Surgeon, rodeo doctor and, now, senator

Former Yale resident John Barrasso is named to fill a senate vacancy.

John A. Barrasso, M.D., HS ’83, the new Republican U.S. senator from Wyoming, recalls that when he was a resident at Yale from 1978 to 1983, his professors stressed the importance of having a plan before going into surgery. “They would tell us that if you don’t have a plan to begin with on how to solve the problem, you’ll have a much tougher time halfway though the operation,” he said.

This advice has served Barrasso well both as an orthopaedic surgeon and as a politician and civic activist. Early in his career, Barrasso’s plan was to provide health care for as many people as possible inside and outside the operating room. That plan culminated on June 25, when he was appointed by Gov. David Freudenthal to fill the U.S. Senate seat vacated by the late Craig Thomas. “Affordable and available health care is a big issue in Wyoming,” he said. “It’s a rural state, and people are spread out. I want to help find ways to get health care to them.”

As a medical student at Georgetown University, Barrasso was already thinking about ways to broaden his impact on the public’s health care needs. He joined the American Medical Student Association, where he worked on issues related to preventive medicine and health care access.

He produced television and radio reports and newspaper articles on health and fitness for more than 20 years, and served as the medical director of Wyoming Health Fairs, a series of programs on preventive medicine held across the state. He presently writes a monthly series of articles on preventive health care for elders called “Caring for Wyoming’s Seniors.” He has also served as a rodeo physician for the Professional Rodeo Cowboys Association and as a sports team physician for Casper College. In 2002 he ran for a seat in the Wyoming State Senate. “I knew I could help patients one-on-one in the office,” he said, “but I felt I could do more to help more people working legislatively.”

Barrasso, now 54, won the seat and was re-elected in 2006. His greatest accomplishment as a state senator, he said, was co-sponsoring the Hathaway Scholarships program, which gives eligible students scholarship money to attend the University of Wyoming or any state community college. “It was sponsored by two Republicans and two Democrats and ultimately was signed by a Democratic governor and named for Republican governor [Stanley Hathaway],” Barrasso said. “It was the best of bipartisan support for a worthy public policy.”

An ongoing desire to broaden the scope of his influence compelled Barrasso to seek the vacant U.S. Senate seat. “I wanted to do on the national level what I had been doing on the state level,” he said, “provide quality education for kids, quality jobs for communities and health care accessibility for everyone.”

Gary E. Friedlaender, M.D., HS ’74, the Wayne O. Southwick Professor and chair of orthopaedics, met Barrasso during his training at Yale and has stayed in touch over the years. What characterized Barrasso as a resident, he said, was his “strong intellect and highly capable technical skills. As a house officer, he was a great physician who had compassion, commitment and ethical moral character.”

Barrasso says he supports “lower taxes, less spending, traditional family values, local control and a strong national defense.” In the state senate he received an “A” rating from the National Rifle Association, voted for prayer in schools, voted against gay marriage and sponsored legislation to protect the sanctity of life.

“In today’s world, his views would earn him a conservative label,” Friedlaender said, “but John is not inured to the needs of people, especially in terms of health care. I would describe his politics as thoughtful.”

In his new job as a U.S. senator, Barrasso serves on the Senate Energy and Natural Resources Committee, the Environment and Public Works Committee and the Indian Affairs Committee.

The senate seat Barrasso filled doesn’t come up for re-election until 2012, but Barrasso must run as the incumbent in a special election during the 2008 general election.

Friedlaender calls Barrasso’s ability to combine a health care mindset with his political skills a “powerful partnership. He’ll do more with it than the average individual,” he predicted.

—Jennifer Kaylin

The physiological and the psychological: how women and men are different

Louann Brizendine, M.D. ’81, never suspected that her third-year psychiatry rotation would lead to her becoming a best-selling author. Recalling that rotation, she said, “I was stunned by the two-to-one female/male ratio. No one knew why so many patients were suicidally depressed women.”

Over the past 25 years Brizendine, director of the Women’s Mood and Hormone Clinic at the University of California, San Francisco (UCSF), has developed many theories about women’s psychological issues. She finally explained them in The Female Brain (Morgan Road Books, 2006), which sold 80,000 copies in its first four months and has been translated into 18 languages. Brizendine believes that physiological differences between men and women lead to significant psychological differences—for example, oxytocin, “the hormone of intimacy,” causes women to crave social contact far more often than men.

Her interest in women’s mental health continued during a psychiatry residency at Harvard and on into her private practice. Recruited by UCSF in 1988, Brizendine taught psychiatry. “Then I got pregnant, and had all the postpartum hormones,” she said. “Phases of a woman’s life were no longer theoretical.”

She began working with UCSF neuroendocrinologists to explore whether fluctuating hormones could trigger women’s mood disorders. “A progesterone metabolite in the brain decreases at menstruation, causing [symptoms similar to] Valium withdrawal: emotional sensitivity, mood changes, etc.,” observed Brizendine, who had read the literature about hormones, estrogen and neurochemical brain changes in mammals. “Animal models aren’t adequate—you can’t ask a mouse how its mood is today.”

Her new perspective led to an innovative course at UCSF in 1993, “Hormones in Psychiatry,” which quickly evolved into her mood and hormone clinic. The clinic now treats about 600 women annually.

Brizendine’s research into hormones led her to a startling conclusion. “It hit me like a lightning bolt—testosterone causes sexual desire. No one ever thought the problem of frigidity might be biological! I started measuring testosterone and correlating it with sexual interest in females. Levels were often low. Watching patients suffer, knowing other psychiatrists weren’t seeing it the same way, I felt a passion to clarify biological aspects of women’s mental health and hormonal issues,” she said.

Surprisingly, some patients wanted to stay on the antidepressant Prozac, even though one of its side effects is decreased libido. They were choosing better moods over better sex. In early Prozac trials, manufacturer Eli Lilly and Company had found (but not publicized) women’s orgasmic difficulties. “Female sexual problems are treated as just ho-hum,” Brizendine said, “but erection or ejaculation problems are treated as a medical emergency.”

Her book’s provocative claims—including the contention that oxytocin gives females so much pleasure that they crave connections like gossip with friends to get that “rush”—are criticized for exaggerating gender differences or oversimplifying research. Some social scientists say her unflattering, dubious presentation of female behaviors weakens crusades for equal pay and opportunities.

Other colleagues remain unruffled. Bruce McEwen, Ph.D., head of the Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology at Rockefeller University, confirmed the biological basis of sex differences in brain and behavior. “Sex hormones and experiences interact over the entire lifespan and alter brain structure and function in both men and women. Brizendine perhaps has not emphasized [these ongoing interactions] as much as she might have.”

He appreciates Brizendine’s efforts to “elucidate biological bases of how many men and women behave. Whether she’s contributed to more prejudice, in spite of the best intentions to educate … is to me the almost inevitable price of writing about this topic.”

Brizendine, ruefully aware of the controversies, had aimed to preclude them. In a mass-market book, she discovered, “you can’t go into details of how and where a study was done. I wrote a more sophisticated section for people in science, so that anyone wanting to know more could go to those 45 pages of notes at the back.” However, determined to shorten the length of The Female Brain, the publisher deleted all of Brizendine’s painstaking explanatory notes during final editing.

How does she endure the negative reactions? “I just breathe deeply,” Brizendine said. “Some days, I need ovaries of steel.”

—Carol Milano

Policy expert finds answers to large health problems come from diverse teams

In the 30 years that Darryl E. Crompton, J.D., M.P.H. ’76, has worked as a public health lawyer, nothing prepared him for the moment he held a 4-month-old South African girl dying of AIDS. As she wheezed and shivered in his arms, all he could think about was how governments, nonprofit organizations and religious groups had failed her and the nearly 1 million other AIDS orphans in Africa.

“This was the first time I had held someone who was dying,” Crompton said. “It made me more sensitive and committed to make a contribution to social change related to AIDS and poverty.”

Crompton spent a month in South Africa in 2005 as a consultant for the humanitarian organization CHF International. His assignment was to determine how well the country’s social infrastructure supports AIDS orphans, some of whom have AIDS themselves.

South Africa was one of many stops on a professional journey dedicated to improving the health of the poor and uninsured, especially children. Crompton, who received his law degree from the University of California, Davis, and his master’s degree in public health from Yale, has taught health law, policy and bioethics at the University of Alabama; trained Siberian physicians in health care policy; and studied pediatric patients’ rights in Scotland, England and Denmark. He is now director of the Institute for International Public Policy of the United Negro College Fund Special Programs Corporation in Washington, D.C. He is also a lawyer and policy, management and organization development consultant in Washington.

Crompton became sensitized to the plight of the poor as a boy. His parents wanted their children to have a multicultural education, so when Crompton was 11, the family left their home in Los Angeles to spend a year in Morocco. “I saw other 11-year-old children who had dropped out of school and were working in various and sundry jobs,” he said. “People were living in mud huts with no running water.”

Crompton’s father worked as an architect, a profession that provided the family with opportunities for international travel. Their next move was to Copenhagen, where Crompton experienced socialized medicine for the first time. When he or members of his family got sick, they received high-quality health care—for free.

Growing up in the political crucible of the civil rights movement and the Vietnam War, Crompton knew he wanted to contribute to social change. He considered becoming a dentist because of his interest in science, but instead chose a career in public health and health policy. “When I looked at how I could make a contribution to social change in health, it wasn’t through the practice of medicine, one patient at a time, but through public policy,” he said.

After graduating from the University of California, Los Angeles, he decided to study law. As a law student Crompton took courses in public health. Those classes, combined with an internship in the Washington office of U.S. Rep. Yvonne Braithwaite Burke, a Democrat from Los Angeles, convinced him to work for an M.P.H. as well.

At Yale, Crompton was pleasantly surprised by the varied backgrounds of his classmates. “We had teachers, musicians, nuns, priests, mathematicians, people with philosophy backgrounds. It was very exciting for me.”

In fact, that multifaceted learning environment informs his approach to public health to this day. “I don’t have a magic bullet, but I know the only way you can achieve transformational change is through interdisciplinary teams of people.” He notes that if a patient with HIV or AIDS is homeless or can’t afford food, antiretroviral drugs alone aren’t going to offer much help.

Crompton saw the complexity of health issues when he was hired in 1988 by the Florida commissioner of education to evaluate drug prevention programs for adolescents. “There are lots of drug and alcohol prevention models, but basically very few are effective,” he said. “It’s an example of the interconnection between public health care and a whole range of broader social, political and cultural issues.”

Crompton is also interested in diversity of another sort. There should be more diversity and minority representation in health care, he says. He would like medical and public health schools, such as Yale’s, to identify, nurture and support talented minority middle and high school students to prepare them for careers in public health.

It’s all part of his lifelong goal of providing universal access to health care. “I don’t see a lot of caring in the health care system,” he said. “How can we improve the caring part of health care?”

—Lori Ann Brass


			Originally published in Yale Medicine, Winter 2008. Copyright © 2008 Yale University School of Medicine. All rights reserved.