The Stanford physician devised a test that saved babies’ lives by showing whether they needed immediate treatment for a parasitic disease called toxoplasmosis.
April 27, 2021 - By Bruce Goldman
Jack Remington, MD, professor emeritus of infectious diseases at Stanford Medicine, died April 8 in Menlo Park, California, of complications from an injury he sustained in a fall. He was 90.
An extreme-sports enthusiast with a penchant for mountain climbing, which over the years exacted a physical toll on his body, Remington was a hard-charging patient advocate who put his patients’ needs above all else.
He was also an accomplished scientist who conducted groundbreaking research on Toxoplasma gondii, a usually dormant protozoan parasite that affects a huge proportion of the world’s population and can be lethal to immunocompromised individuals. He devised a blood test that could determine whether a newborn baby was infected by T. gondii and therefore at risk for toxoplasmosis, a disease with potentially severe consequences. Drug formulations he perfected are still used today to clear the infection.
“Jack Remington is recognized as a pioneer in infectious disease,” said Lloyd Minor, MD, dean of the School of Medicine. “He grasped the great significance and toll of opportunistic infections among immunocompromised patients and newborns and, with a laser focus, set about saving their lives.”
A multilayered personality
Upinder Singh, MD, chief of infectious diseases and geographic medicine at Stanford, said Remington was a giant in the field. “Jack was strong-willed, confident and outspoken,” she said. “But inside the lion was a heart of gold. He served as a mentor to countless colleagues and trainees, and I will always remember his kindness and generosity.”
Remington’s celebrated impatience in the service of his patients earned him the nickname “Stat Jack.” (“Stat” is medical jargon for “Do it right now!”)
If Remington thought a patient under his care was receiving inadequate or improper treatment, he could become fiercely assertive, said Philip Pizzo, MD, professor of pediatrics and of microbiology and immunology.
“He sometimes seemed to have an on/off switch, almost a binary personality,” said Pizzo, the David and Susan Heckerman Professor and former dean of the School of Medicine. “He could be abrupt and abrasive, or extraordinarily calm and focused. But he always placed the patients he cared for, as well as others in need, as his highest priority.”
He served as a mentor to countless colleagues and trainees, and I will always remember his kindness and generosity.
Pizzo’s early acquaintance with Remington’s research on opportunistic infections, and Remington’s subsequent mentorship, helped determine the course of his career. Pizzo first learned of Remington’s work during his third year of medical school in the late 1960s. Remington had popularized the concept of the immunocompromised host, denoting individuals whose weakened immune responses left them susceptible to infection by opportunistic microorganisms, including T. gondii.
“That stuck in my mind,” Pizzo said. During his residency, he decided to focus on immunocompromised children. In 1977, he presented a research paper on the subject at a New York meeting of the Infectious Disease Society.
“When I finished, Jack came up to me, introduced himself and asked me some questions,” Pizzo recalled. “I was blown away, because he was the one who’d launched me on my career path. He became a lifelong mentor, colleague and friend.”
The Centers for Disease Control and Prevention estimates that 1 in 9 Americans age 6 or older — and as much as half of some nations’ populations — have been infected with T. gondii, a single-celled protozoan parasite, typically from eating raw or undercooked meat or from exposure to cat feces. (The microbe sexually reproduces only in cat intestines.) But T. gondii can also be transmitted directly from a pregnant woman to the fetus she’s carrying.
The infection remains dormant and inconsequential in people with well-functioning immune systems. But people with compromised immune systems are vulnerable to the microbe’s active emergence, which can cause a potentially severe disorder known as toxoplasmosis. Into this category fall transplant recipients taking immune-suppressing drugs to prevent organ rejection; those whose immune response has been damaged by, for example, HIV infection; and — of special importance to Remington — newborn babies, whose immune systems have yet to mature.
In these individuals, toxoplasmosis can lead to neurological damage, blindness and death. Remington called attention to this condition, made it detectable and showed it was preventable.
A steady climb to the pinnacle
Remington was born in Chicago on Jan. 19, 1931, to Nathan and Sylvia Remington. He attended Loyola University in Chicago for two years before transferring to the University of Illinois, where he earned a bachelor’s degree in 1954 and a medical degree in 1956. After an internship at San Francisco General Hospital, he began two years of military service as a senior assistant surgeon for the United States Public Health Service and, simultaneously, as a research associate in a lab at the National Institute of Allergy and Infectious Diseases. It was there that Remington began to focus on T. gondii, a then poorly understood parasite that became the focus of his career.
After completing his residency and a postgraduate fellowship, Remington became founding chair of the Department of Infectious Diseases at the Palo Alto Medical Foundation’s research institute, as well as an instructor of immunology and infectious diseases at the Stanford School of Medicine. Promoted to assistant professor in 1964, he became an associate professor in 1969 and full professor in 1974.
Remington not only helped unravel the pathogenesis of toxoplasmosis but, in the early 1970s, invented a test to distinguish between antibodies that a newborn has passively acquired from its mother through the placental barrier and antibodies that indicate a newborn has actually been infected in the womb by pathogens, notably T. gondii, that had been residing in the mother’s tissues. The latter case meant a baby needed immediate treatment to stave off active toxoplasmosis.
Remington also led clinical trials establishing optimal drug-treatment regimens for clearing the parasite.
“The prevalence of toxoplasmosis may be the same now as it was then,” said Gary Schoolnik, MD, professor emeritus of medicine and former chief of infectious diseases. “But now we have the tools to diagnose it, and we have a repertoire of effective drugs to treat it.”
While Remington performed his clinical work at Stanford Hospital, his research was centered at the Palo Alto Medical Foundation, where his toxoplasmosis serology laboratory became internationally recognized among infectious-disease experts as the reference laboratory for Toxoplasma.
“The place where you sent the blood samples was the Remington lab,” Pizzo said. “If you needed advice or consultation, the Remington lab was the place you called.”
Remington also focused on a spectrum of opportunistic diseases afflicting immunocompromised adults, including transplant recipients and HIV patients.
Tireless in service of patients
Remington was a “triple threat” — a combination of world-class basic scientist, brilliant clinical researcher and caring physician, said Schoolnik, who first arrived at Stanford in 1981, at the height of Remington’s activity.
“Aside from being published in Nature and Science, Jack was an absolutely world-class clinician,” Schoolnik said. “There was never any question about him going the extra mile for any patient he was caring for. He identified with that patient, and he would confront any caregiver he felt was doing less than the best job. When he said, ‘Do it now!’ he was basing that command on his huge experience. He was far more often right than wrong. I’m sure he saved many lives.”
There was never any question about him going the extra mile for any patient he was caring for.
Schoolnik once found himself in Stanford Hospital for a couple of weeks after sustaining a fractured femur in a bicycle accident. One night at around 11 p.m. or midnight, he noticed what looked like discolored urine in his catheter. “A hospital is a lonely place at midnight,” Schoolnik said. “Rather than wait for an attendant, I called Jack Remington at home and said, ‘Jack, I think I have a urinary-tract infection.’”
Remington came right in, put a sample under the microscope and wrote a drug prescription on the spot, in the middle of the night.
“It wasn’t just me. He would have done that for any patient,” Schoolnik said.
Remington exuded power and strength along with compassion and empathy, Pizzo said.
“Jack was an incredible athlete,” he said. “Extreme exertion was as natural to him in the physical realm as it was in the intellectual arena. He brought focus, endurance, dedication and exquisite precision to everything he did.” By the time Remington retired in 2005, a series of falls in athletic pursuits — notably rock climbing — had resulted in multiple injuries.
“He’d broken just about every bone in his body,” Pizzo said, but he never gave up.
Remington authored or co-authored more than 600 research papers and held 11 patents. He co-edited a seminal textbook, Infectious Diseases in the Fetus and the Newborn Infant, now in its ninth edition. He served in editorial posts or on the editorial boards at two dozen professional journals.
Remington amassed scores of professional appointments and awards, including an honorary doctorate from Paul Sabatier University in Toulouse, France. He was elected a fellow of the American College of Physicians in 1966, the London-based Royal College of Physicians in 1999, the American Association for the Advancement of Science in 2000 and the American Academy of Microbiology in 2000. At Stanford, he received the Albion Walter Hewlett Award, the Infectious Diseases Divisional Teaching Award and the Kenneth L. Vosti, MD, Teaching Award.
He was a past president of the Western Society for Clinical Research, the Infectious Diseases Society of America and the International Immunocompromised Host Society.
In 1986, Remington was named the Marcus A. Krupp, M.D. Research Chair at the Palo Alto Medical Foundation. In 2019, the laboratory he’d created in 1962 was renamed the Dr. Jack S. Remington Laboratory for Specialty Diagnostics.
He is survived by his wife, Francoise Perdreau-Remington, PhD, of Menlo Park; son David Remington of San Jose; daughter Lynne Remington of Chicago; stepson Matthias Schumacher of Las Vegas; stepdaughter Geraldine Strunsky of Indian Wells, California; and five grandchildren.
Perdreau-Remington has asked that in lieu of flowers, donations be made to the “Remington Fund,” set up at the Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Attn. Dr. Jose G. Montoya, MD, Ames Bldg., Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, California 94301.
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