The contributions of Abass Alavi, MD, to the field of nuclear medicine come into clearer focus when you hear his life story up to this point – raised in a poor family in Iran to becoming one of the world’s preeminent researchers in nuclear imaging.
Alavi started at the University of Pennsylvania’s medical school in 1971 as a research fellow, under tomography pioneer David Kuhl, MD. Kuhl and Alavi joined neurologist Martin Reivich, MD, and investigators from the Brookhaven National Laboratory to form the first group in the world to administer fluorodeoxyglucose with fluorine-18 (FDG-18) to a patient in 1976, becoming the first to obtain tomographic images of the brain and scans of the whole body. These efforts laid the groundwork for use of FDG-18 for improved earlier detection and better treatment for millions of patients with dementia, brain trauma, schizophrenia, and other disorders.
Earlier this month, the Society for Nuclear Medicine hosted a celebration for the 40th anniversary of the FDG compound that Alavi and his colleagues developed.
Over the course of his career, Alavi has published more than 700 original papers, along with several books, detailing his research findings in single photon emission computed tomography (SPECT), positron emission tomography (PET), computed tomography (CT) and magnetic resonance imaging (MRI) imaging. Among his numerous awards and honorary degrees is an honorary doctorate from the Medical University of Gdańsk in Poland earlier this year.
Today, Alavi serves as a professor of Radiology and Neurology at Penn’s Perelman School of Medicine, as well as director of research education in Radiology. I had an opportunity to hear from Alavi about his story, starting with birth in Tabriz, Iran in 1938.
His mother married Alavi’s father at age 14. His father had a sixth-grade education and worked as a merchant. His mother experienced only two years of formal education and helped support the family by selling carpets and jewelry, lending proceeds for interest, and even providing penicillin injections.
Still, the family had little money and lacked running water and electricity in the home for much of Alavi’s upbringing.
In 1943, Alavi’s father developed gangrene in his foot. The family relied solely on prayer instead of the less accessible options of antibiotics or surgery. Alavi’s father passed away from blood clots associated with Buerger’s disease later that year.
“That suffering made my mother see how important physicians could be,” Alavi said. “We watched helplessly what he was going through. Soon after he passed, my mom said to me and my brother, ‘One of you has to become a doctor.’”
Seeing the integral role of education to that goal, when Alavi was six, his mother took him to the neighborhood school, consisting of one room for five grades. As a six-year-old, Alavi was immediately intimidated.
“I went home after the first day and said, ‘Mama, you’ve put me in this school filled with geniuses, I can’t compete with these guys,’” he said.
His mother sat Alavi on the floor and said, “Listen very carefully: you’re going to go to this school and become a doctor or you will die in that school and be buried there.”
That motivation from his mother has served as a driving force throughout Alavi’s life through to this day.
When he wasn’t in school, Alavi’s work ethic proved useful in unique jobs, including an unconventional way of selling ice during the summer.
“They would store snow in caves during the winter, and in the summer,” he said, “I would descend mud steps and use a hammer to cut pieces of ice, bring it upstairs, put it on a scale and sell it to customers.”
That work was critically important as he, his mother, and brother and sister were living on roughly 50 cents a day. From age nine on, Alavi was the oldest male in the family, assuming many of the responsibilities that entails. This included studying by streetlight every evening after the sun went down, and after 10 pm, taking two buckets to the town well to gather water for the family.
Alavi thrived in his studies and was accepted into the University of Tehran’s highly competitive medical degree program, of which Alavi graduated from in 1964 – at a total cost of about 870,000 Iranian rials ($28.50 in US dollars).
A few months after graduating, Alavi started a health clinic through the Iranian Health Service in a mountainous area that previously didn't have one, serving there for a year. "I became a member of the families in this village," Alavi said. "I just went to the mayor of the town and started seeing patients."
Alavi, who would drive those needing complex care to Tehran, including an anthrax patient, learned that sometimes simple cases can change someone’s life forever. For example, one patient he saw believed he was deaf for the previous 20 years. Once Alavi removed his excessive ear wax, the patient shouted through the village, proclaiming him as a miracle worker.
In 1966, Alavi moved to Philadelphia, practicing medicine first at Einstein Medical Center for two years, then the Philadelphia Veterans Administration hospital (now the Corporal Michael J. Crescenz VAMC), and then Penn Medicine, taking on increasing opportunities as a physician, educator and researcher.
Kuhl, Alavi and Reivich first worked with conventional radioactive material, not PET. Later the group utilized more sophisticated imaging through the use of deoxyglucose and PET to image body function non-invasively.
“PET allows us to look at changes in the molecules that are the basis of disease,” Alavi said. “MRI alone is not good enough -- we need to also see structure and function that CT or MRI alone cannot provide.”
By seeing these changes early, when the disease is only at the molecular level, clinicians can use PET to diagnose and act on diseases faster. PET is now the basis for early diagnosis and viewing the effects of treatments within days, rather than months, which is the case with structural imaging such as CT or MRI.
For example, PET can help diagnose Parkinson’s disease 10 years before a patient shows symptoms, which helps care teams treat such patients earlier before the disease progresses. The technology also sometimes helps prevent unnecessary surgery, evaluate a patient’s response to cancer drugs, and influence treatment for brain disorders, inflammation, infection, and many other disorders.
In October 2015, Alavi visited Tabriz for a celebration recognizing his contributions to the field of nuclear medicine, receiving an honorary doctorate from the Tabriz University of Medical Sciences along with honorary citizenship in his hometown.
A few months later, Tabriz University began a new program to study brain, heart, muscle, and other disorders by opening the Alavi Center for the Study of Aging.
Alavi is currently working on using PET imaging techniques (already used in diagnosing millions of patients worldwide each year) to study atherosclerosis and heart disease.
“My colleagues and I are conducting research based on logic, bringing science to medicine,” Alavi said. “This is really what has been my mode of operation over the past 50 years in the United States. Combining powerful imaging modalities, we will continue to change the way clinicians treat some of the most common problems of mankind and reduce human suffering for many years to come.”