Pediatric neurologist revived use of the long-abandoned ketogenic diet known as KD for treatment of childhood epilepsy
The Baltimore Sun | Original Link
by Frederick N. Rasmussen
Baltimore, Maryland, United States —Dr. John M. Freeman, an internationally renowned Johns Hopkins pediatric neurologist and expert in pediatric epilepsy who had also been a medical ethicist, died Friday of cardiovascular disease at the Johns Hopkins Hospital.
The longtime Ruxton resident was 80.
"Few Hopkins physicians have had a more profound effect than John Freeman on how we treat young patients who suffer from epilepsy and congenital abnormalities — and how we address the often-difficult ethical issues surrounding these potentially heart-breaking cases," said Ronald R. Peterson, president of the Johns Hopkins Hospital and Health System and executive vice president of Johns Hopkins Medicine.
"The sensitive, compassionate patient care to which the Johns Hopkins Hospital is dedicated has been enhanced immeasurably by John Freeman's unwavering concern for patient dignity and determination to improve the lives of those entrusted to his care," said Mr. Peterson.
John Mark Freeman, the son of Leon L. Freeman, a real estate developer, and Florence Kann Freeman Lippman, a volunteer and homemaker, was born in Brooklyn, N.Y. and raised in Great Neck, N.Y.
After graduating in 1950 from Deerfield Academy in Deerfield. Mass., Dr. Freeman earned a bachelor's degree in 1954 from Amherst College where he was an honors graduate, and went on to complete his medical studies in 1958 from the Johns Hopkins University School of Medicine.
From 1958 to 1961, he was an intern, assistant resident and senior resident in pediatrics at the Harriet Lane Home of the Johns Hopkins Hospital.
In 1961, he began a three-year fellowship in neurology and child neurology at Columbia Presbyterian Medical Center in New York City, and from 1964 to 1966, was a research physician while serving in the Army at Walter Reed Army Institute of Research in Washington, before joining the faculty of Stanford University.
Dr. Freeman returned to Hopkins in 1969 and rose through the academic ranks, becoming a full professor in pediatrics and neurology. From 1969 to 1990, he was director of the Pediatric Neurology Service at Hopkins Hospital, and he was concurrently director of the Birth Defects Treatment Center at the East Baltimore hospital.
In 1991, he was he was named the Lederer Professor of Pediatric Epilepsy, a position he retained until becoming an emeritus professor in 2007.
It was Dr. Freeman's iconoclastic questioning of established medical practices that revolutionized the treatment of pediatric epilepsy and became the hallmark of his work.
He became a forceful advocate of two long-abandoned therapies — one that required a strict, unconventional high-fat diet, the other involving surgery to remove half of the brain of children that were tormented by unremitting epileptic seizures — which led to their revival and current acceptance as effective treatments.
"A high-fat, low-carbohydrate regimen that change's the body's metabolism so that the brain gets its energy from ketones, a fat byproduct, rather than glucose, or sugar, initially was developed in the 1920s but largely abandoned once chemical anti-seizure medications such as Dilantin (phenytoin) were created in the 1930s. As recently as 1995, many physicians considered KD no longer a viable treatment," according to a Hopkins announcement of Dr. Freeman's death.
Dr. Guy McKhann, founding head of the Hopkins' Department of Neurology, explained in the announcement that Dr. Freeman's "resurrection of KD," which completely eliminated the epileptic seizures of many patients, was accomplished "virtually all by himself, against great skepticism and opposition."
One of Dr. Freeman's patients who was permanently cured of seizures because of the Ketogenic Diet was the son of Hollywood producer, writer and director Jim Abrahams, who was prompted to lead an extensive publicity campaign to promote KD treatment in the late 1990s.
Mr. Abrahams established The Charlie Foundation, named for his son, to promote the diet. He also produced an educational DVD for parents and health care professionals, collaborated on a "Dateline" program regarding KD, and produced "First, Do No Harm," a 1997 made-for-TV movie that starred actress Meryl Streep.
He also funded the first edition of Dr. Freeman's book, "Ketogenic Diets: Treatments for Epilepsy and Other Disorders," that was written with Millicent Kelly and Jennifer B. Freeman, Dr. Freeman's daughter, who lives in New York City, and is now in its fifth printing.
In 1990, Dr. Freeman and his co-authors Eileen P.G. Vining and the late Diana J. Pillas, who was the longtime coordinator-counselor of the Pediatric Epilepsy Center, wrote "Seizures and Epilepsy in Childhood; A Guide for Parents."
Today, Dr. Freeman's ketogenic diet is now considered a mainstream medical treatment and is now offered in more than 45 countries across the world, and new studies indicate it may be an effective treatment for autism, brain tumors, Alzheimer's disease and diabetes.
The second medical treatment that Dr. Freeman revived was the use of hemispherectomies, or the removal of half of the brain, to end crippling seizures, and in this work he was joined by famed pediatric neurosurgeon Dr. Benjamin Carson.
In an email, Dr. Carson, who is now retired, explained that Dr. Freeman, whom he described as "a wonderful teacher and mentor," got him interested in seizure surgery.
"He helped work out many of the techniques and problems associated with cerebral hemispherectomy as well as many other neurosurgical issues affecting patients from around the world," wrote Dr. Carson. "He cared deeply about the patients and had very admirable relationships with many of them and their parents. His shoes will be hard to fill."
Dr. Eileen P.G. "Patti" Vining, a Johns Hopkins professor of neurology and pediatrics who recently retired as director of the John Freeman Pediatric Epilepsy Center, formerly the Hopkins' epilepsy center, was a student of Dr. Freeman's.
"Hemispherectomies help relieve their burdens. They are better. John was stubborn — he had great courage. When he realized that children with devastating epilepsies involving one half of their brains were doomed, he was able to convince hesitant surgeons to live in the present and begin to perform hemispherectomies again," said Dr. Vining.
"He believed we had better procedures and technologies that would make it safe," she said. "He couldn't and wouldn't abandon those children and their families to a life without rational option. They loved him ever since."
In addition to his work with epilepsy, Dr. Freeman, who believed in maintaining the dignity of individual patients, was the founding chairman of the Johns Hopkins Hospital Ethics Committee and co-director of an undergraduate medical student course in bioethics.
He was also a member of the original faculty of the Johns Hopkins Berman Institute of Bioethics, and established the Freeman Family Fund in Clinical Bioethics to help support the salary of a faculty member to teach that subject.
In 2001, Dr. Freeman and co-author Kevin McDonnell, professor of philosophy at St. Mary's College in Notre Dame, Ind., published the still-influential book, "Tough Decisions: A Casebook in Medical Ethics."
Dr. Freeman's work brought him recognition from the American Epilepsy Society, the Lifetime Achievement Award of the Epilepsy Foundation of America and the Child Neurology Society's Hower Award, its highest honor.
The Hower Award's citation described his 40-year career as one where he "played the role of gadfly, critic, and skeptic, the asker of well-formulated questions."
Dr. Freeman had a well-honed sense of humor which he willing shared with his pediatric patients, keeping them amused and calm during examinations.
"John said about himself that he was a curmudgeon," recalled Dr. Vining. "But he didn't accept the classic definition of a crusty, ill-tempered old man. He thought of himself as willing to point out errors or hypocrisy with a sense of humor."
Dr. Freeman enjoyed playing tennis, backgammon and hiking.
"He enjoyed cooking and especially liked making soup," said his wife of 57 years, the former Elaine Kaplan, who retired from Hopkins Medicine, where she had been vice president of corporate communications.
Funeral services will be held at 2 p.m. Monday at Sol Levinson and Bros. Inc., 8900 Reisterstown Road.
In addition to his wife and daughter, Dr. Freeman is survived by two sons, Andrew D. Freeman of Baltimore and Joshua L. Freeman of Chevy Chase; a brother, Donald D. Freeman of Silver Spring; a step-sister, Laura Lippman Sager of New York City; and six grandchildren.