By Arthur Lightbourn
If he had a magic wand, University of California San Diego professor and researcher Dr. Roland Blantz would have the National Institutes for Health double its budget for research grants and medical schools would broaden their admission requirements to admit candidates from a variety of academic disciplines, including engineering, physics and the arts, to breed new life into medical investigative research in America.
Blantz, 70, is a professor of medicine and head of the division of nephrology-hypertension at UCSD for the past 21 years.
Last November, in Dallas, at a meeting of the American Society of Nephrologists, he was presented the John P. Peters Award, the highest honor granted by the ASN for outstanding research and leadership contributions in the field of kidney disease.
Nephrology (from the Greek words, nephros, “kidney,” and logy, “the study of” ) is a subspecialty of internal medicine dealing with the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, and the care of patients requiring kidney replacement therapy, such as dialysis and kidney transplants.
Blantz is renowned for his research on the role of the peptide angiotensin in the regulation of blood pressure and kidney hemodynamics, and in the causes of acute kidney injury.
He has also made longstanding contributions to our understanding of the kidneys’ fluid feedback system and its capacity to adapt temporarily to volume status, sodium chloride intake, and other variations in the kidney’s filtering and reabsorption system.
Kidneys perform the life-essential function of filtering and excreting waste products from the blood through urine and regulating the body’s fluid levels through reabsorption of water, glucose and amino acids.
We interviewed Dr. Blantz on a recent rainy afternoon in his office at the Veterans Hospital on La Jolla Village Drive in San Diego.
“It’s been a disappointment to me in this country,” he said, “that we are importing many of our investigators from other countries because education in the United States is not leading people into scientific [investigative] careers in medicine. It’s a declining interest for some reason.
“Someone who has been imprinted to be a doctor since he was 14 often becomes the worst investigator of all because they are not really interested in the truly intellectual aspects of medicine. They’re interested in care-giving per se, which I think is a valuable task, but there are intellectual aspects to medicine too and they should not be forgotten.
“I’m sure there are a lot of people who’ll be irritated by my comments…but having a few poets go to medical school is not bad.”
Blantz was born in Portland, Oregon. His father, who held a master’s in French, a degree that didn’t pay much during the Great Depression, found work as a high voltage lineman for Portland General Electric power utility and later became an executive with the company.
Perhaps like his father and, as he often advises his sons, “Changing hats …. is not a bad thing. Don’t just stick to the things you know you’re good at.”
Initially, on scholarship at The Johns Hopkins University, Blantz was majoring in chemical engineering, but, changed hats in his junior year, and converted his history minor to his major, earning his undergraduate degree in history in 1961.
“It was the early phases of the Vietnam War,” he recalled, “and I knew I did not want to go to Vietnam particularly, so I applied to business school, law school and to the only three medical schools that would accept my application without having any biology courses.”
He subsequently chose medicine and entered med school at Johns Hopkins because “It seemed like medicine was a little more diverse in its options than law or business.”
“In my class,” he recalled, “there were a lot of physicists, engineers, history majors, all kinds of diverse disciplines that I think should be allowed to go to medical school if they want to at the last minute. They add something. They add a flavor to medicine that pre-meds alone do not.”
Blantz contends that pre-med education today is really neither heavy-duty science and is “usually short-changed in the humanities.”
“The level of motivation of American graduates seems to be declining if anything…Compared to when I was a medical student, I think 62 percent of my class at Johns Hopkins stayed in academic medicine and did some kind of investigative work. Now it’s rare to see more than 5 or 10 percent remain interested in the scientific aspects of medicine.”
He suspects that part of the reason for the shift may lie in the glamour side of medicine being depicted on television in shows like ER “as if everything was quick and easy.”
“Emergency medicine has a certain appeal because it looks like you go in, you do a heroic series of acts and then you’re over and done with the process.”
He argues that is not usually the way medicine is. “It’s a lot of tedium. It’s a lot of chronic disease. It’s a lot of chronically ill, elderly people, who are only getting worse. And some people find that downright depressing.
“I find that some of the medical students now are more interested in being hospitalists or emergency doctors because there is no long-term responsibility for care. It’s a quick fix and 12-hour shifts. It may be a little more exciting, I suppose, but it leaves the more chronic realistic care of patients to other people.
“But also it’s a bit the fault of the admission committees of medical schools,” he believes, “because I think they are a bit narrow-minded that we should only be picking people who are pre-meds to go the medical school.
“But, I think in the long run what is going to be important is trying to convince future MDs, who have as scientific background or interest, to go into investigative work.”
Blantz earned his M.D. from Johns Hopkins in 1965, followed by his internship and residencies in medicine from the University of Colorado Medical Center; two years service in the U.S. Air Force as an internist and flight surgeon; and a research fellowship in internal and renal medicine at the University of Texas.
He joined the faculty at UCSD in 1972.
A fascination with diversity is a key element in Blantz’s personality, his chosen field of specialization and his approach to research.
“For those interested in clinical medicine,” he said, “I think you have to understand the physiology of why people are ill, especially critically ill people. It involves linkages between the cardiovascular system and infection. The kidney tends to be a final common pathway for all of those events; and kidney failure or dysfunction contributes to people’s demise from all of those different problems that cause people to be in ICUs.
“So I guess my interest in internal medicine, critical care and nephrology, led to an interest in the type of regulatory aspect of things.
“The regulatory nature of the type of research I do is more directly akin to the kind of physiologic problems that come up in taking care of sick people, where one process is regulated by another, intertwined, moving and kinetic, as opposed to let’s say molecular biology …[which is] involved in isolating a protein or gene.”
While his office is still at the VA, where he previously served as chief of its nephrology section and where his first lab was located, today he does most of his clinical work downtown at UCSD’s Medical Offices in Hillcrest and at the university hospital in La Jolla treating patients with acute kidney injuries, fluid and electrolyte problems.
He says the awareness of the importance of kidney disease has heightened over the past several years and studies revealed that some 20 million Americans suffer from chronic kidney disease or are showing early signs of the disease, a much larger number than previously estimated.
Why is that important? Because, he said, each case can progress to end-stage, requiring either a transplant or dialysis, but most importantly, it’s been discovered that even modest kidney disease can considerably increase the risk of cardiovascular death.
The major cause of end-stage renal disease is diabetes, followed closely by hypertension.
“Many people who have unsuspected kidney disease end up dying from premature cardiovascular disease well before their kidneys fail completely,” he said. “And if you lose half of your kidney function, your cardiovascular risk is increased at least ten- fold.”
While science hasn’t made much progress in preventing kidney disease, he said, it has made considerable progress in pinpointing causes and developing therapeutic drugs and processes to combat the disease.
: Roland C. Blantz, M.D.
Dr. Blantz, who has served as head of UCSD’s division of nephrology-hypertension for more than 20 years, recently won the John P. Peters Award, the highest honor granted by the American Society of Nephrologists for outstanding research and leadership contributions in the field of kidney disease.
Del Mar since 1994
Portland, Oregon, 70 years ago
: A.B. in history, The Johns Hopkins University, Baltimore, Maryland, 1961; M.D.,The Johns Hopkins University School of Medicine, 1965; internship and assistant residencies in medicine, University of Colorado Medical Center, 1965-67; internist, U.S. Air Force, 1967-69, Harrison AFB, Bedford, Mass.; research fellow in internal medicine, renal division, University of Texas, Dallas, 1969-72.
He and his wife, Christine, have been married 11 years. He has three sons and she two daughters from previous marriages. They have 11 grandchildren.
Singing in the La Jolla Civic Symphony & Chorus, walking and working out with a trainer twice a week.
Recently read the thriller, “The Girl with the Golden Tattoo,” by Swedish journalist/author Stieg Larsson; enjoys re-reading the works of one of his favorite American authors, Thomas Wolfe, and various Russian writers. He is also an avid reader of The Economist, the British weekly news and international affairs magazine.
“Taking unplanned trips through Europe … and just driving and stopping wherever you feel like it.”
“I’m not a big one for planning great distances into the future...and what I’ve try to tell my sons is that, ‘Changing hats frequently or taking apprenticeships later in life on new adventures is not a bad thing. Don’t just stick to the things you know you’re good at.’”