In Memoriam: Lawrence Brass, M.D., Yale School of Medicine Neurologist

Lawrence M. Brass, M.D.

Lawrence M. Brass, M.D., a Yale School of Medicine neurologist and an internationally recognized expert on stroke who helped lead the largest case control study ever conduced for hemorrhagic stroke, died Wednesday of lung cancer at his home in Woodbridge. He was 49.

Brass, a professor in the Departments of Neurology and Epidemiology and Public Health, was best known for his use of innovative epidemiologic methodologies to study stroke, which is the third leading cause of death in this country, and for the intelligence and optimism he brought to major issues in this new field.

He began his career examining the performance characteristics of imaging in clinical stroke, then designed a clinical trial based on accumulating epidemiologic and basic science evidence indicating a possible role of estrogen therapy in protection against stroke. The National Institutes of Health funded the Women’s Estrogen for Stroke Study from 1993-2001, which was one of the first studies to investigate estrogen as a therapy for the prevention of vascular disease. This study focused specifically on post-menopausal women who survived an ischemic stroke.

Concurrently, he led the landmark Hemorrhagic Stroke Project that demonstrated an association between phenylpropanolamine, then the common ingredient in cough and cold remedies and over-the-counter diet pills, and risk for stroke. The findings resulted in the removal of phenylpropanolamine from the market.

One of his extraordinary legacies is a database, which he co-founded, comprising more than six million cases of stroke. The repository contains data on all Medicare beneficiaries 65 years or older with a stroke or stroke-related diagnosis and every hospital admission for those individuals over a 14-year interval. It is the first complete database of stroke among the elderly in the United States.

Brass was also an innovative investigator in the area of quality improvement for stroke care. He was one of the first investigators to demonstrate underutilization of stroke preventing blood thinners in patients with atrial fibrillation. In other work, he demonstrated racial disparities in stroke care and the tragic consequences for patients with acute stroke when physicians fail to follow correct procedures in use of clot-dissolving drugs for patients with acute stroke. He was a leading advocate for the development of quality measures for assessing the care of patients with stroke.

Brass was known among his colleagues as a magnanimous ambassador for stroke medicine. His colorful personality and clever mind attracted students and collaborators from disciplines as diverse as gynecology and epidemiology. “The thing that amazed me about Larry was that he always seemed to be a step ahead. He was very good at identifying scientific issues from various fields that bear on stroke research earlier than other people,” said Edward Feldmann, M.D., professor of neurology at Rhode Island Hospital.

Harlan Krumholz, M.D., professor in the Departments of Internal Medicine, Section of Cardiology, and Epidemiology and Public Health, who often collaborated with Brass on research studies, said, “Everyone who knew Larry feels an acute sense of loss. His intellect, creativity and kindness enhanced our work and our lives.”

The former chair of the Department of Internal Medicine at Yale, Ralph Horwitz, M.D., dean of the School of Medicine and vice president for medical affairs at Case Western Reserve University in Cleveland, said Brass was widely regarded among his peers as a powerful influence who helped shape the direction of patient-based research in neurology. “He had an encyclopedic knowledge of the field and deep insights into the methods and content of clinical research in neurological disorders,” Horwitz said. “He was often among the very first individuals people think of when they want to identify a colleague who can bring boundless enthusiasm and intellectual discipline to research in neurological disorders.”

Many of the attributes that enabled Brass to bring people together for research also made him a successful mentor and teacher. “People liked working with Larry because of what he could do, who he was, and how he treated them,” said his longtime colleague at Yale, Walter Kernan, M.D., professor of internal medicine at Yale. Since 1987, Brass supervised 15 post-doctoral fellows, faculty members in their research and numerous students on theses required for medical school graduation at Yale and successfully mentored three junior faculty members with career development awards.

Brass was an avid reader of literature, history and science. He was a knowledgeable astronomer, an aspiring fly fisherman, and an accomplished amateur magician who frequently entertained his colleagues.

“He also worked magic as a neurologist,” said Stephen Waxman, M.D., chair of the Department of Neurology. “He had a gift for designing uniquely incisive research studies in which he would look at an entire population from 30,000 feet and had an uncanny ability to learn things from these studies that could benefit each person at risk for stroke.”

Brass was born in Brooklyn, N.Y., one of three children of Melvin and Joyce Brass. He received his undergraduate degree in mathematics at the University of Pennsylvania before attending Tufts Medical School. He went on to an internship at Newton-Wellesley Hospital in Massachusetts followed by his residency and chief residency in neurology and a stroke fellowship at the Neurological Institute of New York (Columbia University.) In 1987 Brass was recruited to Yale School of Medicine to establish a stroke service. In addition to his appointments in neurology and EPH, he was chief of neurology at the West Haven Veterans Administration Medical Center and co-director of the Yale Cerebrovascular Center.

Brass’ skill and good judgment in all matters related to stroke care and research won him an international reputation. He had major roles in both the National Institutes of Health and the American Heart Association for work involving stroke research and policies related to clinical care. At the time of his death, Brass chaired the Data and Safety Monitoring Boards for two National Institutes of Health-funded clinical trials and participated in five others. He served on the Steering Committees for four stroke trials and was the medical monitor for three trials. For the American Heart Association, Brass was chair of the study section on pharmaceutical roundtable awards; a member of the leadership committee of the Stroke Council; a recent member of the editorial board for Stroke; represented stroke on the Committee for the Scientific Sessions Program; helped organize the IWG on Quality of Care and Outcomes, and served on numerous other policy and advisory committees.

In addition to his parents, Brass is survived by his wife, Lori Ann Brass, two children, Schuyler and Zachary, and two sisters, Jill Brass of Albany, N.Y., and Susan McInerney of Bohemia, N.Y.

A funeral service will be held at 1 p.m. on Friday, March 10, at Congregation Mishkan Israel, 785 Ridge Road, Hamden, followed by the burial service at the Grove Street Cemetery.

In lieu of flowers, Dr. Brass requested that friends, family and colleagues send letters to his sons, Zachary and Schulyer, sharing stories and memories about their father. In lieu of flowers, memorial contributions may be sent to the Lawrence Brass Stroke Fund, American Academy of Neurology Foundation, 1080 Montreal Ave., St. Paul, Minn., 55116.

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