In an interview with the medical school's weekly newspaper, Drake said she hoped her research would eventually prove significant for treating other stubborn medical problems, including Crohn's disease and rheumatoid arthritis. "We are learning many other things that will help down the road," she says.
Outside medicine, Drake keeps busy running half marathons and being the mother of 12-year-old twin sons. That, she says, "is about all I have time to do." Some might say that’s plenty.
In the rear-view mirror. Looking back at the Amos program after more than a decade, Drake expressed special appreciation for her mentor, Juanita Merchant, MD, a professor of medicine at the University of Michigan (Ann Arbor) and also a former Amos program fellow. (See the Grantee Story on Merchant for more information.)
"She was phenomenal," Drake says. “Very accessible. She laid all options out on the table. It was incredibly helpful to have someone who's a straight shooter helping you.
"As a minority, sometimes you think that things happen to you because you're a minority. You don't want to wrongly accuse someone, but at the same time, you want to be treated fairly. Having a mentor who is also a minority gave me a perspective that only a few people can provide.”
"As I get older, I truly appreciate [the Amos program] more," she says. “There are some talented people who haven't made it the way I have. They haven't had anyone by their side showing them the ropes. The further along I get, the more I understand the impact."
RWJF perspective. The purpose of the Harold Amos Medical Faculty Development Program, launched by RWJF in 1983, is to increase the number of faculty from minority and other historically disadvantaged backgrounds who achieve senior rank in academic medicine and dentistry.
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 historically 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.”
Wonder Drake is one of more than 180 Amos program alumni in academic medicine today. Her career and research exemplify the academic achievement and professional contributions that the program was designed to stimulate.
“The measure of the success of the program is the success of the individuals who participate in it and how they impact the culture of health in the United States,” says Krol.
The research of Wonder Drake, MD, leads to Phase II clinical trial for pulmonary sarcoidosis.