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• W2116710288 abstract "Chung Owyang is the recipient of the 2013 Friedenwald Medal, the highest honor bestowed by the American Gastroenterological Association (AGA). For all of his contributions to the field of gastroenterology, he is richly deserving of this award. Chung has been that unique “triple combination” of an academic physician who is equally outstanding as a clinician, scientist, and teacher. His scientific work has always focused on the tight interface between patients and the scientific basis of their illnesses, and the special perspective he has on the pathophysiology of disease has made him both an outstanding clinician and a gifted teacher. Widely respected and internationally renowned for his work, it is not surprising that he has become a leader who has helped to shape the knowledge and practice of his chosen discipline. Dr Bishr Omary, editor of Gastroenterology, notes that “Few individuals, no matter whether it's in the fields of art, engineering, medicine, or science, continue to contribute selflessly and at the level Chung has for so many years.” Chung was born in Chung King, China, at the end of World War II, one of a pair of identical twins (his brother is appropriately named King). Chi Owyang, his father, grew up in Thailand as the only son of an impoverished family from a village in Guangzhou. He became a banker and financier in China, moved to Singapore when the twins were 2 months old, and joined a group to set up the first (today one of the largest) overseas Chinese bank in Singapore. Following his retirement from banking in 1972, he had a distinguished career as Singapore ambassador to Thailand and played a key role in reshaping the relationship of China with the countries in Southeast Asia. His hard-working ethic, sense of duty, patience, humility, and kindness were passed on to his children, and these traits became clearly evident in Chung and his siblings. Chung's eldest brother, Hsuan, held prominent positions in finance and government in Singapore, his brother John headed a major Hong Kong bank, his brother Ho owns a publicly listed computer engineering firm in Hong Kong, his brother Raymond started 2 firms that were successfully acquired by DuPont, his sister Liang was an executive at Abbott Laboratories, and King is president and CEO of a Fortune 500 computer chip company in Silicon Valley. Chin-Yuen, Chung's remarkable mother, raised this brood of 7 children single-handedly through World War II and the Chinese Revolution. It is not surprising that great things were expected of Chung, the youngest child, with this family background. Chung and King attended a Catholic school in Singapore, the only bilingual school at that time, where many of the teachers were priests from the United States. Their influence led to the twins' decision to study in North America. Chung's interest in medicine developed early because his mother had diabetes and cardiovascular disease and spent much time in and out of hospitals when he was a child. The helplessness he felt as he watched his mother deteriorate motivated Chung to go into medicine, a field that was quite different from the family orientation toward business and finance. Because Singapore was a British colony and required a British Commonwealth degree to practice medicine, Chung set his sights on going to medical school at McGill University; to that end, he enrolled in the undergraduate college there. Once Chung got over the initial shock of the climate and culture of Montreal, he grew to love the vibrancy and international atmosphere of the city. He majored in biochemistry because he understood the momentous implications of the work of Watson and Crick, who unlocked the secrets of life with the elucidation of the structure of DNA. In his junior and senior years he worked in the laboratory of Esau Hosein, a world authority on ethanol metabolism and liver injury, and this experience laid the foundation for his investigative career in biological sciences and medicine. Chung entered medical school at McGill University, where most of the inpatient training was conducted at the Royal Victoria and Montreal General Hospitals, and he quickly became enthralled with the cognitive challenges of internal medicine. As a medical resident at Montreal General Hospital, Chung's future career was very much influenced by 2 important mentors: Drs Lester McCallum and Eldon Shaffer. Dr McCallum was the director of residency training and a master clinician who easily handled the most complex cases with aplomb by adhering to pathophysiological principles and relying on the history and physical examination as his diagnostic tools. These lessons have stayed with Chung as he approaches patients in his practice even today. Dr Shaffer, having just returned from Dr Don Small's laboratory in Boston, convinced Chung to pursue a career in gastroenterology. He shared with Chung his exceptional research experience in the United States and urged Chung to look beyond the borders of Canada. In the summer of 1975, Chung arrived in Rochester, Minnesota, for his gastroenterology fellowship training. Under the direction of Dr William Summerskill, this was a golden age for the Mayo gastroenterology unit, which was at the forefront of gastrointestinal research in humans. Dr Summerskill, who was a world expert in the treatment of hepatitis, was accompanied on the faculty by Dr Alan Hoffman, renowned for his work on bile and gallstones; Dr Sidney Phillips, an expert in small bowel transport; Dr William Go, a leader in gut endocrinology; Dr Eugene DiMagno, a key figure in pancreatology; and Dr Juan Malagelada, who was conducting pioneering work in gut motility. In the early 1970s, the new tool of radioimmunoassay was helping to elucidate the role of peptide hormones in the physiology of the gut, and Dr Go was working on the development of a reliable assay for cholecystokinin (CCK), the hormone believed to be responsible for postprandial pancreatic stimulation and gallbladder contraction. Chung was intrigued by this challenge, and he joined the effort. Unfortunately, the very low level of CCK in the circulation and its structural similarity to gastrin made the development of an assay difficult, and ultimately Chung was unsuccessful. However, the fertile environment at the Mayo Clinic offered Chung many other research opportunities. Working with Dr DiMagno, he investigated the relationship between fasting and postprandial pancreaticoduodenal pressures, pancreatic secretion, and duodenal volume flow; this triggered Chung's lifelong interest in exocrine pancreatic physiology. Under Dr Malagelada's tutelage, Chung learned how to apply multichannel perfusion techniques to record gastrointestinal motility, and using this skill as a springboard he has fashioned a career as a leader in the field of gut motor function. It was a heady time at the Mayo Clinic, and among his compatriots as fellows were Nick LaRusso, Larry Miller, and Arthur McCullough, who to this day remain his friends. Chung spent 4 years at the Mayo Clinic preparing himself for a clinical and investigative career in gastroenterology. His experience there and the people he met have paved the way for his success. In recalling Chung from those days, Dr DiMagno notes that: From the outset of his GI fellowship, it was apparent to me that Chung was exceptional and had the drive and intellect to be an outstanding investigator … It is a tribute to Chung's vision that very soon after beginning his career at Michigan he began asking far more basic questions and established a very successful research program continuously funded by the NIH. The Gastroenterology Division at the University of Michigan was considered a premier unit under Marvin Pollard in the 1960s, but transitional leadership in the Department of Medicine resulted in the division falling on hard times in the 1970s, and there were only 5 full-time faculty members. However, the new chair of the department, Dr William Kelley, set a vision of excellence for the future and convinced Chung to accept a position as assistant professor at Michigan despite offers from other prestigious institutions. I was hired as the chief of the Gastroenterology Division 5 years later, and it was the start of a lasting friendship and collaboration. Chung and I worked closely together to rebuild the division. One of our first initiatives was to respond to a request for application from the National Institutes of Health for a digestive disease center grant. This grant, which we were ultimately awarded, established the Michigan Gastrointestinal Peptide Research Center, the first of its kind in the country. The center, now in its 28th year, provided the infrastructure for us to build a strong clinical and research program in gastroenterology and played a key role in the university's recruitment of Dr Jack Dixon as chair of biochemistry and Dr John Williams and subsequently Dr Omary as chair of physiology. Chung's career progressed rapidly, and he became a full professor before he was 40 years old. When appointed to the position of chair of medicine in 1991, I selected Chung to be my successor as chief of gastroenterology, a position he has held now for 22 years. Dr Gabriel Makhlouf, one of Chung's important mentors, has observed that “In a seamless transition, he took over the leadership of the center in the 90s—lifting it to new heights. It was during those years that his rare qualities as a skilled administrator, deft diplomat, and astute judge of quality and character came into focus.” Under Chung's leadership, the division has flourished. Building on a core of clinical faculty that included Drs Joanne Wilson, Grace Elta, and Tim Nostrant, Chung helped to recruit and/or train Drs C. Richard Boland, Richard Moseley, Rebecca Van Dyke, Paul Watkins, Gary Falk, Michael Lucey, Peter Traber, Joseph Kolars, William Chey, Ellen Zimmermann, Juanita Merchant, John Del Valle, William Hasler, John Wiley, Andrea Todisco, and John Carethers. Chung has established an outstanding presence for the division in hepatology with Drs Anna Lok, Robert Fontana, Jorge Marrero, Hari Conjeevaram, and Grace Su. Recognizing the importance of health services research, Chung established the division's strength in this area with the recruitment of Drs Philip Schoenfeld and John Inadomi. Ever on top of scientific developments, he has recruited and developed young talented physician scientists such as Drs Tom Wang, Ezra Burstein, John Kao, Peter Higgins, Liz Speliotes, and Andrew Tai. Over his tenure, the Gastroenterology Division at Michigan has expanded rapidly in both its clinical services and its outreach programs (Figure 1). With a clinical practice encompassing more than 60 full-time faculty, the division is the second largest digestive and liver health group in the nation and offers a broad base of expertise, as well as a tremendous depth of knowledge, in a variety of gastrointestinal and hepatic disorders. The division's clinical services extend to 14 separate locations and 4 endoscopy centers. Chung manages all of this with remarkable skill and a deep understanding of how to maintain financial stability for the division to provide outstanding support for its clinical, research, and training programs. According to Dr Elta, “The wisdom of this leadership style has led to Chung's long and successful reign of one of the largest GI faculty and fellowship programs in the country.” Chung has always taken an active interest in the nurturing of young investigators and brought out the best in those around him. Chung's mantra for his mentees is to maintain focus and aim high. Many of those that Chung has recruited or trained have subsequently evolved into leaders in their own right. Dr Carethers, now the chair of the Department of Internal Medicine at Michigan, notes that “His relative unassuming style does little to highlight his own highly cited published research, but can bring out the best that is hidden in someone…” Most have chosen to stay at Michigan despite multiple and frequent attempts to recruit them away. This provides testimony to the supportive and productive environment that Chung has created in his division. Chung's contributions have extended well beyond those in Ann Arbor. For the past 3 decades, Chung has helped to train a whole generation of academic gastroenterologists in China, many of whom are in leadership positions in the country, and has made significant contributions to the modernization of teaching clinical practice in China, Thailand, and Singapore. As the only foreign member on the Board of Trustees of Jiaotong University in Shanghai, Chung provided the blueprint for revamping their medical training system and was instrumental in the development of the nation's first MD/PhD program. For his role in developing academic gastroenterologists in Thailand, he was extended an honorary fellowship by the country's Royal College of Physicians. In 2011, Chung was honored by the AGA with the Distinguished Mentor Award. The citation stated that “Chung is an internationally recognized, respected investigator and academic leader … Chung is viewed by peers and students as the epitome of mentorship who has helped guide and groom the careers of all who have had the opportunity to work with him…” Dr Falk reflects the views of many of the fellows who have trained with Chung in noting, “I am truly proud to have been mentored by such an outstanding individual and am immensely grateful for all he has done for me in the formative and later stages of my career.” Dr Chey, another former fellow, says, “Through the many twists and turns that my career has taken over the last 23 years, one of my most consistent touchstones has been Chung. Chung exhibits the attributes that I have tried to emulate as a mentor.” Chung's research almost always begins with a clinical problem, and in seeking to elucidate the mechanisms involved he applies vertically integrated experiments using cutting-edge technologies when appropriate. Few other investigators in gastroenterology can span the gamut from traditional clinical tools such as gastrointestinal motility studies to basic cellular and molecular biological tools to apply to their research. His laboratory has used these tools to make seminal contributions to current understanding of the regulation of pancreatic secretion, gastrointestinal motility, and appetite. As Dr Daniel Podolsky notes, “In applying clinical insight into some of the most challenging problems of our discipline … to develop creative approaches that span animal and human experimental models, Chung is a consummate clinical investigator.” Chung's laboratory characterized a new peptide, CCK-releasing factor, which is secreted into the intestinal lumen in response to food and stimulates CCK release. The pancreatic enzymes subsequently secreted into the lumen inactivate CCK-releasing factor, thereby creating a feedback regulatory loop. This novel observation has provided the basis for understanding the clinical utility of pancreatic enzyme supplements in alleviating pain in patients with chronic pancreatitis by diminishing CCK-mediated stimulation. Although CCK is known to stimulate pancreatic secretion in rodents via specific receptors on acinar cells, humans have no such receptors. Chung showed that CCK acts indirectly on the pancreas through stimulation of a vagal afferent pathway in humans. In addition, he showed that other peptides that are inhibitors of pancreatic secretion, such as pancreatic polypeptides, somatostatin, calcitonin gene-related peptide, encephalin, and pancreastatin, also act by modulating vagal cholinergic transmission. This body of work supports the Pavlovian concept that the nervous system is the major regulator of pancreatic secretion and provides the basis for understanding the role of vagal sensory pathways in gastrointestinal disorders in diabetes. The pivotal role of vagal sensory pathways in the mediation of pancreatic exocrine function in health and disease was not appreciated before Chung's work. Chung has a long-standing interest in the physiology and the pathophysiology of gastrointestinal motility. Among his many observations, using isolated cells, muscle strips, and in vivo animal studies, he has shown that somatostatin has both excitatory and inhibitory actions on myenteric cholinergic transmission and thus plays a critical role in mediating both limbs of the peristaltic reflex. He further showed that somatostatin is a potent agent to initiate intestinal migrating motor complexes in humans and thus can be effective in treating bowel bacterial overgrowth in patients with chronic intestinal pseudo-obstruction. In other studies, Chung showed that acute fluctuations in serum glucose levels can impair gastric motor function, specifically that hyperglycemia stimulates vagal pathways that act on intragastric nitric oxide–containing neurons to induce gastric relaxation, thus explaining the wide day-to-day fluctuations in gastric emptying rates and symptoms of nausea and vomiting in patients with diabetic gastroparesis who have stable gastric neuropathies. He further observed that acute hyperglycemia may cause gastric dysrhythmias due to increased production of prostaglandin in the stomach wall and up-regulation of dopamine 2 receptors in the gastric pacemaker cells. This provides the rationale for using D2 receptor antagonists such as domperidone in the treatment of diabetic tachyarrhythmias. Recently, Chung's research efforts have extended toward understanding the peripheral pathways by which appetite is regulated. His studies have focused on the role of vagal sensory fibers in transmitting satiety signals to the brain and have shown that cocaine- and amphetamine-regulated transcript (CART) in the nodose ganglia is the principal neurotransmitter mediating short-term satiety evoked by CCK/leptin. He hypothesizes that malfunctioning of these signaling pathways may result in eating disorders. Chung's research and scholarship has had a broad impact on the discipline of gastroenterology. He and his coworkers have authored 194 original articles in high-quality, peer-reviewed journals as well as 63 chapters in leading textbooks of gastroenterology and internal medicine. I have personally benefitted greatly from his service as an associate editor of The Textbook of Gastroenterology through its first 5 editions (Figure 2). He has served as an associate editor of American Journal of Physiology and senior associate editor of Gastroenterology and on the General Medicine A2 NIH Study Section. In addition, he served with distinction for 4 years as president of the American Motility Society and provided leadership to the American Pancreatic Association. In recognition of his accomplishments in research, he has been elected to membership in the American Society of Clinical Investigation and the American Association of Physicians and is the recipient of numerous awards, including the Janssen Award for Basic or Clinical Research in Gastrointestinal Motility and the Joseph B. Kirsner Award for Clinical Research in Gastroenterology from the American Digestive Health Foundation/AGA. Although Chung is widely recognized for his enormous contributions to gastroenterology research, he is also a superb clinician specializing in functional bowel disease and motility disorders. In his clinic, he manages patients with irritable bowel with the most complex psychological burdens and is the go-to person for patients with severe gastroparesis and other difficult motility disorders such as cyclic vomiting and chronic intestinal pseudo-obstruction. Despite the challenging nature of these problems with no proven effective therapies, Chung manages his patients with compassion and skill. He is also adept at applying his scientific knowledge to benefit his patients. He was among the first to recognize that the symptoms of patients with diabetic gastroparesis may switch over time, suggesting that different pathophysiologic mechanisms may be in play at different times, requiring different treatment strategies. His research insights into somatostatin led him to be among the first to recognize the utility of the hormone for the treatment of intestinal pseudo-obstruction. Chung is deeply admired by his students, house officers, and fellows as a teacher, and he is at his very best at this when he is with patients. He is a clear thinker and applies his deep knowledge of pathophysiology in deciphering what is going on with a patient at the bedside. I have had students tell me that when they learn something from Chung, they remember it because of the logical context in which he places complex concepts. The best measure of his teaching ability is that fellows will often wait to present their patients to him in the outpatient clinic even if they are busy and there are other attending physicians present. Consistently selected as one of the “Top Doctors in America,” Chung maintains a busy clinical practice despite his heavy administrative load and research activities. Frequently, he will add additional clinics to reduce the wait for patients to see him. He also takes time to personally address patients' correspondence and telephone calls. It is no surprise then that his patients are devoted to him and respect his clinical judgment. Chung finds that a hug or a smile from a grateful patient is the most rewarding experience at the end of a long work day. Beyond his direct professional responsibilities, Chung has several long-standing commitments. As a leader in gastroenterology, he has had a continuing commitment to the AGA. He has served as the chair of the AGA Council on Hormones, Transmitters, Growth Factors and Their Receptors and, as noted in the preceding text, he is currently the senior associate editor of Gastroenterology. Given his background, it is natural that he has played a major catalytic role in the internationalization of the AGA. He chaired the AGA International Task Force, which led to the reorganization of the AGA International Committee. He served with distinction on the International Committee and chaired it as well. Over the course of 10 years, he led the organization of the AGA/Asia Postgraduate Courses, which were held in various cities in the Asia-Pacific Rim. This meeting became the basis for the establishment of the Asian Pacific Digestive Week. Most importantly, Chung is devoted to his family. He and his beautiful and talented wife of 25 years, Jeannette, have 2 children. Stephanie, who is a senior at Williams College majoring in art and biology, has already won awards for her research in gastroenterology. Christopher is a freshman, also at Williams College, majoring in math and economics. As a family, they spend time together in their home in Ann Arbor as well as in their apartments in Chicago and San Francisco. Chung is a devoted fan of the Michigan Wolverines and has had season tickets to their football games for 35 years. For as long as I have known Chung, he has had a love of fancy European sports cars and has always had a Porsche, Ferrari, Audi, or other species in his garage. He rarely ever drives these cars, preferring instead to appreciate them as works of art. His home is decorated with exquisite pieces of Chinese art, both ancient and contemporary, and he has a renowned stamp collection that has been displayed in international exhibitions in London, Tokyo, and New York. Clearly, Chung's life and career reflect his abiding commitment to excellence. In his ability to lead and mentor colleagues, his clinical and teaching skills, his scientific prowess, and his role as a husband and father, Chung has been successful even beyond his father's high expectations of him. He is the consummate professional and lends great distinction to the Friedenwald Medal for his receipt of it." @default.
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• W2116710288 title "Presentation of the Julius M. Friedenwald Medal to Chung Owyang, MD" @default.
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