In Memorium: Burton Rose, 1942–2020

Burton “Bud” Rose, a brilliant educator, entrepreneur, and nephrologist, died on April 24, 2020 from Alzheimer disease complicated by coronavirus disease 2019 at age 77. Rose graduated from Princeton University and New York University School of Medicine. He did his internship at the University of Chicago; residency at Mount Sinai, New York; and renal fellowship at the Massachusetts General Hospital. Rose spent 2 years in the US Navy under the Berry Plan, after which he worked at the University of Massachusetts, the Brigham and Women’s Hospital, and Beth Israel Deaconess Medical Center. At each institution, he mesmerized students and trainees and amassed numerous teaching awards and accolades. This work, his textbooks, teaching style, and his lasting mark on nephrology earned him the Robert G. Narins award from the American Society of Nephrology (ASN).

A generation of nephrologists discovered homeostasis and the nephron with Bud. His book, Clinical Physiology of Acid Base Disorders, harnessed the power of basic physiology experiments and applied these to the clinical arena with a clarity that younger learners craved. Yet, Bud never seemed entirely satisfied with the book and updated it repeatedly and extensively; with each edition, he added whole chapters that explored the physiology of edema, diuretics, and renal failure, layering the new material on the foundations he had crafted earlier.

This quest for improvement coincided with the advent of the personal computer, and the prescient Rose saw an opportunity. Hypercard, a program featured on the early Macintosh conceptually storing topics like a deck of cards, was a natural platform for the content in which each “card” could feature a topic or a question that nephrologists might have, and these could be linked to other “cards” faster than scanning a book index for a related topic. Rose handily wrote and updated content related to fluid and electrolytes and assembled a cast of renal stars to author more “cards,” each in their field of expertise: Phyllis August, Zalman Angus, William Henrich, Gerald Appel, Ron Falk, and countless others all joined in the effort. Helmut Rennke, with whom Rose had written the popular Renal Pathophysiology: The Essentials, was a natural partner for renal pathology, and together, they solved the challenge of converting their Kodachrome images to digital media. Bud needed a programmer and found Joseph Rush, a fellow at Harvard’s Medical Informatics program; in addition to their day jobs as clinicians, they worked seamlessly together on nights and weekends, with Joe in Florida and Bud in Massachusetts.

Gerald Appel, Bud Rose and Richard Glassock

When they rolled out the new product in 1992 on diskettes, they called it UpToDate in Nephrology and Hypertension. Rose and his wife Gloria became fixtures at their popular booth at the ASN to spread the word, and then, they packaged the set and mailed disks to an eager group of subscribers. With the advent of Microsoft Windows, they shifted the product to be personal computer compatible and mailed quarterly revisions to subscribers. Many have reported that Rose started the program in his basement, but in fact, this endeavor really took over the whole house. Still, Rose was not satisfied with these early successes and was not known for complacency either; he set his sights on something more. Because the nephrologist has always been the consummate internist, content for his UpToDate in Nephrology and Hypertension continually crossed specialty borders, and Rose grew convinced that the focus of his product was too narrow. It should encompass all of medicine, and Rose had the vision to do it.

Meanwhile, Rose cultivated an ever-growing following of nephrologists by speaking at grand rounds and Continuing Medical Education courses across the country; then, he created his own nephrology update course in Boston, a magnet for many thousands of nephrologists from around the globe. All year, Rose delighted in a case that might be “great for the course.” On site, Rose treated participants like family: “call me Bud,” he said, always ready to recommend a restaurant or listen to a complex case. From faculty, he had high expectations and insisted on carefully crafted performances of high quality, but he played to their strengths and gave constructive feedback, at once both a colleague and the most demanding of professors. For his own talks, he approached the podium with a skip in his step and delivered lessons with just the right balance of humility and zing.

Armed with an engaging smile plus the power of persuasion, Bud convinced leaders in the gamut of medical specialties to step in line to transform UpToDate in Nephrology and Hypertension to UpToDate in Medicine; then, he branched out to other fields and transformed it to simply UpToDate. The success of the program is on the basis of Rose’s inimitable formula: content should be written by experts in the field who can help translate evidence-based available data into understandable lessons that can be applied to answer questions to care for real patients. The formula worked. Now, UpToDate boasts nearly 2 million users in nearly 200 countries. It is available on hospital networks and at the point of care on portable devices and enabled for use during secure recertification examinations.

Throughout his career, Rose bridged two worlds. He deciphered the old experiments and rejoiced in the new discoveries. His career was launched with a book, but his life’s work has made textbooks largely irrelevant. He transformed how we think about medical knowledge and how we access it for patient care.

Disclosures

All authors have nothing to disclose.

Funding

None.