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Thursday, June 26, 2014 | return to: cover story


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Labor of love: UCSF’s ‘billboard doctor’ leads study on infant mortality

by alix wall

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You may have seen his smiling face on billboards, or on BART trains. You may have spotted it affixed to the side of Muni buses, or on television. If you’ve wondered, “Who is this guy, and why is his face plastered all over the Bay Area?” you wouldn’t be the first.

coverJune27_14The guy is Dr. Larry Rand, the 42-year-old director of Perinatal Services at UCSF’s Fetal Treatment Center, as well as the Lynne and Marc Benioff Endowed Chair in Maternal and Fetal Medicine. A renowned researcher in the prevention of pre-term infant mortality, he is the co-director of a new $100 million research project from the Benioffs and the Bill and Melinda Gates Foundation to reduce the incidence of premature births around the world, particularly among low-income populations.

He is also one-half of a medical power couple with his partner, Dr. Jonathan Fuchs, an associate professor at UCSF. Fuchs is also a 13-year veteran of the San Francisco Department of Public Health who researches HIV vaccines and trains scientists around the world in HIV prevention. The two are active in the Jewish community as members of Congregation Emanu-El in San Francisco.

As for the billboards and TV appearances? When UCSF approached Rand — along with a few of his fellow colleagues, he’s quick to add — to ask if he’d take part in a marketing campaign, he said sure, having no idea that his face would be posted on the side of the N-Judah and on a billboard next to the Bay Bridge on-ramp.

“I said I’d be honored to do it. It’s been funny to be plastered all over town and all over the East Bay. I’d get text messages from friends posing in front of the billboards or ads with huge smiles, many wishing me congratulations. I was so embarrassed to be congratulated, as I hadn’t done anything.”

He may have done relatively little in UCSF’s marketing department, but he’s done plenty to bring recognition to the world-class institution with his groundbreaking work and research.

To get there, Rand did not take a predictable path. His journey — to a career in medical research, to San Francisco, and also back to Judaism — began in an unlikely place: Munich, Germany, where he was born and spent his first seven years.

Dr. Larry Rand  photo/jonathan fuchs
Dr. Larry Rand    photo/jonathan fuchs 

Rand’s father, Alter, was a Holocaust survivor born in Krakow in 1926 to a religious family, the second eldest of eight. On a Shabbat afternoon some time after the Nazis occupied Poland in 1939, the family was eating lunch when there was a knock at the door. The Gestapo entered and unleashed their guns. Alter, who was 12 or 13 at the time, managed to escape undetected with his baby brother in a knapsack and another younger brother in tow. His parents, five siblings and grandparents all were murdered.

The three brothers survived in forests and cemeteries, always on the run and at the mercy of strangers. Toward the end of the war, the middle brother, Pincus, got separated and ended up in a labor camp. Alter and Moishe also were captured, but they escaped when Alter loosened a plank on a death camp–bound train car, grabbed his brother and jumped off the speeding train. Miraculously, both survived that jump, and the entire war, as did Pincus.

After the war, Alter’s brothers were sent to orphanages, later ending up in New York. Alter found himself in Mannheim, Germany, which was now occupied by the Americans and full of displaced persons like himself who had no idea where to go. He was almost 19, too old for an orphanage.

Alter made his way to Munich, where he eventually met Miriam Rosengarten. She was born in Belgium and had spent the war years with her family in pre-state Israel before returning to Europe. The couple married and had two children, Larry and his younger sister, Helen. Alter started a chain of nonkosher rotisserie restaurants; Rand has vivid memories of chickens and brisket hanging on the walls.

Rand and his sister attended a Reform day school. He has no memories of anti-Semitism in the 1970s, and says his parents were happy and reasonably successful in Munich.

Meanwhile, Rand’s uncles Pincus and Moishe would call from New York. “You can’t raise your children in Germany,” they’d say. “You have to come here and give them a Jewish education. It’s an injustice to them to stay there.” His parents began to believe his uncles were right.

Rand isn’t clear on why his parents gave up their lives in Germany and decided to leave in 1978 for a new life in Brooklyn. They were miserable from the start. Rand, who was 7 at the time, remembers his mother sobbing as they walked down the jetway to the plane, and she didn’t stop the entire journey.

“My father never got over it, and my mother still regrets it but has made it work,” he said. “The move caused a deep depression and sense of displacement, and that naturally impacted me as well.”

Image that appeared in a Bay Area ad campaign  promoting UCSF.  photo/christian peacock for ucsf
Image that appeared in a Bay Area ad campaign promoting UCSF. photo/christian peacock for ucsf

The family lived as if they might move back at any moment, with unpacked boxes sitting in the dining room for at least six years, Rand recalls.

Rand and his sister were sent to Yeshiva of Flatbush, a Modern Orthodox co-ed school, which after his more relaxed Jewish upbringing in Germany “was a crazy amount of religion.” He ran away from school so many times that his mother stationed herself in the lobby to make sure he stayed put.

Meanwhile, they were German-style Reform Jews, living in an Orthodox neighborhood. “I’d go to school and pretend to be Orthodox, and it felt like this religion was being shoved down my throat,” he said. “Then on Friday nights, we’d close the shades, turn on the TV and watch ‘Dallas,’ but God forbid the neighbors would know. If we traveled anywhere on Shabbat, we’d leave the house and meet three blocks away.”

When his father took him to the Orthodox shul, the young Rand hated that, too.

When he got to high school, things got worse instead of better. Social interactions befuddled him. “The school was socially divided between wealthy, spoiled kids and normal kids, and I had this immigrant family who was struggling. I had no idea why I was in school. I had no reason to be there.”

By his sophomore year, he had cut school for 30 days straight, failed five classes and was expelled twice. Life took a dramatic turn when his father, who was diabetic, needed a bypass on his leg. “It was like a ton of bricks fell on my head,” Rand recalled. “I suddenly grew up in 10 days, and knew I had to become an adult.”

As complications from his father’s diabetes mounted, Rand found his interactions with the physicians beyond frustrating. “The doctors couldn’t communicate,” he said. “Their bedside manner was completely missing.” Those interactions would play a role in the career he eventually chose and the kind of doctor he wanted to be.

In his last two years of high school, Rand turned his academic life around (he excelled so much, in fact, his teachers thought he was cheating) and was accepted in early admissions to New York University.

Rand performed life-saving laser ablation surgery on Meghann Bauer’s twins, Matthew and William, in 2012.  photo/christian peacock for ucsf
Rand performed life-saving laser ablation surgery on Meghann Bauer’s twins, Matthew and William, in 2012. photo/christian peacock for ucsf

Halfway through college, he became an anthropology major; he says his eventual decision to go into medicine, specifically obstetrics, grew out of his love for anthropology and his fascination with pregnancy and the development of life within.

“It’s truly so amazing, and I wanted to be a part of it, and help when things are not going well.”

“Not going well” is an understatement. Hours before this interview took place in late May, Rand helped deliver the baby of a Fresno woman, Melissa Carleton, who was in a coma after surgery for a brain tumor. The case made the national media. In another prominent case, Rand led a team of doctors who performed fetal surgery on Meghann Bauer’s twins, who shared a single placenta, in a corrective procedure called laser ablation.

Like so much of Rand’s life journey, moving to San Francisco was not something he intended or anticipated.

His father had died of complications from his diabetes during Rand’s senior year of college. Rand was determined to be a different kind of doctor than the ones who had treated his father.

He was accepted to Harvard Medical School, which led to a residency in Boston and then work back in New York.

With his specialization in high-risk pregnancy, and with UCSF being the pioneer of in-utero surgery — one of only a handful of hospitals in the nation that perform the specialized surgery — UCSF colleagues who knew Rand from Boston pressed him to consider a move to San Francisco. At first he wasn’t interested because his entire family was on the East Coast.

He came for a two-day interview, and within the first two hours he was sold. The doctor who interviewed him was everything he was looking for in a mentor. She was Diana Farmer, the first female doctor to perform in-utero surgery (she is now surgeon-in-chief at U.C. Davis Children’s Hospital).

“She had every palpable characteristic of a dream mentor: brilliant, accomplished, dynamic, warm, open and smiling,” he recalled. “She looked right into my eyes and told me, ‘Larry, UCSF is the place for you. Welcome home.’ We hugged at the end of the interview.”

Farmer said she “just clicked” with Rand and sensed that “he was the perfect combination of a guy interested in fetal therapy and [someone with] that energy for innovation and inquiry that made him special.

“He also had great interpersonal skills,” she said. “It’s one thing to be a good doctor and a good investigator, but without good interpersonal skills, it’s hard to get your ideas to the next level. Larry had it all.”

He moved to San Francisco in 2008 and within a year met two people who would change his life.

The first was Marc Benioff, CEO and founder of the San Francisco–based company Salesforce. They met the way Rand meets so many people — he was the ob-gyn for Marc’s wife, Lynne. Their relationship turned into a friendship. Knowing Rand was new to the area, Benioff invited him to attend Rosh Hashanah services.

 

Larry Rand (left) and Jonathan Fuchs in their San Francisco home.  photo/cathleen mclearie
Larry Rand (left) and Jonathan Fuchs in their San Francisco home. photo/cathleen mclearie
Rand had no desire to go. He had rejected his Judaism around the time he came out at age 20. He dated only non-Jewish men and did not affiliate in any way with Judaism. He hadn’t been inside a synagogue for over 17 years. “If it weren’t [for Benioff], I wouldn’t have gone. He’s very convincing.”

 

Seated before the services began, Rand observed men and women sitting together in the sanctuary, something he never experienced when he attended the Orthodox shul with his father in Brooklyn.

He got teary recalling the memory of his return. “The lights went down, and the rabbis were all in the back of the sanctuary, and they all came down aisles with Torahs, and it was so stunning,” he said. He opened the siddur and began to read Hebrew. He felt at home in a way he never had in a synagogue and burst into tears.

Rand began to attend services regularly at Congregation Emanu-El, and as he became closer to his Judaism, it became evident to him that he wanted to meet a Jewish partner. And that is what led him to meet the second person who would change his life.

How does someone find a single Jewish man in San Francisco? Rand did what many do: signed up on JDate. The most recent photo he had of himself was from a medical mission to Africa, where he travels regularly. That caught the attention of Jonathan Fuchs, who often travels to Africa for AIDS research.

Fuchs, 44, came to UCSF from New Jersey for his residency in 1997 and never left. A former board member of the New Israel Fund, Fuchs also has a master’s in public health. “When I was in residency, I had a lot of HIV-infected patients,” said Fuchs. “I moved here right after the cocktail therapy was discovered. I had a lot of patients at death’s door, and as a gay man myself, seeing them survive was incredible for me.”

Rand and Fuchs have been together since their first date in 2009 and plan to marry at some point. Rand said their relationship has not only affected his personal life in wonderful ways but his professional life, too.

“My strength was always in counseling and bedside manner — that gives me the real satisfaction. But Jonathan had this whole other way of looking at things.” As a public health researcher who studies epidemics, Rand said, “his ‘patient’ was the entire population. That concept blew my mind.” It also shifted how Rand approached his own field of medicine, treating it more like a public health issue. “If we just take care of one patient [at a time],” he said, “that doesn’t move the needle.”

That was something Benioff realized as well. Alarmed by a statistic that 15 million babies die of complications from premature birth each year, a million of those infants in the United States (born mostly to lower-income families), Benioff called Rand last year and asked, “Why can’t we do something about this at UCSF?”

To further the global effort to reduce premature births, Benioff brought in the Bill and Melinda Gates Foundation, which had a history of supporting the cause. Rand already was a known quantity to the Gateses — their organization funded research on one of Rand’s ideas, inspired by his work in Africa: a wireless diaphragm device that can detect when a cervix is changing and predict the onset of labor. Rand says the grant never would have happened if not for Fuchs, who encouraged him to apply for it.

But Benioff wasn’t done. He thought he could convince the Gateses to make their largest grant to maternal and fetal health to date, and he was right: They doubled their initial $25 million to $50 million. With the Benioffs’ contribution, the study’s funding hit the $100 million mark.

While Benioff declined J.’s request for an interview, he did say in an email, “Larry’s outstanding leadership at the UCSF Fetal Treatment Center, and incredible innovation focus, made him the logical choice to lead the exciting efforts of the global preterm birth program.”

The 10-year project will be ongoing at UCSF and expand to San Francisco General Hospital next month. After its pilot year, it will grow into a larger clinical study. Rand will work with colleagues in Kenya, Uganda, Rwanda and India, from disciplines inside and outside the medical field, to leverage technology that seeks not only to reduce the number of premature births but also to decrease the number of pre-term babies who die.

While the Gates Foundation funds more work in the developing world, Rand said Benioff is just as concerned about the wealth disparity at home, or the “two San Franciscos.” The rate of preterm birth in white upper-income women is 6 percent in San Francisco; for black lower-income women it’s 14.5 percent, Rand said.

Rand may be a world-class research scientist, but at his core he is first and foremost a doctor who is deeply concerned with the care he gives his patients. Sometimes he toys with the idea of going to rabbinical school. Not as a midlife career change, but because it could improve his medical skills.

“Judaism is so deeply rooted in principles that are consistent with good citizenship, taking care of and respecting your fellow neighbor, and being accountable and responsible for your body along with your soul,” he said. “These principles resonate and connect to good medicine.”

 

on the cover

 

photo/christian peacock for ucsf

Dr. Larry Rand on the job


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