Barry Rumack

Barry H. Rumack (born November 1, 1942) is an American medical toxicologist and pediatrician. His primary clinical and research interest has been in clinical toxicology with a special interest in acetaminophen poisoning. Since 2014 he is emeritus professor of emergency medicine and pediatrics at the University of Colorado School of Medicine.

M.D.

Barry H. Rumack
Born (1942-11-01) November 1, 1942
Chicago, Illinois
NationalityAmerican
CitizenshipUnited States of America
Academic background
Alma materUniversity of Wisconsin School of Medicine and Public Health (MD, 1968)
Academic work
DisciplinePediatrics, Medical toxicology
Sub-disciplineClinical toxicology
Notable ideasPoisindex (1973), Rumack–Matthew nomogram (1975)

Early years and education

Rumack was born in Chicago, Illinois, on November 1, 1942. He grew up in Whitefish Bay, Wisconsin, and graduated from Whitefish Bay High School in 1960.[1][2] In 1964, he graduated from the University of Chicago with a Bachelor of Science in microbiology in 1964.[3][1]

In 1968, Rumack completed medical school at the University of Wisconsin School of Medicine and Public Health, where he received his M.D.[3] He was a clinical research fellow at the National Institutes of Health, National Cancer Institute, Baltimore Cancer Center in the section of neurosurgery and a research fellow with Jordan Holtzman, MD, PhD in the Section of Pharmacology.[4]

In 1971, he returned in 1971 to the University of Colorado to complete a pediatric residency and then did a fellowship at the University of Colorado School of Medicine in clinical pharmacology and toxicology.[3] During the second half of 1973 he was clinical fellow with Dr. Henry Matthew MD at the Royal Infirmary of Edinburgh in Edinburgh, Scotland.[5][6][2] He developed a significant interest in acetaminophen and along with Professor Matthew collected 34 cases of overdose and combined them with 30 previously published cases in creation of a nomogram relating blood level to time of ingestion. That was then published in 1975 and is used worldwide in the assessment of acetaminophen overdose treatment as Rumack–Matthew nomogram.[7][8]

Academic career

In January 1973, Rumack joined the faculty of the University of Colorado School of Medicine as assistant professor of pediatrics.[9] He has been with the university ever since and was named emeritus professor of emergency medicine and pediatrics in 2014.[3]

In 1973, Rumack developed Poisindex, one of the first commercial databases, which could retrieve diagnosis and treatment data for a vast variety of poisonous substances.[10] Published first on microfiche and later on CD-ROM it became the standard software used by the majority of poison control centers in the US and globally.[11][12]

In January 1974, he became the director of the Rocky Mountain Poison and Drug Center (now Denver Health Medical Center) and served in this role until his retirement in 1992.[13] His early work at the center was focused on developing a regional resource for poison information and treatment. Part of that work involved the development of Poisindex.[14] Within that system an international mushroom toxicology classification system was developed. Similar systems for plants and snakes were also incorporated. Having such technical advantage, Rumack established a hotline at the Rocky Mountain Poison & Drug Center Rumack, where every poison enquiry could be answered within 30 to 50 seconds.[15] The Kansas City Star 1978 feature story noted that the center "has become a technical prototype for similar operations around the country".[15]

In 1973, he and co-authors published a paper examining hepatic drug metabolism and malnutrition. This paper was based on extensive work with monkeys who were also assessed for cognitive and other functions in separate publications and forms the metabolic basis for the understanding of the importance of correcting malnutrition during early brain development. This work is utilized today as part of the basis for the United Nations emergency feeding programs.

In 1976, along with co-authors he published a paper regarding unrecognizable salicylate intoxication which revealed numerous missed cases of aspirin poisoning in patients who were thought to have metabolic acidosis of unknown origin.[16] In September 1976, he began a protocol and was the principal investigator of the use of n-acetylcysteine for the treatment of acetaminophen overdose as part of a National Multiclinic Study which collected and published the largest series of acetaminophen cases ever collected in The New England Journal of Medicine in 1988.[17] This treatment, now given intravenously, has been the standard approach to this overdose to this day worldwide.[18][19]

In 1978, together with Emanuel Salzman Rumack co-authored Mushroom Poisoning:diagnosis and treatment, which had a second edition in 1994 with David Spoerke as a co-author. In 1980, he was portrayed in the movie Airplane! (1980) as Dr. Rumack (played by Leslie Nielsen), who took care of passengers on the plane with food poisoning.[20] In 2008, in a testimony at court he explained that he used to live in Milwaukee next door to filmmakers David and Jerry Zucker and they took his name for the movie role.[21]

In May 1989, Rumack visited Georgia as part of a three experts team commissioned by Physicians for Human Rights to investigate a possible use of toxic gas during the April 9 tragedy.[22][23][24] He was able to identify the gas as chloropicrin, which is an illegal war gas, utilizing a mass spectrometer at the Tbilisi State Medical University.[25]

In 1999, he was doing a sabbatical at the Food and Drug Administration when he was asked to evaluate safe levels for exposure to methylmercury in pediatric vaccines.[26] Rumack developed a pharmacokinetic model to analyze the amount of mercury to which infants were being exposed and found that mercury levels at Thiomersal-containing vaccines were far exceeding safety guidelines established by EPA, FDA and ATSDR.[26] Unfortunately, the FDA did not share this information with the public.[26]

Rumack has continued with academic work at the University of Colorado School of Medicine both teaching and doing research. His most recent publications were focused on the use of fomepizole as a treatment for delayed and massive ingestions of acetaminophen (Akakpo 2019, Kang et al. 2019, Adkakpo et al. 2020.).

Selected publications

Selected books
  • Rumack, Barry H.; Salzman, Emanuel (1978). Mushroom Poisoning:diagnosis and treatment. CRC Press. ISBN 9780849351853.
  • Bayer, Marc J.; Rumack, Barry H., eds. (1983). Poisoning & overdose. Aspen Systems Corp. ISBN 9780894438097.
  • Bayer, Marc J.; Rumack, Barry H.; Wanke, Lee A., eds. (1984). Toxicologic emergencies. R.J. Brady Co. ISBN 9780893031886.
  • Spoerke, David G.; Rumack, Barry H., eds. (1994). Handbook of mushroom poisoning : diagnosis and treatment. CRC Press. ISBN 9780849301940.

Awards and recognition

Rumack received three highest American career achievement awards in the field of clinical toxicology: an Annual Recognition Award from the American Association of Poison Control Centers (1985),[3] Matthew J. Ellenhorn Award from the American College of Medical Toxicology (2001)[27] and the Career Achievement Award from the American Academy of Clinical Toxicology (2011).[28][6] His work was also recognized by the Clinton Thienes, M.D., Award from the American Academy of Clinical Toxicology (1991) and by Honorary Doctorate from the Jagiellonian University (1995).[3]

References
  1. "Kudos". Wisconsin Jewish Chronicle. 1968-06-07. p. 7. Retrieved 2021-06-02 – via Newspapers.com. Barry H. Rumack, a 1960 graduate of Whitefish Bay High School, will graduate from the University of Wisconsin medical school on June 10. He received his B.S. degree from the University of Chicago in 1964. Dr. Rumack will intern at University of Denver Hospitals, a major pediatric center, and will eventually practice in adolescent pediatrics... He is the son of Mr. and Mrs. Al Rumack, N. Ardmore ave.
  2. Alden, Sharyn (2015). "A Partnership for Life" (PDF). Quarterly. University of Wisconsin School of Medicine and Public Health. 17 (3): 23–25. Archived from the original (PDF) on 2021-06-02. Retrieved 2021-06-02.
  3. "Barry Rumack, MD: Professor Emeritus, Pediatrics-Administration". University of Colorado School of Medicine. Archived from the original on 2021-06-02. Retrieved 2021-06-02.
  4. "4 Doctors in household". Daily American. Associated Press. 1969-07-28. p. 2. Retrieved 2021-06-02 – via Newspapers.com.
  5. Proudfoot, Alex T.; Good, Alison M.; Bateman, D. Nicholas (2013). "Clinical toxicology in Edinburgh, two centuries of progress". Clinical Toxicology. 51 (6): 509–514. doi:10.3109/15563650.2013.802329. PMID 23731376. S2CID 20609395.
  6. Lovejoy, Jr., Frederick H. (2002). "Barry Rumack - A Tribute". Internet Journal of Medical Toxicology. 5 (2): 5. Archived from the original on 2021-06-02. Retrieved 2021-06-02.
  7. Pillay, VV (2012). Modern Medical Toxicology (4th ed.). Jaypee Brothers. p. 418. ISBN 978-93-5025-965-8 – via Google Books.
  8. Hodgman, Michael J.; Garrard, Alexander R. (2012). "A Review of Acetaminophen Poisoning". Critical Care Clinics. 28 (4): 499–516. doi:10.1016/j.ccc.2012.07.006. PMID 22998987.
  9. "Barry H Rumack". ResearchGate. Archived from the original on 2021-06-04. Retrieved 2021-06-04.
  10. Engel, Margaret (1990-06-05). "Accidental Poisonings". The Washington Post. Archived from the original on 2021-06-05. Retrieved 2021-06-05.
  11. "Historical Context of Poison Control". Forging a Poison Prevention and Control System. National Academies Press. 2004. p. 91. ISBN 9780309166201. Archived from the original on 2021-06-04. Retrieved 2021-06-04. Drug information and poisoning management cards used by the early poison control centers were replaced by microfiche as the required database grew. The first major commercial product for this purpose was the Poisindex® (founded in 1973 by Barry H. Rumack). Although there were several other databases such as ToxiFile from Illinois and a compilation of NCHPCC cards from Detroit, they did not publish for more than a few years. Poisindex was published on microfiche in August 1974 and contained a compilation of consumer and commercial products coded to treatment algorithms (Rumack, 1975). These "managements" were written by an editorial board and covered care of exposed patients at home or in a healthcare facility. Poisindex was provided electronically for mainframe computers beginning in 1981. In 1985, Poisindex was published on CD-ROM for the first time and coupled with a personal computer. Although CD-ROM continues to be its major method of distribution, the software is also available through Internet subscription and over private intranets. Poisindex is used by all U.S. poison control centers and the majority of centers around the world. Validity of the Poisindex database has been independently verified (Wan et al., 1993). Data contained within Poisindex is provided voluntarily by consumer product, industrial, and other manufacturers and repackagers.
  12. Public health informatics and information systems. Springer Publishing. 2003. p. 339. ISBN 0-387-95474-0 – via Internet Archive. The old system took a quantum leap forward in the early 1970s, when Dr. Barry Rumack undertook a comprehensive survey of companies marketing commercial products, asking for information on their precise chemical formulations. The response rate to this survey was overwhelmingly high, and the study effort required so much time, effort, and space that Dr. Rumack was forced to move it out of the hospital and continue it independently. He formed a company (the predecessor of Micromedex®) that produced a microfiche product including both (1) clinical information on specific toxicants and (2) precisely which commercial products contained those toxicants and in what concentrations. This combination of these two types of information had tremendous clinical utility, and the microfiche product was an instant hit. This was the original Poisindex®, which rapidly became the principal information source for most US and Canadian poison centers. In the late 1980s, the product was made available in CD-ROM format for computers and computer networks, further facilitating rapid access to the most clinically relevant parts of the database.
  13. "Rocky Mountain Poison & Drug Center: 50 years of Saving Lives With Answers" (PDF). 2006. Archived from the original (PDF) on 2021-06-04. Retrieved 2021-06-04.
  14. Evenson, Vera S.; Wilson, Andrew W.; Bates, Scott T. (2018). "Of Medicine, Mountains and Mushrooms: The Life and Legacy of Sam Mitchel" (PDF). Fungi. 10 (4). Archived from the original (PDF) on 2021-06-04. Retrieved 2021-06-04.
  15. Fowler, Giles M. (1978-06-11). "Lifeline: The Rocky Mountain Poison Center". The Kansas City Star. pp. 17–22. Retrieved 2021-06-27 – via Newspapers.com.
  16. Anderson, RJ; Potts, DE; Gabow, PA; Rumack, BH; Schrier, RW (1976). "Unrecognized adult salicylate intoxication". Annals of Internal Medicine. 85 (6): 744–748. doi:10.7326/0003-4819-85-6-745. PMID 999110.
  17. Smilkstein, Martin J.; Knapp, Gary L.; Kulig, Kenneth W.; Rumack, Barry H. (December 15, 1988). "Efficacy of Oral N-Acetylcysteine in the Treatment of Acetaminophen Overdose". The New England Journal of Medicine. 319 (24): 1557–1562. doi:10.1056/NEJM198812153192401. PMID 3059186.
  18. Rumack, B. H.; Peterson, R. C.; Koch, G. G.; Amara, I. A. (February 23, 1981). "Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment". Archives of Internal Medicine. 141 (3 Spec No): 380–385. doi:10.1001/archinte.141.3.380. PMID 7469629 – via PubMed.
  19. Villeneuve, Eric; Gosselin, Sophie (November 2, 2016). "N-Acetylcysteine". In Brent, Jeffrey; Burkhart, Keith; Dargan, Paul; Hatten, Benjamin; Megarbane, Bruno; Palmer, Robert (eds.). Critical Care Toxicology. Springer International Publishing. pp. 1–10. doi:10.1007/978-3-319-20790-2_151-1. ISBN 978-3-319-20790-2 – via Springer Link.
  20. Thurbsy, Keith (2010-11-29). "Serious actor became a comic star". Los Angeles Times. Archived from the original on 2021-06-06. Retrieved 2021-06-06.
  21. "One month later, defense calls first witness in Mark Jensen case". St. Paul Pioneer Press. 2008-02-05. Archived from the original on 2021-06-06. Retrieved 2021-06-06.
  22. August, Marilyn (1989-05-25). "French Doctors Partially Withdraw Claim About Toxic Gas in Soviet Georgia". Associated Press. Archived from the original on 2021-06-05. Retrieved 2021-06-05.
  23. Norman, Colin (June 9, 1989). "U.S. physicians probe deaths in Soviet Georgia". Science. 244 (4909): 1133. doi:10.1126/science.2524878. PMID 2524878. Archived from the original on 2021-06-05. Retrieved 2021-06-05.
  24. ""Bloody Sunday": Trauma in Tbilisi (Report of a Medical Mission to Soviet Georgia by Physicians for Human Rights)" (PDF). Physicians for Human Rights. 1990. Archived from the original (PDF) on 2021-06-05. Retrieved 2021-06-05.
  25. Ottaway, David B. (1989-05-26). "Expert says Soviets used toxic gas". The Washington Post. Archived from the original on 2021-06-27. Retrieved 2021-06-27.
  26. Burton, Dan (May 21, 2003). "Mercury in Medicine Report". Congressional Record. United States Government Publishing Office. 49 (76): E1027. Archived from the original on 2020-10-19. Retrieved 2021-06-06.
  27. "Matthew J. Ellenhorn Career Achievement Award". American College of Medical Toxicology. Archived from the original on 2021-03-04. Retrieved 2021-06-03.
  28. "Dr. Barry Rumack wins the 2011 Career Achievement" (PDF). AACTion. American Academy of Clinical Toxicology. 21 (4): 4. 2011. Archived from the original (PDF) on 2021-06-03. Retrieved 2021-06-03.
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