Like many of my colleagues, I was very saddened to hear of the passing of Dr Burton “Bud” Rose on April 24, 2020 at the age of 77 years. There were two important sides of Dr Rose: First, he was well known in the nephrology community as an extremely modest, brilliant nephrologist who published 2 important textbooks on nephrology. Second, and more importantly, he was the founder and editor of UpToDate.
Dr Rose was born in Brooklyn NY in 1942. He attended Princeton University, where he majored in history. He then attended New York University School of Medicine, where he also completed his residency and fellowship. After serving in the US Navy as a nephrologist, he moved to Wellesley, Massachusetts and began his academic career, with positions at the University of Massachusetts Medical School in Worcester, Massachusetts, and Brigham and Women’s Hospital and Harvard Medical School in Boston.
Dr Rose seems to have touched every nephrologist of my generation. I first came across his work “Pathophysiology of Renal Disease,” when I was a student on the nephrology rotation at Baylor College of Medicine in Houston. This book, as well as “Clinical Physiology of Acid-Base and Electrolyte Disorders,” provided me with my foundation and interest in nephrology. Dr Rose was known for his clear style, and especially his ability to express complex nephrologic concepts in a way that a student, resident, and fellow like myself could understand.
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When I was a fellow, 2 of his articles were also of great importance to me. “New approach to disturbances in the plasma sodium concentration,” published in the American Journal of Medicine (1986;81:1033-1040), still helps me to understand pathophysiologic changes that occur with hypernatremia. His Kidney International Nephrology Forum on diuretics (Diuretics, Kidney International (1991;39:336-352) was also well-read by me and many of my colleagues. It was a great privilege to have a fellows’ lunch with Dr Rose when he visited the University of Pennsylvania in 1991. He was extremely approachable and charismatic. During lunch, he described his idea for UpToDate. Several fellows at the dinner were quite enthusiastic, but others thought it was not such a great idea.
In 1992, Dr Rose started his flagship UpToDate. Like many of my colleagues, I would see him at American Society of Nephrology annual meeting in his at first very small booth. Nephrology was the first component of UpToDate, and I was fortunate to be an author of several topic cards. UpToDate was not successful just because it was the first computer access program for medical doctors. There were several things that Dr Rose did to make it special: Topic cards were directed to busy practitioners and provided expert advice; Topic cards were updated regularly, at least annually; UpToDate was established without industry funding or support, which must have been quite hard early on when there were few subscriptions and very little income; and UpToDate has an international outreach program that has donated subscriptions to clinicians and organizations providing care to poor or underserved populations.
You know the rest: There are now 25 specialties covered in depth, with more than 7,100 authors and editors. Some 1.9 million doctors and 38,500 institutional sites worldwide use UptoDate. There are more than 50 million topic views per month. The median time to obtain information needed during a search is a little over a minute. It is estimated that UpToDate changes physician practices one-third of the time. What an impact!
I consider Dr Rose to be the most influential clinical educator in the history of medicine, with an unsurpassed impact on physician education and patients’ lives. While we keep alive the memories of great historical figures like Hippocrates, Galen, and Osler, their impact lessens over time as medicine changes. In contrast, Dr Rose’s accomplishments will live on and his impact will become even more substantial with each passing day and each new click leading a clinician to learn more at UpToDate.
While (thanks to Dr Rose) I may not be able to effectively teach students about medical conditions like deep venous thrombosis or Hashimoto’s thyroiditis because they get to UpToDate before me, I can tell them the history of UpToDate and how a kind, modest, brilliant nephrologist was responsible for much of the learning that occurs in medicine today. I hope that we will all keep alive the memory of Dr Rose and that someday he will be recognized for his unparalleled contribution to medicine and patient care.
I encourage you to watch the following youtube video, in which Dr. Rose discussed the origins of UpToDate https://www.youtube.com/watch?v=k4nQWM6U298
Anthony J. Bleyer, MD, MS, is Professor of Internal Medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina and a member of Renal & Urology News editorial advisory board.
