Birth of UCI College of Medicine

Dr. Stanley Van den Noort, MD, interviewed by Dr. Michael Seffinger, DO

at Gottschalk Medical Plaza in Irvine, California
April 26, 2006

Dr. Seffinger: I guess we should start off Dr. Van den Noort at stating your name, where you came from, how you got involved with medicine and how you became involved with the osteopathic profession; then go on from there.
Dr. Van den Noort: I’m Stanley Van den Noort. I was born in Lynn, Massachusetts just outside of Boston. My father was a history teacher in a high school in Lynn, Massachusetts. He had been born in Holland. My mother came from Portland, Maine. My father had been a missionary teacher in Java in the 1920s and came back here when my older brother got malaria. I was born in 1930, in the United States. School teachers didn’t get very much money and we lived on very limited means where I was growing up. I was aware that in order to get ahead you had to get scholarships. I was a good student. There was a time in high school when I thought running a garage sounded very fascinating and that was something I would like to do. But my father was a history teacher and I then became fascinated with history and was very serious about going into history. My father who was aware of the economic limitations of teaching history said I had to go to medical school. My brother had gone to medical school ahead of me and was a budding neurosurgeon in Philadelphia. I got a full scholarship to Dartmouth College. Harvard offered me a loan, but I turned down the loan for the full scholarship at Dartmouth. I was probably the only man who went to Dartmouth who didn’t ski, because I knew if I fell down that would be the end of my career. I also said you shouldn’t drink and ski and I enjoyed drinking my beer. I never did ski at Dartmouth, but it was a wonderful time there. At that time Dartmouth had a two year medical school. We started out with 250 pre-meds in the first year, and 24 of us went to that medical school. So the competition was fairly severe. I flourished in it and so it went well. I graduated from Dartmouth Magnum cum Laude, then after two years at Dartmouth Medical School I did two years at Harvard Medical School, and graduated cum Laude from there. And then I went to intern in medicine at Boston City Hospital. My plans at that time were to be a general internist in rural New Hampshire. Then I began to fall in love with neurology and I came under the influence of Dr. Denny Brown (who was the Chief there), Joe Foley (who was another doctor there and my mentor), and also William B. Castle (a major teacher there who discovered intrinsic factor). I always loved Dr. Castle. He taught me that people who are sick are almost never well and people who are well are almost never sick; which I always thought was the reason why we shouldn’t have health insurance based on employment insurance. And I think that was very true then and still is true. He was a Brahman and he drove to the hospital in a Model A Ford, a great man. When the sink leaked he came to fix it with his tool kit. In Boston, I had never heard of osteopathy or chiropractic. They didn’t exist there. And then I got married and we had five children and I discovered that Harvard did not want to pay a living wage to people with five children. You are supposed to be a wealthy person who lives on your coupons I guess and so I migrated to Case Western Reserve Cleveland Clinic where Dr. Foley had gone before and became an Assistant Professor and later an Associate Professor at Case Western Reserve Medical School in Cleveland. That was one of the first places I learned about osteopathy because there was an osteopathic neurosurgeon, Sam Sheppard, D.O., in Ohio who had allegedly murdered his wife and that was a famous trial. The coroner at Case Western and I were discussing another case vise vis the coroner involved in the trial, and my friend who is another neurologist (who is now at the University of Arizona) Bill Sibley said, “You know, I always thought Sam Sheppard was framed and now I know it.” He said that in 1964 I would guess. (That is when Sam Sheppard was exonerated and released to resume his career-ed.). Now more recently, it has come out that the coroner was wrong and Sheppard was right, a little too late, but that’s all I knew about osteopathy. In about 1968 Western Reserve was a private school with very little money for research except through grants and the grants were getting a little harder to get. I was working in the Multiple Sclerosis Research and Fatigue field (neither one of which had lots of funds to work with). The annual days of sunshine in Cleveland resembled those in Seattle and every year we had a suicide of a student, a resident, a researcher or somebody I would know. My wife didn’t like the cold either. She was very sensitive to cold even though she had been born in New Hampshire. So I began to look around a little bit. I was invited to talk at a seminar on uremic coma based on some of my research in Monterrey in January 1969. There was a nephrologist there from UCI that I knew from Boston City Hospital. He said, “We need a neurologist down here” and I said, “I’m coming” and that was the extent of that. And no one else had picked up on the job. I’ve been here in California for 36 years now and have only seen 1 suicide. The sunshine prevents depression. I was the first academic neurologist at UCI. It was then the county hospital. Warren Bostick was the Dean. That was 1970 when I came here. Over the first year that I was here I became engaged a little bit in faculty politics and there was a “to-do” about the hospital on the campus. The funds had been appropriated; there was a bond issue; there was money to build a hospital here; the university hired an architect; drawings were being made of this hospital; and meanwhile doctors in Newport Beach (Fashion Island) wanted to build a hospital over here called Western World. That was a time of certificate of need, so if they built one that meant we wouldn’t get one. So the faculty opposed the Western World proposal and we won. I can still remember Arnold Beckman shaking his finger at me and saying, “You will regret this,” and I have not lived to regret this and he’s dead. And I’m glad we defeated it. After that then we got Willie Brown, the Speaker of the House, who was very powerful. I got a compromise from him that we could build a hospital on the campus, but we would also run the County Hospital and develop a program in Family Medicine, which he was interested in. So we did all that. And for a long while he backed us up. Finally we got again the appropriation for the hospital through the legislature. Then Jerry Brown, just after he took office, blue penciled it and took it out. It made me furious. So then I tried a number of other ways to get a hospital here. I worked with Kaiser. I wanted Kaiser to build another tertiary hospital here. There was a group planning for that and they all went down on a PSA plane above San Diego. They were all killed and that was the end of that proposal. And then I began to work with Health West which was in Northridge. I can’t remember the man who ran that, but he was quite a guy. We developed a lot of plans there, not then for a hospital, but for a large outpatient building here with multi- specialties, family medicine, and so forth and that was pretty good. We went quite a ways with that. Then the Irvine Medical Center sprung its head up as a child of Hoag again to block us. Hoag did not want a hospital over here. They had a semi-circular area that they served; they didn’t want anybody being in that semicircle. Irvine Medical Center was going to be far enough away and they could control what they did down there. So they were in favor of that and I lost that battle. At about that time Willie Brown called me and said, “You know that Irvine Medical Center is not such a bad idea.” I said, “The hell it isn’t.” I don’t know how much money was given to Willie to pull my chain, but he did. And then there was a review of me and they decided they didn’t want me to be the Dean anymore. They wanted me to resign. I said, “I’m not going to resign; you can fire me, that’s fine; I’ve no problem with firing, but I’ve been here working hard to get a hospital for these guys and I’m not going to quit. But you can fire me.” Peltason said he never heard of such a thing. But I refused to resign. I just let my term run out and then I went back into neurology. In the midst of all that I got to know a lot about osteopathy because Forest Grunigen was my buddy, supporter, and advocate all the way through this. I loved that man. He was very close to me. And I had no problem with osteopathy. I thought it was a good idea. In recent years, a lot of neurologists have gotten into osteopathy and manipulation therapy. I think it’s a fine thing to do. I have no problems with it. As I view that past time from my perspective, I think what was happening in California towards the end of the Korean War and that era was that a lot of the MDs in California had been off to wars such as World War II, the Korean War and that the osteopaths didn’t go off to war. It made them more powerful in the organization of medical care in California. The CMA was nervous about that and so, ‘how can we change this in a way that would be acceptable’ and the idea was cooked up, that well, ‘lets give them all an MD from this school and make them all MDs and get rid of osteopathy’, that was the plan. I had no role in that what-so-ever and it was done. In ’62, a very large number of DOs got MDs from this school and the players in that were Dorothy Marsh, Forest Grunigen, and Steve Teale. Steve Teale was a wonderful character. He was great. He was the Chairman of the Senate Finance Committee for Pat Brown. One of my favorite stories is from when they were building the medical school in San Diego. They hadn’t started any medical students yet. So he called up the President’s office and said, “Why can’t they take medical students next year.” Finally the word came back, ‘well they have to take eight medical students next year.’ So they called the Chancellor up to the conference committee; he sat in front of Dr. Steve Teale, DO; and said that they were going to take eight medical students next year. And Steve said, “Why can’t you take more.” He said, “You laymen wouldn’t understand” and Steve said, “There will be 30 medical students in San Diego next year or there will be no medical school.” And that’s how the class size was determined in San Diego. He and Fory (Forest) were very close and worked together through all of this. There were some studies in manipulation done at UC Irvine thereafter; I was working with Dr. Tobis on some manipulation studies and helping in those regards, but I never got terribly involved in it. After I came out of the Dean’s office we did a course here for neurologists on manipulation therapy and I supported that, but I’ve never directly participated in it very much. What I was trying to do was run a medical school, build it, and I could recruit faculty as long as I could promise that they were going to get a hospital on the campus. When they took that away from me, it was more problematic. But the College of Medicine has grown very well indeed. We are now, I think, in the very top rank of medical schools and the hospital in Orange has become a very fine institution. It’s just in the wrong place.
Dr. Seffinger: You were the Dean for how many years?
Dr. Van den Noort: Twelve years
Dr. Seffinger: Twelve years from 1973 to 1985?
Dr. Van den Noort: Yes ’73 to ’85 and then I came back in neurology and I became the Chair in Neurology and I did that until 1997. I’m officially retired, but I’m working approximately the same number of hours per week at my age, which is 75. I never really took the Deanship very seriously. I was popular and they wanted me to do it. I said I know I’m a good neurologist, but I don’t know if I’m a good Dean or not. I told people that neurologists make very good Deans because they deal with chaos and confusion and don’t expect things to get better; they usually tend to get worse. So, I said we are used to that.
Dr. Seffinger: Well, you told us about some of the disappointments about not getting a hospital on campus, but what are some of the accomplishments that you were able to achieve?
Dr. Van den Noort: Well, we took over the hospital from the County and made it, I think, into a fine teaching hospital and each of the departments has done very well. There have been a few failures like this fertility thing and so forth, but...
Dr. Seffinger: That’s the hospital in Orange?
Dr. Van den Noort: Orange, yes and it’s a good hospital. This clinic out here is a very good place too. The departments in general have done very well. I think neurology has done particularly well. I’m very proud of this institution and what it has achieved. We are in the top rank of American medical schools and can compete with anybody. I say that the three letter medical schools - UCI and USC, and us get along just fine. But the four letter medical schools, UCSD and UCLA and we don’t get along so well. When I was the dean at UCI, UCLA always wanted to tell me what to do. “This is how you should do this and this is how you should do that” and they would say, “How do they do it at Harvard? Is that the way they do it at Harvard?” That was my background. And I thought they were very arrogant and difficult to deal with. The other thing I did was bring in a lot of minority medical students and women to this school. That wasn’t very popular even with the faculty at that time. Willie Brown was supporting me and I supported him and brought in minorities, but I thought it was a good thing to do anyway. I’m an old liberal democrat from way back. I never voted for a Republican in my life. I don’t intend to start now, which also put me out of sorts with the crowd around here. But Joan Irvine Smith and her mother, Athalie R. Clarke, were supporters, and the College Board of Trustees was very helpful. We all got along well in spite of our political differences. Harris Moyed (1925-1998), who was a microbiologist, was my Associate Dean for many years. He died a few years ago. He always told me that two things rise to the top in the university, one is cream and the other is crap and the only way you can tell them apart is heat them up. But he was wonderful. He also would protest because periodically the Chancellor would want to form a task force to do something. And Harris would say, “A task force headed by an admiral, who has a battle ship, two cruisers and five destroyers, and is out to kill and destroy the enemy. What you want is consensus - that’s not a task force, that’s a consensus committee; no I don’t want to serve on it.” That was his approach to a task force. So we were kind of the outcasts. And of course the basic scientists over here when we came (to the UC Irvine campus), kind of held up their noses at those of us people in the medical school. And of course, once we got here, we out distanced them in many respects in many of the departments and certainly the basic sciences and many of the clinical departments are really better then some of these biological sciences. They wanted to run the medical school basically. They wanted to run the basic sciences and ‘you guys go over there to the hospital and teach, but don’t bother us’. We didn’t let them do that. We insisted on having our own basic science department, which I think was the right thing to do and those are the major, major events. We had many financial troubles. I remember once the auditors from MediCal came into my office when I was the Dean and said, “Dr. Van den Noort we determined that you owe the state of California 5 million dollars.” I got up and said, “Congratulations gentlemen, you now own a medical school.” And they reported me to the Office of President because I wasn’t taking them seriously. And it ended up that we never paid them a dime. Later on I learned that auditors are soldiers sent into the battlefield after the battle has been lost to stab the wounded. So we had a good time. The school developed well and we’ve got some wonderful faculty.
Dr. Seffinger: It’s been about, I guess, 20 years since you stepped down from the Dean’s position, have you seen changes that were made during that time period persist or grown or expand or develop...?
Dr. Van den Noort: Well, I think that they were ordered not to talk about a hospital here, which I think was wrong. And this clinic should be three times this big. There’s no hospital between South Coast Hospital and Laguna and Hoag. You’ve got all these millionaires moving into this territory over here and there’s this little rinky-dink Irvine Medical Center over there in the valley. Somebody’s going to get a hospital here; there should be a hospital here; and it ought to be ours. And I still think that’s the right thing to do. If the university had gone that way, they would have made a lot more money out of their population then they would...I love the indigent people. I’ve always said, “If you will build a teaching hospital on campus, I don’t want to be here. I want to be in Orange because that’s where I come from. I’d rather be with the indigents.” But the university thought otherwise. I think osteopathy is fine. I think allopathy is fine. I think there ought to be some sort of effort at slowly integrating... You know the osteopaths now go into medical residencies (allopathic residencies). I think we ought to teach osteopathic manipulation in medical schools; and gradually see this come together rather then be a separate entity.
Dr. Seffinger: Were you a part of the California Medical Association?
Dr. Van den Noort: Oh yes, Orange County Medical Association, California Medical Association, CMA, oh yes, I’ve been in it for over thirty years and still am.
Dr. Seffinger: Has there been any discussions at that level through the ‘70s and ’80 about that?
Dr. Van den Noort: Oh yes. I worked with them and they never opposed the hospital on the campus. They were okay with that. Of course all the Hoag doctors wanted to knock it down, but I was an ex officio member of the Board of the Trustees of the CMA for twelve years. I sat with them in all their big meetings, so I was very well aware of what was going on. In general, they were supportive of us.
Dr. Seffinger: What happened with the Osteopathic College, College of Osteopathic Medicine of the Pacific which began in Pomona in 1977 - what was the relationship between UC Irvine and that school at the time?
Dr. Van den Noort: At the time in 1977, I ignored it. I had too much on my plate to be worried about it. If they wanted to do that, that’s fine with me, as the osteopathic licensing board’s inability to license new DOs in the state was overruled by the courts. I didn’t have any problem with it. I would like to see us work together that’s all. I have no opposition to it.
Dr. Seffinger: I know that through the years a lot of the osteopathic students and graduates worked at UC Irvine with attending doctors here. And there have been some relationships and clerkships and things like that over the years. Were you involved with any of that at all?
Dr. Van den Noort: Not directly, no. I think in neurology we have had clerkships from your school and I think we’ve had two residents with DOs who graduated from neurology, the training program here.
Dr. Seffinger: Did you have any relationship with the 41st Trust Fund and using those funds or knowing anything about how that developed?
Dr. Van den Noort: Well, the 41st Fund was originally I think was split into two funds; one was to provide legal support for anybody who got into trouble over having the MD degree; and one was this fund to support osteopathic medicine. I was certainly in favor of that and whatever they wanted to do. I think after the money came into the university we used it to support some manipulation studies. Dr. Starr, who is a neurologist had a research associate who was measuring somatosensory evoked potentials on muscles which I thought was very important; he subsequently has gone to some chiropractor school back east...
Dr. Seffinger: Dr. Yu Zhu?
Dr. Van den Noort: Yu Zhu, yes. I thought what he was doing was very good. Some of them finally supported him. But then they moved in the direction they are going now which is fine, I don’t have any problem with that. And there was always competition between PM&R and neurology as to who will have the first say on that whole thing, but I’m quite content with the way it is going now and I think it did support some good work with Yu Zhu. I think research in manipulation is important. I think it is a very important field.
Dr. Seffinger: And that’s when I first met you when I was a resident here in family medicine. Dr. Greenman, I guess, gave you my name. And I worked with Yu Zhu for a couple of years while I was a resident in Family Medicine at UC Irvine. We worked with Scott Haldeman (MD, PhD, DC) and Arnold Starr (MD).
Dr. Van den Noort: Yes, right, Scott, yes. I know Scott very well because he trained in our program too.
Dr. Seffinger: That’s right. So then there was a concept of having a Research Department that Murray Goldstein (DO) came over to interview with you. Do you know anything about that?
Dr. Van den Noort: Well, we tried to get Murray Goldstein interested and be involved. I knew Murray from the NIH and NIN CDS and so forth. But I was not at all greatly involved with what was going on here with that. I was involved there on another level. I was on the Board of the MS Society of New York and became quite senior in that. They liked me because I was a Dean and I didn’t want a grant. I was Chairman of the Research Committee for many years in the National MS Society. And then Sylvia Lowry, who formed that and Mr. Woody Guthrie’s widow got me in a corner and wanted me to sit on this committee for research in neurological and communicative diseases, which was a committee in Washington. And I agreed to do that. And then they said, well they needed somebody that could be the Chair of that and I got James Roosevelt, who was a patient of mine, to be the Chair. We did a lot of great things, but I came back from an MS meeting in Sweden and they had just had a year for the disabled authorized by congress. And I said, “We have to get a decade of the brain!” And we did. Jimmie Roosevelt pulled that off with the lobbyist in Washington in front of us. I’m the first one who said we needed a ‘decade’ of the brain.
Dr. Seffinger: Congratulations! That’s great.
Dr. Van den Noort: The problem was that Nixon had this war on heart disease, stroke and cancer. He lost all three. And the brain was being ignored at a time when it was exploding in terms of research. And so we had to kind of get the focus we made there and I think we were helpful in doing that.
Dr. Seffinger: Okay. Were there interactions between you and some of the other osteopathic doctors that became MDs? Did you work together on projects that developed this institution here or programs?
Dr. Van den Noort: Well, many of the alumni of the school were very critical of our development here. And the Alumni Association was very powerful and very helpful to me. Then after I got kicked out, the university kind of broke up the Board of Trustees, medical school, the Alumni Association, and turned it into a more general one. That’s too bad because those people had a lot to contribute.
Dr. Seffinger: What happened to them?
Dr. Van den Noort: Well, it was kind of dissolved and now reformulated a little bit, but it’s nothing like it was. It was a very powerful institution in those days. There was a lot of money there. I think that’s what the campus saw and wanted to get involved in. We had at that time a College of Medicine Foundation. We had raised quite a bit of money. Then the Chancellor hired a fund raiser who insisted on taking over that Foundation - taking it away from us. I was very angry with him, but he got AIDS and died so I can’t say I’m mad at him anymore.
Dr. Seffinger: So the school then, in the initial 15 years of its existence, was supported pretty much by the DOs that graduated from the previous school then. They were alumni basically of the institution, and they supported with a lot of money each year.
Dr. Van den Noort: Yes, they were very helpful. The other curious thing, you see, what happened was most of the faculty of the old school were in Glendale and Pasadena and San Marino and they weren’t being paid by the school. They were volunteering their time to teach. When the school came down here, they weren’t going to do that. Very few of them came down here. And so in a way, we got a new medical school and recruited everybody new. But we did have help from those that were down here; Vince Carroll in Laguna Beach was enormously helpful; Fory Grunigen; Dick Kammerman and there were others, very helpful.
Dr. Seffinger: So what happened to the ex-faculty of the old school? Dorothy Marsh and Forest Grunigen continued. Were there others that continued on to teach?
Dr. Van den Noort: Yes there were some. There were several people in anatomy that came down here. And there was one in biochemistry that I know came down. And there were several others. Some of the basic science faculty came down here.
Dr. Seffinger: And the rest of them just went back to practice?
Dr. Van den Noort: Yes, continued their practices up there. That was their major source of income.
Dr. Seffinger: Did they get involved with the new school, the new osteopathic school or you have no idea?
Dr. Van den Noort: I have no idea.
Dr. Seffinger: All right. Have you noticed any effect of the DOs that helped found the school here or became MDs or faculty members from that merging of the two professions in the 1960s? Have you noticed any affect on medicine in general of that event?
Dr. Van den Noort: Well, I think it helped, you know. I think it was a good thing to do in California at any rate. The AMA and the American Osteopathic Association didn’t think so, but I thought it was a good idea. I would like to see manipulation taught in medical schools and I would like to see more emphasis on it. We get a lot of resistance today from orthopedists and neurosurgeons, but I think neurologists and physiatrists would welcome manipulation. The Academy of Neurology has a section on manipulation medicine and is very much involved. So I think it can be brought in, not by closing your school but by gradually working together to promote common programs, I think that’s a very good idea.
Dr. Seffinger: Is that the main distinction between the professions in your mind?
Dr. Van den Noort: Well, I think we don’t have enough manipulation medicine here. To me, that’s the difference. I don’t know any other difference. The university counts papers, bibliographies and grants. And if you don’t have a grant, ‘get out of here and so forth and so on.’ It’s a little bit too research oriented. There’s little money for the support of clinical programs. That’s where we are. If we had a hospital here and generated a lot of income, it would be very different, and then we would be like UCSF. We would have a lot of good things to do, but we worked in this relatively indigent hospital over there for so long that the clinical departments have suffered from that.
Dr. Seffinger: Are you involved with the American Back Society at all?
Dr. Van den Noort: I was, yes. Well only with Scott Haldeman; through Scott. I don’t know that I’m a member, but I support him certainly.
Dr. Seffinger: Okay. All right, I guess there were some DOs involved with that.
Dr. Van den Noort: Yes, I think so.
Dr. Seffinger: What I’d like to do is try to trace the effect of the DOs becoming MDs and moving into the MD profession on California medicine over the last forty years, and see if we can figure out or trace that.
Dr. Van den Noort: It’s been interesting. I was somewhat surprised in the Academy of Neurology to see the emergence of manipulation medicine as a major theme about 15 years ago. Lots of neurologists learn how to manipulate. There is a guy up in Palo Alto I used to send patients up there to him. He was a very good neurologist. And that wasn’t, I don’t think, out of the California experience. That was sort of a national thing. And we’ve had that wonderful man from Lansing, Michigan come out and talk at our meetings.
Dr. Seffinger: Dr. Greenman?
Dr. Van den Noort: Yes, he is fantastic. I just think that manipulation medicine is good and that we need to emphasize it and make it more scientific and proceed in that that direction and I am fully supportive of, but the problem is where the money is going to come from to do it. The university has emerged into two different directions. In the old days if you did half your day in the laboratory and half your day in the clinic you could survive in a medical school. That’s not true anymore. If you are going to do basic research, you’ve got to do it 85% of the time; at least to be competitive for grants. On the clinical side you have to make your money off seeing patients, setting up programs, and different things. You have to make your own money.
Dr. Seffinger: Are you aware that the NIH just now set aside funding for manipulation research?
Dr. Van den Noort: That’s great.
Dr. Seffinger: with the National Center for Complementary and Alternative Medicine and they just came out with requests for proposals in... this month actually for experiment. They want people to look at the biology of manual therapies; look at the basic science behind the effectiveness, and bring that to the bedside as well.
Dr. Van den Noort: That’s a great idea. My work is in the immunology of multiple sclerosis, so I’m far away from that. I think Starr would be a good guy to get back into that because he is very good. He’s still going. He still has grants. But that’s a wonderful idea, I just can’t participate.
Dr. Seffinger: It’s taken quite some time for the NIH to support it...
Dr. Van den Noort: Oh yes, It’s been very slow.
Dr. Seffinger: Were you involved with any of the conferences that were at UCI over the years? Dr. Tobis, I know, was involved.
Dr. Van den Noort: Oh yes, I was involved with all of those.
Dr. Seffinger: Can you talk about some of those conferences?
Dr. Van den Noort: I thought they were very good and it was just presenting material on manipulation therapy and various people coming to talk. I didn’t play any major role in them, but I was very much aware of them. I attended most of them.
Dr. Seffinger: So they were an attempt to bring together the various professionals investigating and in clinical practice using manual methods. Was there any outcome from those conferences that you could see a measurable outcome of some sort?
Dr. Van den Noort: Well, I think the hostility to manipulation therapy has declined to nearly the vanishing point in medicine; maybe not to the vanishing point in orthopedics. It’s near the vanishing point. I think that most internists, neurologists, physiatrists are willing to embrace manipulation therapy as a technique. And I’m very anxious to see the epidemic of back surgery that has gone on in the last 50 years held in check. In the field of multiple sclerosis, it is frequently 10 or 20 years before they make the right diagnosis. The number of those who have low back surgery or neck surgery in the interim is very high. I periodically get asked to testify against whoever it was that operated, and I say no because that’s the standard of care. It’s so common that you can’t say it’s not the standard of care.
Dr. Seffinger: I see you’ve worked on a lot of research projects and published many many papers. Have you published papers or worked with people who were osteopathic physicians or had become MDs after being...?
Dr. Van den Noort: I don’t think so, but I don’t recall.
Dr. Seffinger: Okay. Thinking about the students of the future of both medical students and osteopathic students, any advice or thoughts for them as they move into a world where they have two different professions growing up in California? There are two osteopathic medical schools and there are perhaps an increasing number of MD schools, in California there are about seven or so of those, do you have any thoughts on some of the interactions amongst the different students in the professions?
Dr. Van den Noort: Well, I support the interactions. The medical education in California is in some ways a joke because most of the doctors in California come from outside of California. We have a class size in medicine, MDs for all of the schools including Stanford and USC about a 1,000 medical students for 33,000,000 people. Ohio has that number for 6,000,000 people. So that if you want your kid to go to medical school the worst place you can live in the world is California to get into the California system. And when I was Dean, the people in Newport Beach would say, “You know, he has been interviewed at Harvard and Yale, why can’t you interview him?” Well, that’s crazy. We would really get the cream of the crop because they don’t want to pay $50,000.00 a year to go to Yale when they know the educational program here is very good. I’m not saying it’s better, but it’s certainly very good. So it’s been difficult for people to get medical education and that’s why a lot of them went off to Grenada and Guadalajara and so forth. One of the anatomists, who was very involved, was Lyle Dearden. I don’t know if you met Lyle, but he was a very good anatomist here, he died a few weeks ago. I think they will gradually grow together as time goes along and manipulation will become more and more a part of everybody’s medicine and I’m a little sorry to see it tied up into alternative medicine, but I don’t regard osteopathy as alternative medicine. I think it is medicine.
Dr. Seffinger: What happened at the NIH there is that they put manual treatment as complementary. They put osteopathy as not included at all, not as alternative, or complementary because it was standard of care. So they just took that one piece, osteopathic manipulation, and put it along side of chiropractic manipulation as a modality. It was not taught in medical schools and is therefore is complementary, but it is not alternative...
Dr. Van den Noort: I see. I fight with Scott Haldeman a little bit about neck manipulation.
Dr. Seffinger: Yes, what are your thoughts about that? That is a contentious point of view between the people who do manipulation of the cervical spine. The neurologists and neurosurgeons think that’s too dangerous to do - a high velocity or low velocity thrust or some kind of forceful manipulation. What are your knowledge and thoughts about that?
Dr. Van den Noort: It’s all anecdotal. I had a patient a few years ago. He was an optometrist. He thought manipulation was very good and he was manipulating some of his patients. The optometry society took his license away. And then he manipulated his own neck and knocked off his vertebral artery and had a massive stroke, which I took care of, and he was very seriously handicapped. I’ve seen a fair number of vertebral dissections. I’ve seen more vertebral dissections from Knott’s Berry Farm and Disneyland than I do from chiropractors. We had a man here who was a warrant officer in the army, brought his young Philipino bride here and took her to Space Mountain. They went on about 15 times. Then he was driving back to Mareno Valley and got a hell of a headache and ended up at Mission. They transferred him up to me. He had a stroke in his brain stem. He was “locked in” (couldn’t communicate his needs) and could only move his finger, and that was about all he could do. So there is no question that manipulation can affect the neck, whether it is done by a person or high velocity thing. I think that I have no problem with massage and gentle stretching. But the snap, crackle, pop stuff in the neck because of the risk of vertebral dissection or carotid dissection is very real. On the low back, you can do anything you want as far as I’m concerned, but not the neck. The husband of one of our nurses dissected his carotid artery one day and he had a little bit of a headache and he came to the emergency room. I couldn’t see anything wrong with him. I had another doctor look at him and couldn’t find anything wrong. We sent him back and they went home. He collapsed with a hemiplegia when he got home. He had dissected his carotid and I think it was because his wife put a vibrator on it (he had some discomfort there) which is not good for the carotid artery. I think people should be taught not to vibrate their necks. And of course, automobile accidents are the other one. I was defending, actually, I think he was a chiropractor. He had manipulated this patient and then the guy had a dissection and they wanted me to testify that it wasn’t his fault. But they found a large bottle of cocaine in the front seat of the car and that was the more likely cause of the dissection. It happens. It’s rare. I don’t think it’s a problem, but people with migraine are more likely to dissect than people who don’t have migraine. In fact, people with migraines can have spontaneous dissections. So you better be careful in that area with people with migraine headaches. Today the new word is any headache is migraine. You know the idea of tension headache is probably largely wrong and most headaches are really migraine. So it’s a risky business. The carotid and vertebral arteries are very tenuous and many people have only one vertebral artery that’s big enough to work and so you really have to be very careful.
Dr. Seffinger: Okay. Do you have any kind of documents that we should include as part of this project or copy the things that you think are historical in nature that you want for us to include?
Dr. Van den Noort: No. I haven’t written much about that. I probably have some old things that I could go through and find, but I don’t know where they are, but if I find something I will bring it to you.
Dr. Seffinger: Is there any body else that we should contact that you think was instrumental in the historical development of osteopathy in California?
Dr. Van den Noort: I think you know more about those people then I do. Carroll and Grunigen and the Alumni Association were really all that I dealt with. Paul Alloy was a big help to me. They were a great bunch of guys, they really were. I think we should have had our California College of Medicine Foundation persist. And if we had, that would have directed much more money to osteopathic manipulation research than we are going to get out of the foundation as a general foundation for all medicine.
Dr. Seffinger: Okay. Is there anything else you would like to address or talk about in relation to osteopathy in California?
Dr. Van den Noort: No. I think we are all in trouble in medicine. For me, what I do is see patients. I can’t see patients for less than half an hour. Partly because the record system here is so difficult to get through, but mainly because I can’t do this ten-minute-medicine stuff (10 minute office visit that is in vogue now). I talk to people, find out how they are, where they are coming from and what’s bothering them; and that takes me a half hour for an old patient and an hour or more for a new patient. I see my patients about once every three to six months rather than every week. I tell them, “Don’t come back next week because I see can’t see you until three months or six months.” And so it’s a very elaborate planning as what you are going to do over those three months or six months. That’s the kind of medicine I like. It doesn’t pay very well. I think I only get about $15.00 an hour for what I do, but it’s the only kind of game I want to play and happily I’m retired so the money, the income from the practice, is not critical. I get paid pretty well for speaking about MS, so that helps. But you are doing a good thing and I’m glad you are doing this project and I think it’s very important.
Dr. Seffinger: Thank you very much. Thank you for your time.
Dr. Van den Noort: Okay.