Association of University Cardiologists
Michael Lesch, M.D.
1939 - 2008
Dr. Michael Lesch, a medical educator whose name is attached to a hereditary disorder characterized by self-mutilation that he helped identify as a medical student, died on March 19 while on a fishing trip in Patagonia. He was 68.
His death came during sleep and was confirmed by St. Luke’s-Roosevelt Hospital in Manhattan, where he had been chairman of the department of internal medicine since 1998. Each year, he oversaw the training of more than 200 residents and fellows in one of the largest teaching programs of medicine in the country.
Dr. Lesch was also a professor of medicine at Columbia University.
Although Dr. Lesch spent his career as a cardiologist, he is best known for the research he performed as a medical student while working with his mentor, Dr. William L. Nyhan, at Johns Hopkins in the early 1960s.
The rare disorder they identified quickly became known as the Lesch-Nyhan syndrome. It is characterized by frequent episodes of painfully biting fingers and lips, often leading to amputations. Many people with the syndrome are aware that they are compulsively and painfully harming themselves. Though they say they fear their behavior, they cannot stop their actions. To protect themselves, many of them often wear restrainers and mittens.
The syndrome is due to a deficiency of the enzyme, hypoxanthine-guanine phosphoribosyltransferase, or HPRT. Mothers who carry the gene for the deficiency pass it on to their sons in a hereditary pattern similar to that for hemophilia. The defect, which affects the brain, leads to excessive production of uric acid.
Drs. Lesch and Nyhan’s first case was a 4 ½-year-old mentally retarded boy who developed a urinary tract infection. Other doctors tested the boy’s urine and detected crystals that they mistakenly believed caused a different disease, cystinuria.
Dr. Nyhan, a pediatrician who had been called in as a consultant, performed a series of tests that showed the crystals were not cystine, confirming his suspicion that they were uric acid crystals, which can produce gout.
On further questioning, the doctors learned that the boy’s 8-year-old brother was also mentally retarded and bit his hands and chewed away his lower lip.
At the time, Dr. Lesch was spending a year in Dr. Nyhan’s laboratory studying the role of certain proteins in cancer. But, Dr. Nyhan recalled, “the idea of a potential new disease with all its ramifications seemed so great that we immediately quit” the protein project. Dr. Nyhan added that “Mike worked full time and essentially did 100 percent of the lab work documenting that this was an inborn error of purine metabolism,” a biochemical abnormality.
The syndrome cannot be cured. But symptomatic treatment of gout and other complications has allowed a number of patients to live into their 40s instead of dying before their fifth birthday, said Dr. Nyhan, who now works at the University of California, San Diego.
Lesch-Nyhan syndrome has become a legendary example of a classic method of medical investigation: taking observations made at the bedside to the laboratory for the research that comes back to the bedside with advances that improve the standard of care.
Dr. Lesch’s passion for teaching students how to care for patients led him to make rounds with them seven days a week during the periods when he served as an attending physician.
He was a critic of the restrictions on the hours that residents can now spend working in hospitals each week because he believed it made it harder for young doctors to learn. But he used his administrative talents to make the new system as effective a learning experience for his trainees as he could, said Dr. Henry M. Greenberg, a cardiologist who worked with Dr. Lesch for many years.
Michael Lesch was born on June 30, 1939, in Queens, where his parents, Maurice and Rose, were real estate investors.
After graduating summa cum laude from Columbia University in 1960, Dr. Lesch earned a medical degree from Johns Hopkins and then trained there in internal medicine. He later did research at the National Institute of Mental Health in Bethesda, Md., and trained in cardiology at the Peter Bent Brigham Hospital (now Brigham and Women’s Hospital) in Boston.
From 1976 to 1989, Dr. Lesch was chief of cardiology at Northwestern University Medical School in Chicago. He then served as chairman of the department of medicine at the Henry Ford Hospital and Health System in Detroit until he moved to New York.
Dr. Lesch is survived by his wife, Bella Samuels Lesch; a daughter, Leah D., of Los Angeles; a son, Ian S., of Chicago; and six grandchildren.
Since 1971, Dr. Lesch was co-editor of a journal, Progress in Cardiovascular Diseases.
A few months ago, a colleague, Dr. Henry M. Greenberg, a cardiologist who worked with Dr. Lesch for many years, said that Dr. Lesch asked him and another colleague to organize a symposium on sudden death and then to edit the papers for the journal.
“It is such a strange irony that Mike died basically a sudden death in his sleep,” Dr. Greenberg said.