Doug Heimburger, M.D.
Global Health Roots Run Deep
Doug Heimburger, M.D., MD ’78, entered the global health field about four years ago, but it was a calling that developed over two centuries in his family.
One hundred years before Heimburger was born, his great-grandparents were missionaries to China and lived there for 56 years from 1864-1920. His great-grandmother founded a hospital in the Shandong province, which is still running today and will soon grow to 3,000 beds.
Their daughter, Heimburger’s grandmother, served as a medical missionary with her husband in the same province from 1912-1934. His grandfather was superintendent of another hospital, now a Shandong provincial university hospital.
Heimburger’s father, Robert, was born and raised in China until age 17 and graduated from Vanderbilt University School of Medicine in 1943. He had a long career in Neurosurgery at Indiana University School of Medicine and frequently engaged with surgeons from Japan, Taiwan, Pakistan, and other South Asian countries. He spent the last six years of his career teaching residents at a large private hospital in Taipei.
Heimburger didn’t realize the extent of his family’s global health activity until June 2009 when 19 family members traveled to China to visit the places their relatives had lived and worked.
“We arrived at this hospital and in the lobby was a marquee that listed the directors ever since it was founded in 1873, and our great-grandmother’s name was at the top of that list,” he recalled.
“Global health must be something genetic or ingrained. I couldn’t resist it. My ancestors were calling.”
From Birmingham to Zambia
Heimburger joined the Vanderbilt Institute for Global Health in August 2009 as associate director for Education and Training after a long tenure at the University of Alabama at Birmingham in the Departments of Nutrition Sciences and Medicine.
It was his father’s influence that led him to medicine and to VUSM, but Heimburger wanted to plan a gap year for travel between graduating college and starting medical school. He worried Vanderbilt would see the time off as a negative, but he was actually accepted early and encouraged to make the most of his travels.
He spent three months in Switzerland at a Christian study center called L’Abri Fellowship and three months at Cambridge University in England studying informally in their history of medicine department.
“The idea was to integrate my faith with science in a way that might help me explore and understand the philosophy of science. Plus, I loved to travel,” he said.
During medical school, he spent Saturdays writing up his findings and even hired a clerical worker to type up a manuscript but has never published it.
Heimburger’s chosen specialty – clinical nutrition – is considered a “very minor specialty” in his words, and he was challenged to go into it by the disparaging remarks of a college classmate’s parents.
“They were really into alternative nutrition and sort of shamed me in a way. They said, ‘Oh, you’re going to be a doctor, and you’re not going to care about nutrition because doctors don’t care about nutrition.’ I was offended by that and decided to some degree to prove them wrong,” he said.
As he dove deeper into the field, it raised stimulating questions for him – are there areas of medical care that really could benefit from nutrition? Could nutrition really lead to prevention?
After a residency in Internal Medicine at St. Louis University, Heimburger entered a fellowship in Clinical Nutrition at UAB in 1981 and joined the faculty the following year. He spent his 28 years there involved in educating and training medical students, residents and nutrition fellows, a thriving clinical practice and research primarily in the nutritional aspects of cancer prevention.
But then his genetic code kicked in.
“I wanted to take on a new challenge,” he said. “My focus had been almost entirely on the United States and developed countries and the chronic diseases we suffer. I felt deficient in terms of my own personal experience and understanding of nutrition in developing countries. You could argue that the world’s biggest nutrition problems are still in places with significant under-nutrition and malnutrition, and I wanted to take on that challenge.”
So Heimburger turned to Sten Vermund, M.D., Ph.D., now director of the Vanderbilt Institute for Global Health who was also at UAB at the time. He asked the “guru of global health” what he recommended and Vermund pointed him to the Centre for Infectious Disease Research in Zambia (CIDRZ), the research and service facility in Zambia, Africa, that he founded in 2000.
“Sten’s influence on that turning point in my career has been tremendous. He and I sat down once to talk about this, he gave me the contacts in Zambia, and the rest is history.”
Heimburger received a Fulbright Scholarship to spend six months at CIDRZ researching nutritional aspects of HIV/AIDS treatment. After an increase in the use of antiretroviral therapy (ART) for HIV treatment beginning in 2004, physicians had noticed an increased mortality rate in the first month of ART use in people with certain risk factors, one of which was being underweight. Heimburger connected this early mortality with a phenomenon called “refeeding syndrome.”
“The classic example of refeeding syndrome is after World War II when prisoners of war who had gotten very underweight were liberated and a feast was laid on. Some of them died in the feasting after surviving the starvation,” he explained.
When someone shifts from a period of starvation to a period of feeding, metabolic changes occur as the body realizes that some systems it had to shut down to conserve energy can now be restarted. The mineral phosphorus is in particular demand because it is involved in the
production and trafficking of energy. Phosphorus is in ample supply in bones, but it can take a few days or weeks to be accessed. In the meantime, the body can run out of phosphorus, seriously impairing the acute production of energy.
“I asked the simple question – is there a variant of refeeding syndrome happening in these people who die after ART begins? And we did find that people who begin ART therapy with low-normal levels of phosphorus are at significantly higher risk of dying, even if we supplement them,” Heimburger said.
Next, Heimburger wants to perform intervention studies to reevaluate mortality rates if HIV/AIDS patients have nutritional rehabilitation before beginning ART. He is also interested in patients who survive HIV/AIDS long-term only to develop metabolic syndrome, becoming overweight and at higher risk for diabetes, cardiovascular disease and hypertension – problems usually seen in developed nations.
After returning from Zambia, Heimburger’s appetite for global health work only increased. “It wasn’t enough. I didn’t want to get back to everything the way it used to be,” he said.
Then Sten Vermund came knocking with an offer to do global health full time at Vanderbilt.
At first I told him, ‘You’re crazy because you know how new I am to global health,’” Heimburger recalled. “But he said he needed more senior faculty presence, particularly in mentoring and developing the education portfolio. I realized I knew enough about education and mentoring and training that maybe I could import those ideas into global health and make a contribution.”
When Heimburger mentions his lack of global health experience, Vermund insists he is selling himself short.
“Doug contrasts himself to me, but I’ve been at this for 30 years,” Vermund said. “He has a good solid background. He broke all the records at UAB for teacher of the year for students, for residents, you name it. He is a very talented teacher and is adept at nurturing faculty members. He has a good track record of NIH funding and a background in clinical practice. He is a fully-actualized academic leader.
“Plus he’s a real natural in global health. He is modest, he listens and he wants to see the point of view of the host. He knows he’s a guest in the country, not the stereotypic American that comes barging in with a fixed point of view. He doesn’t have to have that explained; he just understands the need to learn what the host country experts want from us visitors.”Heimburger is primarily responsible for providing faculty leadership for the education and training programs at VIGH, such as the Fogarty International Clinical Research Scholars and Fellows program and the AIDS International Training and Research Program.
He relishes mentoring young physicians and researchers just beginning their careers.
“The people that apply for these programs are really talented, interesting and motivated. It can sort of keep you young to see the kinds of ideas and the vitality and energy they have. I’m thrilled to be in a position here where I have the opportunity to interface with people who are trying to go places and build things and implement ideas and find opportunities.”
Jamy Ard, M.D., says Heimburger has no agenda except to help his mentees succeed. Ard is an associate professor in the department of Nutrition Sciences at UAB, and Heimburger worked for years to recruit him to the institution.
“He is unselfish and not one to grab the spotlight and take the credit,” Ard said. “He creates opportunities for the people he is mentoring. There were several opportunities that he brought me in on that I wouldn’t have otherwise had a chance to do, like writing book chapters and getting involved with student education. His own agenda wasn’t a priority.”
And Heimburger’s mentoring went beyond the hospital.
“When my wife and I moved to Birmingham we were pregnant with twins,” Ard recalls. “We moved into an apartment and there were two nights where we had no air conditioning, which is not good for a pregnant woman in the summertime. Doug and his family gave us a place to stay and have become really good friends, very generous and kind.”
Ard said it was clear that Heimburger’s global health work had energized him.
“Global health fits right in with his values and his view on community work, service, giving back to people and using his knowledge to help people live healthier lives. There is no better place to put that to use than the global scheme.”
Heimburger said it was hard leaving UAB, and Nashville was one of the few cities for which he and his wife, Beth, would consider pulling up 28-year roots. They met and married in Nashville while he was in medical school and she was a research nurse. Vanderbilt also granted him that first opportunity to travel and sent him down a path of success that eventually circled right back where it started.
“I’ll never forget my first resident on my first rotation as an intern saying, ‘Whoa, you’re really prepared.’ That was the most immediate thing that made me really glad for the education I had gotten at Vanderbilt. I also have gratitude for the kind of mentoring I got here and the kinds of role models I had. That has motivated me to be a role model and mentor to others.”
As Heimburger leads the next generation of global health workers out into the field, his ancestors would be proud.