N. Scott Adzick

You currently serve in multiple positions at the Children’s Hospital of Philadelphia (CHOP), including Surgeon-in-Chief, the C. Everett Koop Professor of Pediatric Surgery, the founder and Director of the Hospital’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Director of the Division of Pediatric General, Thoracic, and Fetal Surgery, and Professor of Surgery, Obstetrics and Gynecology, and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. Could you tell us about your path to these roles and about a day in your shoes?

As for all of us in medicine, the path to these roles was a long but very enjoyable journey. I attended Clayton High School in St. Louis, followed by Harvard College where I majored in History and Science, and then on to Harvard Medical School. I completed general surgical residency at the Massachusetts General Hospital and pediatric surgery fellowship at the Boston Children’s Hospital. During surgical training, I did a two-year research fellowship at the University of California San Francisco, which is the “birthplace” of fetal surgery beginning with experiments in fetal animal models. I was an attending surgeon at the University of California San Francisco from 1988 until 1995, when I was recruited to serve as Surgeon-in-Chief at CHOP.  I have been very fortunate to help pioneer fetal surgery with a focus on the pursuit of groundbreaking prenatal treatments for life-threatening and debilitating birth defects, including leading a breakthrough study that demonstrated that performing fetal surgery for spina bifida results in significantly improved outcomes compared to conventional postnatal repair. Along the way, I earned a Master of Medical Management degree in 2003 from Carnegie Mellon University which helped me with administrative work at CHOP and provided the business plan opportunity for the creation of the Garbose Family Special Delivery Unit in 2008, the world’s first birth facility in a pediatric hospital specifically designed for healthy mothers carrying babies with known birth defects.  

What is a day like in my shoes? I am an active pediatric general, thoracic, and fetal surgeon. In addition to fetal surgery, I perform a large volume of neonatal surgery. One of my most rewarding collaborations is with our Congenital Hyperinsulinism Center team, where I have performed nearly 600 pancreatectomies, enabling us to ameliorate this devastating disease surgically and completely cure more than 300 babies with focal hyperinsulinism. I am also a leader of the Pediatric Thyroid Center team which recently demonstrated that high thyroid surgery volumes at CHOP are associated with extremely low complication rates. I have trained 52 pediatric surgery fellows and more than 50 pediatric surgical research fellows at CHOP. It is a miracle and privilege to work at CHOP, and it is an honor to serve as a CHOP institutional leader.

Congratulations on being a Fellow for 25 years this year! What first interested you about becoming a part of The College of Physicians of Philadelphia?  

I am a student of the history of medicine, and there is no place like Philadelphia! Philadelphia is the home of many medical firsts including the nation’s first hospital (Pennsylvania Hospital, 1751), first medical school (Penn, 1765), first eye hospital (Wills Eye, 1832), first children’s hospital (CHOP, 1855), and first professional medical society (College of Physicians of Philadelphia, 1787). My first exposure to the Mütter Museum was 26 years ago.  When Bill Kelley was the Dean of the Penn medical school, he would host lunches and dinners for members of the faculty holding endowed chairs. One of the dinners was at the Mütter Museum and as the newly minted C. Everett Koop Professor of Pediatric Surgery in 1995, I was riveted by the displays in the Museum – the plaster death cast of conjoined twins Chang and Eng Bunker, the depiction of the stages of fetal development, the Megacolon, the newborn skeleton with massive hydrocephalus, and the astounding collection of 2,374 foreign objects inhaled or swallowed that were adroitly removed by Dr. Chevalier Jackson. I was hooked!  

As a newly elected Board Trustee, how do you hope to be involved in the present administration and future plans of the College?  

As a “newbie” on the Board of Trustees, I first plan to watch and listen, and then pitch in to help achieve the worthy goals of the College. For example, I look forward to participating in the process of re-imagining, transforming, and preserving the Historical Medical Library so that researchers and the public have more access to this incredible collection. The College provides a wonderful medical “Switzerland” nexus of medical, scientific, educational, and artistic facets. I am excited by the potential of the College as a home base for new initiatives to benefit our truly remarkable and diverse Philadelphia medical community.  

Tell us about one of your favorite items in the Library or Museum, or your favorite aspect of the College.

I was fortunate to have a thrilling behind-the-scenes tour of the Library several years ago. I learned that the Library’s holding includes more than 400 books dating to before 1501—the incunabula. Priceless books of particular interest to the surgeon include two copies of the 1543 (“On the Material of the Human Body”) by Andreas Vesalius; the 1573 Paris edition of Ambroise Paré’s Deux Livres de Chirurgie; one of the world’s best copies of William Harvey’s 1628 De motu cordis (“On the Motion of the Heart”), the first book to describe the circulation of the blood; the 1643 London edition of Sir Thomas Browne’s Religio medici; the 1745 Philadelphia edition of Thomas Cadwalader’s An Essay on the West-India Dry-Gripes (printed by Benjamin Franklin); the founding book of modern pathology, De sedibus et causis morborum (“On the Seats and Causes of Disease”) written by Giambattista Morgagni and published in Venice in 1761; and Anatomia uteri humani gravida (“The Anatomy of the Human Gravid Uterus”) by William Hunter in 1774.

I have personal links to two collections contributed by surgeons to the Library. The extensive library of surgical and medical books of Dr. Samuel Gross (1805-1884) is housed in the Library. Dr. Gross figured prominently in the development of surgery in the United States in the 19th century, and he was the subject of the masterpiece The Gross Clinic painted by Thomas Eakins and famously shared between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts. In 2015, I was honored to give the Samuel D. Gross Award Lecture, dating back to 1895, and relished that special opportunity to appreciate his many contributions. The papers and books written by Dr. C. Everett Koop (1916-2013), my predecessor as Surgeon-in-Chief at CHOP, are also housed in the Library. Dr. Koop was also a very distinguished Surgeon General of the United States from 1982-1989.

In 2015 you appeared in a three-part documentary series that aired on PBS called TWICE BORN: Stories from the Special Delivery Unit. The documentary offered a look inside The Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP where you perform rare surgeries on babies still inside the womb. I read that the production crew was with your team for 15 months. Would you mind sharing what that experience was like for you and for your team and what you hoped to shed light on for viewers?  

This PBS trilogy is about the work we do in the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP. The television mini-series documented the lives of four CHOP fetal surgery patients over the course of 15 months. Prior to that time, we had not allowed reporters or film crews to follow our families prospectively for two reasons. First, we are very protective of vulnerable parents who are making difficult, sometimes gut-wrenching decisions about their pregnancy; and second, the fetal surgery field was new, so we worried that the work might be sensationalized in an unbalanced way. But our patients - our mothers -are unbelievably courageous and resilient as the PBS trilogy demonstrates, and so with the parents’ consent, we believed that the field was mature enough to let the outside world in to see the wonderful world inside the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP. A big surprise was that TWICE BORN won an Emmy in 2017 for Outstanding Science and Technology Programming. Monica Lange and Bonnie Cutler were the Directors.

When you founded The Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment in 1995, did you foresee the impact you would make on your patients’ lives?

With over 2,051 fetal surgeries performed, 5,146 deliveries, and significant outcome improvement for children with spina bifida. What do you hope comes next?   Over the past 26 years, we have had more than 27,000 referrals from all 50 states and more than 70 countries of pregnant mothers carrying babies with birth defects. Stunning - no one could have predicted that in 1995 - and impossible without the remarkable team with whom it is my privilege to serve! The work is extraordinarily challenging but often extraordinarily gratifying. Dr. Koop wrote that “when you operate and save the life of a baby, you save a lifetime.” An incredibly generous gift from the Wood family will ensure that the future of fetal therapy is bright. The Wood family has been involved with CHOP since its founding in 1855 until the current time. For example, Dr. George Bacon Wood (1797-1879) was one of the signers of the Articles of Incorporation for CHOP. He served as President of The College of Physicians of Philadelphia for three decades, from 1849 until this death, and he was also the President of the American Medical Association and the President of the American Philosophical Society! Along with Franklin Bache, he published the first edition (1833) of The Dispensatory of the United States, which soon became the national standard of uniformity for the prescription and dispensation of medicinal drugs. The College’s Library holds a copy of the first edition.

Our research efforts are funded by the Wood family gift, the NIH, and other sources including CHOP. These efforts include the Center for Birth Defects Outcomes to garner real-time birth defects outcomes using BIG DATA, and the Birth Defect Biorepository to provide whole-exome and whole-genome sequencing of the triad (mother, father, fetus) for specific birth defects in order to shed light on the genetic causes of those defects and suggest therapeutic strategies for prenatal treatment. Ongoing work in experimental animal models includes the Artificial Womb to serve as a life-saving bridge for those babies born too soon at 23-25 weeks gestation; in utero hematopoietic stem cell therapy to treat prenatally diagnosed cellular deficiency disorders such as sickle cell anemia; and fetal gene editing using CRISPR technology to treat prenatally diagnosed single-gene disorders. We have an incredibly talented multidisciplinary team, and I anticipate that the tempo of fetal therapy breakthroughs will accelerate.