The Story Behind Crohn and Ginzburg and Oppenheimer(CGO) Collaboration
Crohn, Ginzburg, and Oppenheimer all graduated from Columbia University’s College of Physicians and Surgeons and subsequently succeeded in becoming house staff at the Mount Sinai Hospital. Their careers were certainly lifted by their publications on Crohn’s disease. Crohn became a private practice gastroenterologist.
Ginzburg continued at The Mount Sinai Hospital and later became Chief of Surgery at the Beth Israel Hospital in New York. Oppenheimer specialized in Urology and served as Chief of Urology at Mount Sinai.
Despite the appearance of shared collaboration in the authorship on the title page of the CGO paper, controversy exists over the significance of each of the individual’s contribution to the publication. The significance of the paper itself is all that is truly important to medical progress; however, there exists a degree of drama that underlies the work and is of historical interest. The Mount Sinai Hospital Levy Library Archives holds copies of many correspondence, letters and speeches given by Crohn and Ginzburg regarding the origins of Crohn’s disease at Mount Sinai. Within these letters and autobiographical articles, the original authors reflected on their lives some 50 years later to tell of the controversy beneath their discovery. Amongst these, Ginzburg and Crohn report a disparate sequence of events.
According to Ginzburg’s account, the story begins with his interest in inflammatory granulomatous diseases in 1925 when he was on the surgical service of Dr. A.A. Berg (attending surgeon) and continued thereafter when he was an attending in his private practice. Dr. Berg had an extremely busy clinical practice and had operated on many cases of inflammatory masses of the intestines dating back to 1920. Ginzburg recruited Oppenheimer who was working in surgical pathology as an assistant, at that time, to help him begin his research. They collaborated to retrospectively review all the cases that involved surgical excision for an inflammatory mass of the large or small intestine. Using pathological analysis, they attempted to classify these cases, which amounted to 52 in total. Twelve of these patients disease had disease limited to the terminal ileum and did not fit any well-described pathological process. Dr. Ginzburg recalls that he and Dr. Oppenheimer referred to this group as “segmental, hypertrophic ulcerative stenosis of the terminal ileum.” They attempted to study these cases more intensively, and owing to their limitations with more advanced pathologic evaluation, sought assistance from the Department of Pathology. It was this group of patients that, in collaboration with gastroenterology colleague Burrill B. Crohn, ultimately culminated in the Crohn, Ginzburg, Oppenheimer 1932 publication entitled “Regional ileitis: a pathologic and clinical entity” which included 14 cases (two added by Dr. Crohn). The larger group of 52 patients, put together by Ginzburg and Oppenheimer alone was published soon after in the Annals of Surgery 1933.
The story of their collaboration is where the controversy begins. As recounted by Dr. Ginzburg, this began when Crohn approached Ginzburg during lunch, about two cases of Dr. Berg’s he was involved with, who had inflammatory tumor of the terminal ileum . Dr. Crohn inquired in the pathology lab and was referred to speak to Ginzburg who was actively researching the topic.
Dr. Berg requested that Dr. Crohn be given a copy of the draft publication. Unbeknownst to Ginzburg, Crohn reviewed the research and presented it at the A.M.A. meeting in New Orleans in 1932.
Better understanding of the epidemiology of Crohn’s disease (e.g. differences in prevalence of Crohn’s disease based on gender or geographical region) may identify areas for further research.
Multiple studies have reported the incidence, preval ence, gender distribution and age of onset of Crohn’s disease in well-defined, population-based cohorts of patients in North America and Western Europe. However, these trials have reported a wide variationin the prevalence and incidence of Crohn’s disease.
Some of these differences between studies may be due to different study methodologies, while some differences in trial results may be due to true differences in the genetic or environmental factors present in certain populations. Multiple studies have also reported wide variations in the natural history of Crohn’s disease.
Many of these studies utilized referral centre populations, which may create a ‘referral centre’ bias (i.e. patients referred to quaternary medical centres may have the most severe disease activity levels and be more likely to undergo surgery and use multiple medications). Therefore, studies of the natural history of Crohn’s disease should be performed in well-defined, population-based patient cohorts.
The use of systematic reviews may facilitate the identification of appropriately designed studies and a comprehensive evaluation of divergent results, while delineating topics that require further research.
Crohn further prepared the document originally written by Ginzburg and Oppenheimer, added to it and submitted it for publication without further discussion with them. Ginzburg, notably, had disdain for Crohn. He believed that Crohn intentionally omitted their names from the program of the 1932 meeting to claim the science as his own. Ginzburg emphatically reported that Dr. Crohn played “no role whatsoever in the development of either the concept, the research, the interpretation or the writing of the original draft of ‘regional enteritis’” . A committee was created within Mount Sinai to review possible academic misconduct of Crohn, chaired by Dr. Berg after the presentation in New Orleans. No minutes or records were kept and per Ginzburg’s account, the matter was swept aside with the promise of shared authorship on the final paper.
Crohn’s recollection of the history of the collaboration was quite different. In 1983, Kovalecik recounted Crohn’ version of event as described by Crohn in Gastroenterology in 1967.
...we were enabled to see and to examine for the first time a specimen of typical granulomatous terminal ileitis. Within two years Dr. Berg and I were able to gather 13 more cases of identical nature which constituted the basis for the first publication.
Dr. Berg, with unnecessary modesty, declined or preferred not to act as co-author, but suggested that the two younger men, Ginzburg and Oppenheimer, who were then engaged in the study of intestinal granulomas, act as co-authors.
Ginzburg regarded this description of events as “sheer fantasy” and further outlined his view of events in a letter to the editor of Gastroenterology dated September 20, 1985.
Much of Ginzburg’s consternation of the events likely has to do with the recognition Crohn received in the years following the initial report.
Fig. 1.2 Ginzburg and Crohn at the 50th Anniversary IBD symposium at Mount Sinai in New York, May, 1982. (Courtesy of Arthur H. Aufuses Jr. M.D.)
Following publication of the landmark 1932 article, the eponym “Crohn” appeared in the literature almost immediately. Crohn was the first author on the publication purely as a function of alphabetical order. It is interesting to speculate that had A.A. Berg not declined to have his name included on the paper, we would today be discussing “Berg’s disease.” This, in addition to Crohn’s advocacy and charisma, likely led to his name becoming the identifier of the disease. The first article known to use Crohn’s name as a synonym for the disease was published in 1933 by Harris et al. entitled “Chronic cicatrizing enteritis: Regional ileitis (Crohn)” and later in 1937 it appeared as the disease name in the British Encyclopedia of Medical Practice . The authors of both of those articles were known personally to Crohn, and any personal involvement, on Crohn’s part, promoting the use of his name is purely speculative. One exception to the universal acceptance of “Crohn’s disease” exists in Poland where the disease is referred to as Lesniowski-Crohn’s disease to commemorate the Polish surgeon Lйsniowski who published case reports of likely Crohn’s disease cases in 1903. Despite the appellation of the disease with his own name, Crohn maintained that it was not specific enough a designation and preferred the name “Regional ileitis”; however, as the spectrum of the disease widened, a title more suitable to the syndrome was necessary and the eponym became widely used.
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J. E. Bornstein , MD
Division of Colon and Rectal Surgery, Department of Surgery , Icahn School of Medicine at Mount Sinai , New York , NY 10029 , USA
R. M. Steinhagen , MD
Division of Colon and Rectal Surgery , Mount Sinai Medical Center , One Gustave L. Levy Place , Box 1259 , New York , NY 10029 , USA
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