Herbert L. Fred, MD, MACP

Herbert L. Fred, MD, MACP

Herbert L. Fred, MD, MACP, was 89 years old when he died peacefully at home on 30 December 2018. For nearly 6 decades, he was a renowned and highly honored full-time medical educator at Baylor College of Medicine (BCM), and later at the John P. and Kathrine G. McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). He was a prolific author with worldwide influence. His meticulous training of several thousand medical students and internists helped them to become better doctors.

Herbert Leonard Fred was born in Waco, Texas, on 11 June 1929. His father was a jeweler. His mother taught him the importance of education, discipline, integrity, and high standards.

Herb was the valedictorian of his senior class of 400 students at Waco High School. A gifted table tennis player, he spent most Saturdays at the YMCA, defeating anyone who challenged him. He earned his BA degree at the Rice Institute (1950) and his MD at The Johns Hopkins University School of Medicine (1954). His training in internal medicine (1954–1959), under Maxwell Myer Wintrobe at the University of Utah Medical School, made indelible impressions on Dr. Fred, and this merits detailed discussion below.

After completing his training in Utah, Dr. Fred served as a medical officer for 2 years in the United States Air Force. In 1962, he joined BCM as an assistant professor. I (JTW) met him during my junior year at BCM, when my classmates and I entered a small room at Ben Taub Hospital to begin our internal medicine training. Dr. Fred was sitting in front of a viewing machine that displayed radiographs of patients who had been admitted the night before. Purely from these films and each patient's medical history, Dr. Fred made the correct diagnosis—even before he had seen or examined anyone. After this exercise, he dismissed us, but not before he said, “Listen up, you guys—if any of you believe that you're going to Harvard, Johns Hopkins, Duke, or Stanford, it is going to be through me.” That got my attention and sparked my competitive spirit. I whispered to myself, “Okay, Dr. Fred—it will be through you.”

He continued to inspire us by example. His demands for universal excellence began with himself. He insisted that his students learn, work hard, read extensively, and help patients in every way, always with kindness and compassion. Students at all levels were expected to be punctual, alert, and intimately knowledgeable about every aspect of a patient's medical situation, through personal interaction and exhaustive background study. In addition, it was beyond question that caring for patients took priority over sleep. Recognizing the worth of these high standards, the senior classes at BCM repeatedly honored him as the Outstanding Full-Time Clinical Faculty Member, and the class of 1967 dedicated its annual Aesculapius award to him.

In 1971, Dr. Fred was appointed Professor of Internal Medicine at the newly created UTHealth Medical School. Focusing his teaching efforts there and at St. Joseph Medical Center, he continued to receive Excellence in Teaching awards from the medical students. He also created a bimonthly journal, Houston Medicine, which was distributed to all physicians in Harris County and was published for almost 9 years.

For 55 years, Dr. Fred supervised the medical care of more than 1,000 indigent patients at Ben Taub Hospital and Lyndon B. Johnson Hospital, both in Houston.

A scholar's scholar, Dr. Fred collected and catalogued approximately 3 million medical reprints, most likely the world's largest collection. These files and his papers, documents, awards, and photographs are housed in the Houston Academy of Medicine–Texas Medical Center library.1  He donated the Herbert L. Fred, MD, 24/7 Study Hall for Texas Medical Center students to use around the clock.2 

Herb had embarked on his writing career when he was 10 years old, publishing a poem in the Waco Herald Tribune. He ultimately wrote 511 medical journal articles and 6 medical books. He served on the editorial boards of 5 national medical journals, and he was an associate editor for Circulation (one of the largest and most prestigious medical journals) and the Texas Heart Institute Journal.3 

Many of Dr. Fred's former students had distinguished careers and titles of their own, including a head of the U.S. Food and Drug Administration; a medical school chancellor; presidents of the American College of Physicians, the American College of Gastroenterology, the Infectious Diseases Society of America, the Southwestern Surgical Congress, a health science center, and a state medical association; 3 medical school deans; 13 department chairs; 17 division chiefs; 8 training program directors; an executive director of a state board of medical examiners; and 3 different presidents of the Harris County Medical Society, the largest county medical society in the U.S.

It would take many pages to list all of Dr. Fred's awards for teaching and writing. Chief among them was a visiting professorship in Medical and Biomedical Education at the Institute for Excellence in Education of The Johns Hopkins University School of Medicine. The Texas Chapter of the American College of Physicians gave him The Laureate Award for his abiding commitment to excellence in medical care, education, and community service. In 2013, the Quality of Life Research Center at Claremont Graduate University (Claremont, Calif) granted him a certificate of recognition as an exemplary mentor in the positive development of junior colleagues in the medical profession. In 2017, he won the John P. McGovern Compleat Physician Award, presented annually by the Harris County Medical Society to one U.S. physician whose career exemplifies Oslerian ideals of medical excellence. Previous recipients included Michael DeBakey and Denton Cooley.4  In 2002, his former trainees established The Herb Fred Medical Society, Inc. (http://herbfred.org) in his honor.

Dr. Fred was personally committed to physical fitness for most of his adult life. His strict diet left him lean and wiry. He participated in marathons and ultra-marathons, including 100-km, 100-mile, and 24-hour races. He established many age-related records in the U.S. for these long-distance races. At age 86, he ran at least one mile each day for an entire year, setting a world record. He stopped running in 2016, having logged 253,010 miles—a record currently unequaled.5,6 

In discussing his 5 years working with Max Wintrobe,7  Dr. Fred noted the impact of his mentor's philosophies. One tenet was to listen perceptively. Even when in his late 80s, and despite whatever scholarly pursuits consumed his attention, Dr. Fred instantly and completely shifted into “good-doctor mode” when anyone called to ask him about a personal medical issue. He would listen alertly to the history and symptoms, ask insightful questions (including some that no other doctor would think of), calmly offer his chief diagnosis, explain the typical natural history of the condition, and, when appropriate, reassuringly add, “I'm not worried about you.” You could wager your life's savings that he would conclude with, “My cell phone is with me all the time. You have my number. If you need me for any reason, I want you to call me, anytime—night or day.”

Another principle from Dr. Wintrobe was to speak authoritatively. Like his mentor, Dr. Fred demanded much of those around him, yet he was both firm and fair, able to criticize without attacking and never leaving doubt as to where he and others stood, and why. People unfamiliar with Dr. Fred's forthright intensity and ardor were often taken aback to the point of taking offense. To them, I would say with a smile, “That's Herb. You either love him or you hate him—nothing in between.” I count myself among the overwhelming majority in the former group.

Max Wintrobe would say, “However good a job we do, we can always do a better one.” Despising mediocrity in all its forms, Dr. Fred combined Wintrobe's high standard with a healthy sense of urgency. In an eloquent tribute,8  an executive director of the Texas Medical Board wrote of Dr. Fred, “Just floating on the periphery of his charisma, I began driving myself harder, striving to excel rather than being satisfied with just doing my job.” With manuscript editors, Dr. Fred would spend 45 minutes on the telephone, painstakingly debating a single turn of phrase or the use of a comma instead of a semicolon, invariably followed by, “Read that entire paragraph back to me exactly as we have it now!” However, he was also keenly aware of deadlines. He generated final manuscripts so prolifically that one admirer noted, “He's in his 80s and still publishes like a wild man!” This productivity continued almost to the time of his death, and indeed we are publishing his remaining papers in this Herb Fred tribute issue of the Texas Heart Institute Journal.

Of Max Wintrobe, Dr. Fred wrote, “I never fully appreciated his effect on me until years later. Only then did I realize that I, too, am intolerant of mediocrity, and that I teach as he taught, speak as he spoke, and think as he thought about medicine. . . .”7  The illustrious Dr. Wintrobe lived on through Dr. Fred, and both now live on through successive generations of medical graduates.

Dr. Fred's fertile mind routinely launched him into spur-of-the-moment scholarship on widely varying topics. Liberally interspersed amidst his articles on medical education and general clinical competence are those about weightlifting injuries,9  diagnosis by exclusion,10  accurate blood pressure measurements,11  the broad value of ophthalmoscopy,12  unsuspected pulmonary thromboemboli,13  pericardial fat necrosis,14  and pseudomyxoma peritonei (“jelly belly”).15  Many of these are review articles that are refreshingly succinct, easy to read, and solidly supported by references that might never have been cited before. Happily for students and scholars who wish to learn, and for experienced practitioners who appreciate being reminded of details, all of Dr. Fred's publications in the Texas Heart Institute Journal are freely and fully available through PubMed.

Observers worldwide have noted Dr. Fred's points about good medical writing and proper clinical practices. The editors of a Brazilian cardiovascular journal announced their intention to remodel their publication16  according to Dr. Fred's framework for successful journals.17  One seminal article about the importance of clinical skills18  has been cited as far away as Singapore and Sudan, and it was translated verbatim into Portuguese.19  His analysis of medical education from the past to the present20 —perhaps his most influential work—stimulated agreement and respect from clinicians in multiple fields.

Some award-winners develop inflated egos. Never did I see Herb Fred exhibit one iota of pretense. When he indisputably connected pulsating varicoceles with tricuspid valve insufficiency21  and I officially named this condition “the Fred syndrome,” he was humbled, awed, and (as a first) nearly speechless. This last promptly dissolved into loud guffaws when someone asked him, “So let's get this straight, Herb: 60 years in medicine, and you're forever associated with a throbbing scrotum?”

Herb was a devoted husband and father. His former wife, Lucy, predeceased him. He is survived by his wife of 41 years, Judy; 3 children, Stuart, Michael, and Nancy; 4 stepchildren; and 7 granddaughters, a grandson, 2 great-granddaughters, and a great-grandson.

Herb Fred was a fine man, an unparalleled medical educator, a brilliant physician with enviable clinical skills, a meticulous and industrious medical writer, a warrior against mediocrity, and an inspiration to medical students, physicians, and scholars. He always went the extra mile. In my 55 years as an educator and physician, I have never known anyone else like him in medicine, nor do I expect to. I am forever grateful for his indelible impact on me. We, and the world, will miss him tremendously, even as his influence lives on.

To view Herb's memorial service (held on 6 January 2019), visit https://hcrj.org/live-stream and see the video archived for that date.

References

References
1.
The Herbert Fred, MD, papers; MS 159; John P. McGovern Historical Collections and Research Center, Houston Academy of Medicine-Texas Medical Center Library [Internet]
. .
2.
McAshan
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Fred
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A quarter-million miles and more: 50 years of running
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Meet the streakers who just can't stop running [Internet]
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Maxwell Myer Wintrobe: new history and a new appreciation
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9.
Fred
HL.
More on weightlifting injuries
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Tex Heart Inst J
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4
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10.
Fred
HL.
The diagnosis of exclusion: an ongoing uncertainty
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Tex Heart Inst J
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40
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379
81
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11.
Fred
HL.
Accurate blood pressure measurements and the other arm: the doctor is ultimately responsible
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Tex Heart Inst J
2013
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40
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217
9
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12.
Fred
HL.
Little black bags, ophthalmoscopy, and the Roth spot
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Tex Heart Inst J
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115
6
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13.
Fred
HL.
Unsuspected pulmonary thromboemboli: a continuing clinical challenge
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Tex Heart Inst J
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1
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9
12
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14.
Fred
HL.
Pericardial fat necrosis: a review and update
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Tex Heart Inst J
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37
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82
4
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15.
Fred
HL
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Jelly from the belly button: what's the diagnosis?
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What makes a medical journal successful? Five crucial components
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18.
Fred
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Hyposkillia: deficiency of clinical skills
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.
19.
Fred
HL.
Hyposkillia: deficiencia de habilidades clinicas [Internet; in Portuguese]
. .
20.
Fred
HL.
Medical education on the brink: 62 years of front-line observations and opinions
.
Tex Heart Inst J
2012
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):
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.
21.
Fred
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The tricuspid insufficiency-pulsating varicocele connection: a syndrome and its history
.
Tex Heart Inst J
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302
5
.