Thoughts on Mark Josephson

I’m sure there will be plenty of tributes to Dr. Josephson in the next few days from his colleagues who knew him well and those who didn’t know him personally but learned so much from his books and articles. I fall somewhere in the middle. I wasn’t one of his students at Penn who learned from him directly. I did meet him several times. I did work for years at the University of Colorado with Alden Harken, the surgeon with whom Dr. Josephson developed the “Pennsylvania Peel” — endocardial resection, the first surgical treatment for ventricular tachycardia. Oh, and I did live in the same apartment Mark used to live in during my cardiology fellowship in Philadelphia in the 1970s. More on that later.

Mark Josephson may represent somewhat of a dying breed in academia. In the great academic triad of clinical care, research, and teaching, the last element, teaching, which makes the least money for institutions, is emphasized less and less. Dr. Josephson excelled as a teacher. A lucky few were able to experience his teaching skills first-hand. A far greater number learned from his writing, in particular, from his opus magnum Clinical Cardiac Electrophysiology. Originally a relatively small but densely written book in a red binding, subsequent editions were more massive, filled with page after page of painstakingly labeled intracardiac recordings and clear-cut explanations of obscure electrophysiologic phenomena. I cut my teeth on this book, reading the original through when I was an EP fellow in Houston, and then reading the 2nd edition straight through when preparing for my first EP boards.

The book was important because it set a standard for analysis of intracardiac recordings that inspired subsequent researchers and students of the field. Back in the 70s and 80s, the mechanisms for most major arrhythmias (with the exception perhaps of atrial fibrillation) were worked out solely by analysis of intracardiac recordings and a few pacing techniques. Mark Josephson was instrumental in this process. Back then, working on arrhythmia mechanisms was the important thing. Therapies for ventricular tachycardia were drugs like quinidine or procainamide, and EP-guided drug therapy was, in retrospective, a pseudoscience. Yet working out the mechanisms of WPW syndrome, supraventricular tachycardia, and ventricular tachycardia eventually led to effective ablation and device therapy in the 1990s and beyond.

Dr. Josephson, who along with a cadre of first-generation EP superstars trained by Dr. Anthony Damato (the “godfather” of EP) at the Staten Island Public Health Hospital, set a standard for teaching in the field of electrophysiology that was often emulated, but never matched. Moreover he wrote a number of incisive editorials over the years in an attempt to keep the field rooted in its scientific basis, rather than be swept away by the insidious influence of industry or the idea that it wasn’t necessary to understand the pathophysiology of an arrhythmia if you were just going to burn it away.

As mentioned above, I was lucky enough to meet him on a few occasions and to round with him. By coincidence we discovered that the apartment on Henry Avenue in Philadelphia where I lived when I was a fellow was the exact same apartment he had lived in several years before. He remembered well the old guy who lived one floor above us, a fellow by the name of Sullivan, nicknamed “Sully.” I was just a plain cardiology fellow when I lived there, only subsequently deciding to go into EP and move to Houston for training. I always wondered if I picked up some kind of EP karma from living there. Who knows?

The advances in diagnosis and treatment of arrhythmias that have occurred since the 1970s are extraordinary, and uncounted numbers of people have benefited from these advances.  It seems a shame that most lay people, saddened at the loss of actors, musicians, sports heroes, and other celebrities, have no knowledge whatsoever of the passing of people who have actually had much more impact on their lives, like Dr. Josephson.  So it’s up to us, his colleagues, to remember Mark Josephson and give thanks for his incredible contributions to medicine and the world.