The Peura Family

Brian & Jen
Zach & Kyle
Cook Family
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Zachary Peura
7 Months

May 2005 • Volume 128 • Number 5
American Gastroenterological Association
Our New President—David A. Peura, MD
James W. Freston, MD, PhD
Cynthia M. Yoshida, MD
bulletService to Gastroenterology Organizations
bulletNew England Roots
bulletA Path Less Traveled: The U.S. Army (1971–1990)
bulletThe Second Career: The University of Virginia (Since 1990)
bulletThe Master Teacher
bulletPublishing and Reprint Information

We were thrilled by the news in 2002 that David A. Peura was nominated and elected to the AGA presidential succession, and we are honored to introduce the AGA’s 100th President to our membership. He is uniquely qualified to lead our organization at this time because of his personal qualities, leadership skills, and breadth of relevant experience and remarkable service to the AGA and the entire field of gastroenterology. It is our privilege to describe his journey to this prominent place, recounting important influences along the way, and to share with our colleagues what we have learned about him from personal experience and from others whose careers have been influenced by this remarkable person.

   Service to Gastroenterology Organizations  TOP 

David comes to the presidency with an extraordinary record of service to organized gastroenterology, particularly the AGA. Several of these activities are listed in Table 1 and some are described in more detail later; their volume, variety, and increasing level of responsibility are evident and enviable. He served on the ASGE Postgraduate Education Committee and as Co-Chair and Chair of the ACG Board of Governors. His first major role in the AGA was on the Public Policy Committee from 1987 to 1989. Medicare reimbursement changes were emerging as a major issue for the subspecialty, and few gastroenterologists were sophisticated enough to interpret the impact of change or develop strategies for modifying them. David was an exception. He showed remarkable astuteness concerning Medicare, as well as managed care reimbursement, and he contributed substantially to organizing the AGA’s position and advocating it directly to Federal legislators and regulators.

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Table 1. David Peura’s Remarkable Record of Service to Gastroenterology Organizations

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Activity Dates Role
ASGE Postgraduate Education Committee 1986–93 Member
ACG Board of Governors 1988–92 Co-Chair/Chair; planning 5 regional CME programs annually
AGA Constitution and Bylaws Committee 1986–89 Member
AGA Public Policy Committee 1987–89 Member; reimbursement policy development and advocacy
AGA Clinical Practice Section 1991–95 Co-Chair/Chair; planning and oversight of AGA’s Clinical Education Program at DDW
AGA Training and Education Committee 1991–94 Member
AGA Education Committee 1997–2001 Chair-Elect/Chair; oversight of AGA’s CME and non-CME education programs; in charge of AGA’s ACCME accreditation renewal—successful 4 year accreditation with special recognition in 2 key elements; innovative new programs, including DDSEP
Digestive Health Initiative of the American Digestive Health Foundation 1994–97 Co-Chair of Ulcer Campaign; planning, development, and oversight of physician and lay ulcer education/information programs.
AGA CME program: The Contemporary Gastroenterology Practice: Managing Change 1994 Editor; CME multimedia program dealing with private practice issues (over 3000 copies distributed)
AGA CME Program: The Academic Gastroenterologist: Meeting the Challenges of Change 1995 Editor; CME multimedia program dealing with academic practice issues (over 750 copies distributed)
American Digestive Health Foundation 1994–97 Digestive Health Initiatives steering committee to identify new initiatives for physician and law education
AGA Nutrition Task Force 1999 Identifying and planning educational programs in clinical nutrition
AGA International Relations Task Force 1999–2000 Identifying and planning international educational opportunities
AGA “Got Guts” programs 2000–01 Organized consumer education programs at DDW in Dan Diego and Atlanta
AGA Industry Relations Task Force 2000 Explored opportunities for and planning collaborative educational programs with industry
Foundation for Digestive Health and Nutrition 2001–04 Board of Governors and Vice Chair for Public Health Programs
AGA Governing Board President 2004–present Vice President/President Elect
Miscellaneous DDW, AGA, and ACG activities 1994–present Meet the Professor sessions; presenter at Post Graduate Courses, abstract reviewer; chair of scientific sessions; advocacy in Washington for GI issues

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The clinicians elected him Chair of the Clinical Practice Section in 1993. This recognized both his credibility as a clinician and his leadership skills. He invigorated the section with new initiatives, securing broad participation, and infusing its members with enthusiasm and a sense of purpose and loyalty. This effort was critically important to the AGA in capturing the interest and loyalty of many clinicians who were increasingly looking to participate in the organization with the recognition and respect it entailed. David was and is deeply respected by clinicians for the manner in which he relates to them and works on their behalf.

He served for 3 years on the Training and Education Committee, and, because of his stellar performance, was then asked by AGA leadership to chair the Education Committee, a post he held for 4 years. Much of AGA’s current array of educational activities and products flowed from his committee, including the innovative Digestive Diseases Self Education Program (DDSEP), which is now in its fourth edition. Under his leadership, the AGA’s CME program was reaccredited by the ACCME for 4 years. He and Mel Wilcox of Alabama co-chaired the enormously successful national campaign that raised public and professional awareness of the importance of Helicobacter pylori in peptic ulcer disease. His vital role in this project is described more fully later.

The quality of David’s AGA service is underscored by the fact that the AGA leadership continues to appoint him to important posts, such as the Nutrition Task Force and the International Relations Task Force in 1999, and the Industry Relations Task Force in 2000. He edited CME programs for clinicians and researchers in coping with the serious changes in our field. Until his election as AGA Vice President, he served as Vice Chair for Public Health Education in the AGA’s Foundation for Digestive Health and Nutrition. He has served on the AGA Governing Board for the past 2 years.

How can a person with a demanding day job accomplish all of this, and what does he do in his spare time? The answers lie in his roots, discipline, and talent.

   New England Roots  TOP 

Born on June 15, 1946 in Lynn, Massachusetts to second-generation Americans with strong Finnish roots, David was raised in a busy household with his parents and grandparents, all of whom shaped his development. His mother was an artist and schoolteacher and his father a musician and dental technician with a practice in the home. The language spoken at home was Finnish; he did not learn English until starting school. His parents instilled in him a strong work ethic and sense of responsibility and commitment. Both caring people themselves, they imbued David with strong religious faith. Says the Reverend George F. Lobien, who ministered to the Peuras, parents, and children in Washington years later and came to know the entire family well, “He is more than the biological son of Warren and Mary Peura. David reflects the warmth, compassion, and generosity of his parents. He absorbed many of their spiritual values from the environment they created in their home and he added to what he observed in them by intellectual pursuits which are characteristic of his personality.”

His grandmother also greatly influenced David’s development, bringing him unique culture and experience. She told him the family legend that every generation of Peuras had a healer, and before David’s birth, it was foretold that he would fulfill this role. Collectively, the houseful of mentors emphasized core values that serve him well: respecting and serving others, making the most of oneself, and conducting oneself with honor and integrity…and a robust sense of humor.

The University of Vermont was the gateway both to a career in medicine and to his marriage to Kristin Pattee, his wife of 36 years. They were assigned as lab partners in freshman chemistry. There was chemistry of their own, but by the time he mustered the courage to ask her out, she was “pinned” to another student. They reconnected 2 years later in a campus leadership conference and have been together since. After graduation, Kristin went to New York City to pursue a Master’s degree in Speech Pathology and Audiology while David stayed on at the University of Vermont Medical School. They married in Vermont on a snowy Saturday in January in David’s second year of medical school right after Kristin graduated.

In those days, there was a draft and we were in the middle of the Vietnam conflict. Two years of ROTC training was mandatory at the University of Vermont. David decided to take advance training so that he would be an Army officer after graduation and better able to control his future in the wartime military. Building on this experience, he took advantage of a military scholarship in his last year in medical school so that he and Kristin could start a family. Upon graduation, he had a 3-year military obligation, chose military house staff training, and ended up staying in for 20 years.

   A Path Less Traveled: The U.S. Army (1971–1990)  TOP 

David’s active duty with the Army began with a residency in internal medicine at Letterman Army Medical Center in San Francisco. Never having been west of Chicago, the opportunity to go to San Francisco was just too much to pass up. David, Kristin, and baby Jessica Marie set off, driving across the country expecting that San Francisco would be a city of palm trees and sun. But they loved the City by the Bay and expected to spend the rest of their lives in the area. Their second child, Brian Christopher, was born there. David received solid training under the direction of Jack Deller and Marvin Sleisenger at Letterman and the San Francisco Veteran’s hospital, respectively, and he was able to pursue his passion for golf, which had begun when he worked as a caddie at age 11 at Kernwood Country Club in Salem, Massachusetts. He was asked to stay on as Chief Resident, which he was excited to do, not only for its medical and administrative challenges, but because it gave him another year to play golf on the famed Presidio course!

David had planned on being a neurologist, but as luck would have it, he had the opportunity to work with Walter “Pete” Peterson who was stationed at Letterman for 2 years during David’s residency. Pete was a great role model, and Marvin Sleisenger also influenced David’s decision to pursue gastroenterology. Role models coupled with the explosion of new knowledge, emerging technologies, including advanced endoscopy, and the huge morbidity and mortality of peptic ulcer disease at the time, made his decision easy, and he was off to fellowship training at Walter Reed Army Medical Center in Washington, DC.

Roy Wong, who succeeded David as Chief of the Gastroenterology Service at Walter Reed, recalls that from fellowship on, it was clear that David “stood head and shoulders above most practicing gastroenterologists.” He became a “super consultant,” handling the most difficult cases referred to the Army’s premier hospital and performing an array of exacting procedures. He was among the first in the country to place stents in the esophagus to bypass carcinomas. He was an expert in ERCP, laparoscopy, and dilating advanced strictures.

His legendary teaching prowess, described more fully below, traces back to his early period as a staff member at Walter Reed. Frank Moses, Director of Gastrointestinal Endoscopy at Walter Reed, describes David as the “heart and soul” of the fellowship program, one who encouraged the fellows to excel through example. He pushed them to participate in projects and to present papers and publish manuscripts. He encouraged them to participate in his pioneering studies of esophageal stenting and the prevention of stress-induced peptic ulceration by intravenous cimetidine.

David rose in the ranks at Walter Reed, becoming the Consultant to the Army Surgeon General in Gastroenterology, and Chief of Gastroenterology from 1986 to 1990. He held the rank of Colonel and Associate Professor at the Uniformed Services University of the Health Sciences. He received several outstanding awards, including the Eddie Palmer Endoscopy Award for Excellence in Endoscopic Research and Training and the “A” Professional Designator Award for Excellence in Clinical and Professorial Work, and the Legion of Merit Award for Outstanding contributions to Military Gastroenterology, the highest recognition a departing physician can receive.

   The Second Career: The University of Virginia (Since 1990)  TOP 

Following his 16-year tenure at Walter Reed, David “retired” to nearby Charlottesville and the University of Virginia. Fortunately for those at UVA, at 44 he wasn’t old enough to really retire. He resolved to bring about clinical excellence to the Division of Gastroenterology, and he soon became the cornerstone of leadership within the division. As the Director of Clinical Services and Medical Director of Endoscopy and later as Associate Chief Director of the Digestive Health Center of Excellence, Division of Gastroenterology and Hepatology, his standards of excellence set the tone for students, residents, and fellows as well as faculty. From his first day attending on the inpatient service, “The Colonel” was up before dawn and pre-rounding with the house staff. They soon found that he often knew as many details about the patients as house staff who had been on service for weeks. House officers and fellows are still taken aback by his exceptional depth and breadth of knowledge, vast clinical experience, and unparalleled work ethic, and they are inspired by his compassionate style of practice. Says former fellow, Vanessa Shami, “From my first day as a GI fellow, I knew I would learn a lot as I was being taught by the best, however, I learned more than I could have expected. We were taking care of a woman just diagnosed on endoscopy to have an unresectable esophageal adenocarcinoma. When we went to the bedside to deliver the news, Dr Peura sat next to her, taking her hand in his. The next words he spoke seemed to take an eternity, but the compassion and warmth with which they were delivered made an otherwise unbearable moment comforting to us all. Bedside manner like this could never be taught in a textbook.” Says Reverend Lobien, “One of the reasons David’s patients frequently recover as completely as they do is that he ministers to the whole person. He is sensitive to the spiritual needs of people as well as to their physical problems. David will discuss their condition with the sensitivity of a healer.”

John Fang, Director of Endoscopy at the University of Utah, captured the enduring quality of David’s approach to patient care: “I continue to this day to model my career and approach to patient care that I learned from him. I find myself often repeating the exact phrases that he delivered in his patient care.”

Given his advanced endoscopy experience at Walter Reed, his initial appointment as Medical Director of the Endoscopy unit at UVA was a natural fit for the institution and for him. Former fellows and colleagues describe his endoscopy skills as “phenomenal.” Always the diplomat, he forged a collaborative endoscopy program with UVA surgeons that serves the institution well to this day. He was also willing to teach endoscopy to his surgery colleagues. In the year before David arrived, a surgeon, Dr Bruce Schirmer, had started doing ERCPs because no one else on the staff was doing them. He heard about David’s prowess and asked him to teach him to be better at the demanding procedure. “Instead of taking a territorial attitude, he was gracious in assisting me to be certain I did the procedures safely. His goal was, and always has been, the safe care of the patient and imparting of safe medical practice to his colleagues. By the way, I stopped doing the procedure within the year once I saw how well he did it.”

David brought a more systematic approach to training in endoscopy, a focus on evidence-based endoscopic strategy and an appeal for quality. Through his leadership and hallmark efficiency, the endoscopy unit has grown and flourished in terms of the volume and complexity of cases.

A commitment to clinical research and lifelong learning also characterize David Peura’s life. His early research in the management of acid-related disorders, particularly stress-induced injury, evolved into the study of H pylori. The deciding factor in his move to Charlottesville and the University of Virginia was the ability to work in close collaboration with Dr Barry Marshall. Together, and with several of the fellows, they studied and published a number of excellent papers on the noninvasive detection of H pylori: gram stain of touch preps from gastric biopsies, early studies of CLO-testing, serology, and breath testing. He has published 69 abstracts, 78 full articles, and 26 book chapters.

The Peura family has evolved through close ties, education, and adversity. David replicated his experience as a child in a multigenerational household by building a house for his family, which included an apartment for his parents. The parents are now deceased and the kids are gone from the home as well. Like her mother, Jessica is just this month completing her master’s degree. Brian holds a masters degree in finance and works in St. Louis where his wife, Jennifer, is a cardiology fellow at Washington University.

The family was tested severely in 1997 when Kristin was diagnosed with breast cancer, and battled through surgery, chemotherapy, and radiation. The Peuras were sustained by their faith, Kristin’s courage, and David’s ability to navigate the myriad medical and emotional challenges the family faced. They were buoyed by the outpouring of encouragement and support from friends throughout the country. They say the experience, while devastating at the time, left them with a refined sense of priorities, deeper faith, and a profound appreciation of the value of friendships. Today, Kristin manages several shopping centers in the area and is the Director of Information Technology for Great Eastern Management Company in Charlottesville. She is the webmaster for Peace Lutheran Church, The Oratorio Society of Charlottesville-Albemarle, Great Eastern Management Company, and the Peura family website, She publishes inspirational articles in the Sunday Worship Bulletin at Peace and on the Internet.

   The Master Teacher  TOP 

Most gastroenterologists know David through his teaching activities. His educational contributions to our profession have been extensive, sustained, and durable. He has been described as the quintessential educator, a master communicator, an innovative teacher, and a creative planner of educational programs. He was awarded the AGA’s prestigious Distinguished Educator Award in 2002, an award that honors his many achievements over the years.

Throughout his career, David has been absolutely committed to the academic mission of teaching excellence. He is recognized at UVA as an irreplaceable asset for fellows, residents and medical students. He dedicates himself to their education and career goals, and he regards teaching as a privilege rather than a chore. On rounds, he is able to actively engage all members of his clinical team, from medical students and residents to the senior fellow. He encourages active debate about treatment options and clinical controversies, and he fosters an evidence-based approach to the practice of medicine that is the hallmark of his trainees.

He also has an awesome capacity to instill trainees with a great enthusiasm for gastroenterology. any medical students and residents have found themselves fascinated in a field they might never have considered simply by being on service with him, seeing patients with him in clinic, or hearing him give a Grand Rounds lecture. And following that interaction, he is incredibly approachable and receptive to an inquisitive student. After meeting with him in his office and telling him about a new-found enthusiasm for GI, he will have the student eagerly heading to the library to read about the exciting clinical research project on which they are about to collaborate. Every year, at least 2 or 3 residents choose a career in GI because of his influence, and he always has his eye out for new residents to recruit to gastroenterology. Writes Peter McNally, Director of Clinical Gastroenterology and Endoscopy at the University of Colorado Health Sciences Center, “Perhaps the most important contribution by Dr Peura has been to involve the talented young gastroenterologists in the educational process. David’s foresight to recruit and groom the next generation is his greatest legacy to the profession.”

David Peura’s GI fellows affectionately call him “The Big Kahuna.” Most fellows consistently regard him as the foundation of their clinical education and the foremost influence on their clinical GI training. Any fellow who has worked closely with Dr Peura immediately recognizes his impressive command of the scientific literature and his ability to bring that to bear at the bedside. And his wisdom and breadth of clinical experience are beyond compare. Fellows know that interacting with him often results in a great learning experience, whether discussing a case or facing the most emergent procedures, when they are relieved to have him on call because of this vast experience and calm demeanor under pressure. He also has a keen ability to gently nudge fellows into research or writing projects. They often incorporate his educational techniques into their clinical practice and find themselves repeating his exact phrases or wondering, “What would Dr Peura do in this situation?” even several years after completing their training. Writes Phillip Kiyasu, a former fellow and now a practicing gastroenterologist in Oregon, “David is one of those rare educators whose impact far outlives the finite period of encounter with the pupil. In the near decade that I have been out of my formal training, I continue to share with students, patients, and colleagues, his clinical pearls of wisdom. From his ‘31 flavors of life’ to ‘don’t poke a skunk’ or ‘we’re in deep Kim-chee now,’ he has the ability to transcend the boundaries of the traditional schooling period and to impart learning throughout our lifetime experience.”

The fellows are keenly aware of his twin passions for teaching and golf. Says former fellow David Balaban, “Dr Peura once remarked that he intended to train enough fellows that he would be guaranteed a complimentary round of golf with them anywhere he traveled in the country. I would venture to say that a round of golf would be insufficient repayment for the years of distinguished teaching he has provided.”

David is also a national and international leader in education. He has worked with all of the GI societies to create, plan, supervise, or chair over 50 successful educational programs. Dr Peura is also a vital asset to the educational efforts of the AGA. Serving as the Chair of the AGA Education Committee, he fostered an unprecedented expansion in programming and educational innovation. A vital function of the AGA is to provide quality CME for its members. To assure that our ACCME accreditation was secure, the AGA turned to David Peura. His keen administrative skills and creative ideas were largely responsible for the AGA’s successful accreditation.

Hard to miss at DDW, he was Co-director of AGA’s Spring Postgraduate Course in DDW 2003, and he has taught at Meet the Professor sessions, presented at the postgraduate courses, and served as Scientific Session Chair. He developed and managed the innovative consumer education programs “Got Guts” during DDW in San Diego and Atlanta.

One of his most spectacular educational endeavors was the hugely successful multidimensional program of the American Digestive Health Foundation (ADHF) in educating physicians and the lay public about the importance of H pylori in peptic ulcer disease. The initiative was launched with a media blitz that began in Grand Central Station in New York City and spread by print, radio, and TV media throughout the country. Peer-reviewed teaching slides and handbooks were utilized in grand rounds, conferences, and gut clubs over the ensuing 18 months. The program put H pylori on the map and enhanced the standing of gastroenterologists. The campaign was capped by a consensus conference involving international H pylori experts, chaired by David, which developed management guidelines, most of which endure to this day. David influenced every aspect of the H pylori initiative except one. The advertising agency involved in the program developed a cartoon character named “Dr Dan,” who bore an eerie resemblance to David Peura—avuncular, articulate, optimistic, and entirely credible. For nearly 2 years “Dr Dan,” aka David Peura, was the public face of gastroenterology.

It has been our privilege to work with David on a variety of projects and in various settings. Our colleagues and we are deeply impressed by the quality of his contributions, his personal qualities, and the effective way in which he works with various constituencies. The “Big Kahuna” has a commanding presence but is approachable. He listens to others, yet he is decisive. His wit and sense of humor are used effectively to enrich his teaching and to defuse tense situations. He brings to bear a wealth of experience in clinical gastroenterology, clinical research, education, and public policy. His understanding of the issues facing gastroenterology is formidable, and his knowledge of the pressures that bear on our field is rooted in relevant public policy activities and a deep concern for the well being of our field. We are extraordinarily fortunate to have his wisdom, innovative thinking, and leadership as he moves ahead to become our next President.

   Acknowledgements  TOP 

The authors thank Kristin Peura, Reverend George F. Lobien, and over 20 colleagues and former fellows for providing us with their recollections and insights about Dr David Peura.

© 2005 by the American Gastroenterological Association

   Publishing and Reprint Information  TOP 
bulletaDepartment of Medicine, University of Connecticut Health Center, Farmington, Connecticut
bulletbPrivate Practice, Charlottesville, Virginia
bullet*Address reprint requests to: Dr James W. Freston, University of Connecticut Health Center, 263 Farmington, Connecticut 06030-1111. fax: (860) 679-1856.
bulletEmail address: (James W. Freston)
bulletCopyright © 2005
bullet doi: 10.1053/j.gastro.2005.03.055