A self-described “simple country doctor,” he won national attention in 2020 when the White House embraced his hydroxychloroquine regimen.Vladimir Zelenko, a self-described “simple country doctor” from upstate New York who rocketed to prominence in the early days of the Covid-19 pandemic when his controversial treatment for the coronavirus gained White House support, died on Thursday in Dallas. He was 48.His wife, Rinat Zelenko, said he died of lung cancer at a hospital where he was receiving treatment.Until early 2020, Dr. Zelenko, who was also known by his Hebrew name, Zev, spent his days caring for patients in and around Kiryas Joel, a village of about 35,000 Hasidic Jews roughly an hour northwest of New York City.Like many health care providers, he scrambled when the coronavirus began to appear in his community. Within weeks he had landed on what he insisted was an effective cure: a three-drug cocktail of the antimalarial drug hydroxychloroquine, the antibiotic azithromycin and zinc sulfate.He was not the first physician to promote hydroxychloroquine. But he began to draw national attention on March 21 — two days after President Donald J. Trump first mentioned the drug in a press briefing — when Dr. Zelenko posted a video to YouTube and Facebook in which he claimed a 100 percent success rate with the treatment. He implored Mr. Trump to adopt it.A day later, Mark Meadows, Mr. Trump’s chief of staff, reached out to Dr. Zelenko for more information. So did talk-show bookers. Over the next week Dr. Zelenko made the rounds on conservative media, speaking on podcasts hosted by Steve Bannon and Rudolph W. Giuliani. Sean Hannity of Fox News touted his research during an interview with Vice President Mike Pence.“At the time, it was a brand-new finding, and I viewed it like a commander in the battlefield,” Dr. Zelenko told The New York Times. “I realized I needed to speak to the five-star general.”On March 28, the Food and Drug Administration granted emergency authorization to doctors to prescribe hydroxychloroquine and another antimalarial drug, chloroquine, to treat Covid. Mr. Trump called the treatment “very effective” and possibly “the biggest game changer in the history of medicine.”But, as fellow medical professionals began to point out, Dr. Zelenko had only his own anecdotal evidence to support his case, and what little research had been done painted a mixed picture.Still, he became something of a folk hero on the right, someone who offered not just hope amid the pandemic but also an alternative to the medical establishment and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who insisted that months of research would be needed to find an effective treatment.Dr. Zelenko continued to text and speak with Mr. Meadows, Mr. Giuliani and several members of Congress. But he clashed with leaders in Kiryas Joel, who said that his talk of treating hundreds of Covid patients gave the impression that the community was overwhelmed by Covid, potentially stoking antisemitism.Over the next few months, researchers cast further doubt on the efficacy of hydroxychloroquine. A study published in The New England Journal of Medicine found no benefit from the treatment, and other studies highlighted a risk of dangerous heart arrhythmias in some patients.Those results and others led the F.D.A. to revoke its emergency authorization on June 15, 2020.A quiet, unassuming man, Dr. Zelenko seemed unprepared for the attention he received, which included harassing phone calls and even death threats. In May 2020, a federal prosecutor opened an investigation into whether he had falsely claimed F.D.A. approval for his research.That same month, Dr. Zelenko announced in a video that he was closing his practice and leaving the Kiryas Joel community. He accused several of its leaders of instigating a campaign against him.After the F.D.A. rescinded its approval of hydroxychloroquine as a Covid treatment, he founded a company, Zelenko Labs, to promote other nonconventional treatments for the disease, including vitamins and quercetin, an anti-inflammatory drug.And while he claimed to be apolitical, he embraced the image of a victim of the establishment. He founded a nonprofit, the Zelenko Freedom Foundation, to press his case. In December 2020, Twitter suspended his account, stating that it had violated standards prohibiting “platform manipulation and spam.”Dr. Zelenko was born on Nov. 27, 1973, in Kyiv, Ukraine, and immigrated to the United States with his family when he was 3, settling in the Sheepshead Bay section of Brooklyn.His father, Alex, drove a taxi, and his mother, Larisa (Portnoy) Zelenko, worked in a fur factory and later, after studying computer programming, for Morgan Stanley.In a memoir, “Metamorphosis” (2018), Dr. Zelenko wrote that he grew up nonreligious and entered Hofstra University as an avowed atheist.“I enjoyed debating with people and proving to them that G-d did not exist,” he wrote. “I studied philosophy and was drawn to nihilistic thinkers such as Sartre and Nietzsche.”But after a trip to Israel, he began to change his mind. He gravitated toward Orthodox Judaism, and in particular the Chabad-Lubavitch movement.He graduated from Hofstra in 1995 with a degree in chemistry, and he received his medical degree from the State University of New York at Buffalo in 2000. After returning to Brooklyn for his residency, he moved to Monroe, a town that neighbors Kiryas Joel, in 2004.Dr. Zelenko spent three years working for Ezras Choilim, a medical center in Monroe, and advising the local Hatzolah ambulance service. He opened his own practice in 2007, with offices in Monroe and Monsey, another upstate town with a large Orthodox Jewish population.In 2018, doctors found a rare form of cancer in his chest and, in hopes of treating it, removed his right lung.Dr. Zelenko’s first marriage ended in divorce. Along with his second wife, he is survived by their two children, Shira and Liba; six children from his first marriage, Levi Yitzchok, Esther Tova, Eta Devorah, Nochum Dovid, Shmuel Nosson Yaakov and Menachem Mendel; his parents; and a brother, Ephraim.

A waiver named for her daughter, Katie, has allowed hundreds of thousands of children to receive medical care without having to live in a hospital.Julie Beckett, who with her daughter, Katie, pushed for changes to Medicaid that enabled hundreds of thousands of families to raise and care for their disabled children at home, died on May 13 in Cedar Rapids, Iowa. She was 72.Her brother John O’Connell said she died at her home of a heart attack.Katie Beckett was born in March 1978, and just four months later she contracted viral encephalitis. The disease paralyzed her diaphragm and left her dependent on a ventilator and other equipment.Within three years, the Becketts had exhausted their $1 million health insurance policy. They applied for government support, but were told Medicaid would not cover in-home care.Faced with the prospect of seeing her daughter grow up in a hospital, Ms. Beckett invited her congressman, Tom Tauke, to visit Katie. She presented him with data she had collected showing that allowing children like her daughter to live at home was not just better for the families but would save the government money.On a flight to Iowa with Vice President George Bush, Mr. Tauke, a Republican, pleaded the Becketts’ case. Mr. Bush was so moved that he immediately told President Ronald Reagan about it.At a news conference in November 1981, Reagan singled out the Becketts’ story.“Now, by what sense do we have a regulation in government,” he asked, “that says we’ll pay $6,000 a month to keep someone in a hospital that we believe would be better off at home?”The White House paid attention to Ms. Beckett’s advocacy. In 1984, President Ronald Reagan (seen holding Katie Beckett) met with the Beckett family on the tarmac of Cedar Rapids Municipal Airport in Iowa.Courtesy Ronald Reagan LibraryTwo days later, Richard S. Schweiker, the secretary of health and human services, issued a waiver stating that Medicaid would in fact cover Katie’s care at home. By the next day, 247 families had called asking for the same treatment. They all got it.Reagan established a commission to work out the criteria for what came to be known as Katie Beckett waivers, and to encourage states, which administer Medicaid, to adopt them. Today every state has a Katie Beckett program.Katie Beckett became one of several children — like Ryan White, who contracted H.I.V. through a blood transfusion, and Amber Tatro, who was born with spina bifida — whose health struggles in the 1980s made them human-interest celebrities, the subjects of nightly news coverage, sympathetic newspaper profiles and, ultimately, state and federal legislation.Katie and her mother used their sudden media exposure to push for changes in government policy that would move the focus of long-term care away from institutions and toward a family-centered approach. That development has helped millions of children live significantly longer lives than they might have in the past.“When we have those who are directly affected at the table and able to share our stories, we’re able to put a human face on these issues,” Elena Hung, a co-founder of the disability-rights group Little Lobbyists, said in a phone interview. “We’re going to have all the data, all the policy analysis, all the experts speaking on these issues, but it really doesn’t bring it home until we can see who is directly affected, and humanize those issues. I think Julie and Katie did that expertly.”Ms. Beckett did not stop once her daughter returned home, just before Christmas in 1981. She left her job as a junior high school social studies teacher to care for Katie and work as an activist full time. She traveled the country, lecturing, lobbying and teaching parents of children with disabilities how to advocate for change in their communities.She testified before Congress, wrote opinion articles and co-founded the group Family Voices, a nonprofit organization that supports families of children with disabilities. She was also a leading figure behind the Family Opportunities Act, a 2005 law that further expanded Medicaid coverage such families and created a series of programs to help those families engage with one another.Even after Katie died, in 2012, Ms. Beckett continued her activism. She helped lead the charge in 2017 against Republican efforts to repeal the Affordable Care Act and turn Medicaid into a program of block grants to states — two moves that could have meant drastic reductions in funding for families on Katie Beckett waivers.“It’s unacceptable to Katie’s memory and to people with disabilities across the country that the services I fought so hard for are now being threatened by Republican members of Congress,” she wrote in a 2017 article for the website of the American Civil Liberties Union.By then, it was a given that the campaign to protect the Affordable Care Act would feature the faces and families of people directly affected by the proposed changes — a humanizing strategy pioneered by Ms. Beckett.“She was truly a groundbreaking hero,” said Alison Barkoff, the acting head of the Administration for Community Living, a federal agency that facilitates family- and community-based care. “Julie, together with her daughter Katie, changed the world for millions of people with disabilities.”Julianne Ethel O’Connell was born on Nov. 9, 1949, in Cedar Rapids. Her father, John O’Connell, owned a wholesale lumber company, and her mother, Barbara (Ryan) O’Connell, was a homemaker.Julie graduated from Clarke College, in Dubuque, Iowa, in 1971 with a degree in history, and later received a master’s degree, also in history, from the University of Dayton in Ohio.She married Mark Beckett in 1978. They later divorced. Along with her brother John, she is survived by her sister, Barbara Lenz, and four other brothers, William, Patrick, Michael and Jamie.Though she was widely regarded as one of the most significant figures in the history of the disability rights movement, Ms. Beckett insisted that she was simply looking out for her daughter, and that everything flowed from there.“There comes a moment in parenting,” she wrote in 2017, “where you discover strength you didn’t know you had — all because your child needs you.”

His company, Emergent BioSolutions, won a lucrative contract to produce Covid vaccines but then had to throw out millions of contaminated doses.Fuad El-Hibri, whose biotech company won billions of dollars in government contracts to manufacture a vaccine against anthrax but stumbled in 2021 when, having been hired to produce Covid vaccines, it had to throw out the equivalent of 75 million contaminated doses, died on April 23 at his home in Potomac, Md. He was 64.His death was announced in a statement by his family. A representative for the family said the cause was pancreatic cancer.Mr. El-Hibri’s Maryland-based company, Emergent BioSolutions, was an obscure player in the world of government contracting, but an influential one: It deployed extensive lobbying efforts and campaign contributions to secure a near-monopoly on the production of an anthrax vaccine in the early 2000s. The contract accounted for nearly half the budget for the Strategic National Stockpile, a medical reserve held in case of crises like a bioweapons attack or a pandemic.Though the relationship occasionally drew scrutiny — including an extensive investigation by The New York Times in March 2021 — it also made Mr. El-Hibri’s company a seemingly obvious choice to produce the Covid vaccines developed by Johnson & Johnson and AstraZeneca. Emergent received a $628 million contract from the federal government in 2020.Mr. El-Hibri testified via videoconference before the House Select Subcommittee on the Coronavirus in May 2021, two months after his company announced that the equivalent of some 15 million doses of the Johnson & Johnson vaccine had been contaminated and had to be discarded. Pool photo by Stefani ReynoldsBut in fact, Emergent was not at all ready for the imposing task. Though it was already part of a government program to rapidly scale up vaccine production in an emergency, it had yet to demonstrate such a capacity when it began to churn out Covid vaccines in early 2021.In March of that year, the company announced that because of worker error, the equivalent of some 15 million doses of the Johnson & Johnson vaccine had been contaminated and had to be discarded. Production nationwide shut down temporarily, creating a political headache for the Biden administration, which had been hoping for a smooth rollout to tamp down vaccine hesitancy.Congress launched an investigation, and in May Mr. El-Hibri, who was Emergent’s executive chairman, and Robert G. Kramer, the company’s chief executive, testified before the House Select Subcommittee on the Coronavirus.While both men defended the company and cited the unprecedented challenge their task presented, Mr. El-Hibri was contrite about its failures.“The cross-contamination incident is unacceptable,” he said, “period.”About 60 million additional doses were found to be contaminated in June.Fuad El-Hibri was born on March 2, 1958, in Hildesheim, Germany, the son of Elizabeth (Trunk) El-Hibri, a homemaker, and Ibrahim El-Hibri, an engineer and entrepreneur. He grew up in Lebanon and Germany and graduated from Stanford University in 1980 with a degree in economics. He received a master’s degree in public and private management from the Yale School of Management in 1982.He is survived by his wife, Nancy (Grunenwald) El-Hibri; his mother; his brother, Samir; his sister, Yasmin El-Hibri Gibellini; his daughters, Faiza and Yusra El-Hibri; his son, Karim; and three grandchildren.Mr. El-Hibri began his career working for Citicorp in Saudi Arabia and later worked for the consulting firm Booz Allen Hamilton in Indonesia. After returning to the United States, he started a business that helped national telecom companies upgrade their networks in Russia, Venezuela and El Salvador.In the 1990s he advised the Saudi Arabian government on its efforts to buy millions of doses of an anthrax vaccine. That experience seeded the idea for what became Emergent BioSolutions.He co-founded the company, originally called BioPort, in 1998. He and his partners, including William J. Crowe, a former admiral, soon won a bid to buy a disused government laboratory in Lansing, Mich., and upgrade it to produce anthrax vaccines for the U.S. military.The company changed its name to Emergent BioSolutions in 2004. It went public in 2006.Mr. El-Hibri co-founded Emergent BioSolutions, originally called BioPort, in 1998. It went public in 2006.Jim Lo Scalzo/EPA, via ShutterstockThough it mostly focused on just one product and one customer (it also produced Narcan, used to treat opioid overdoses), Emergent grew rich under Mr. El-Hibri’s leadership, reporting $1.5 billion in revenue in 2020.As The Times’s investigation found, the company’s financial success was in part attributable to its aggressive efforts to win a large part of the strategic stockpile’s budget. Many experts consider it an outsize chunk, given the relatively low risk of a widespread anthrax attack and the option to use cheap antibiotics for many cases.“Purchases are supposed to be based on careful assessments by government officials of how best to save lives,” the investigation found, “but many have also been influenced by Emergent’s bottom line.”Mr. El-Hibri and his wife were prolific campaign donors; they gave nearly $1 million between 2018 and 2021, mostly to Republican candidates. An employee political action committee at Emergent gave another $1.4 million over the same period.Those connections proved crucial in the fall of 2020, when Emergent was one of two facilities contracted to produce Covid vaccines. Shortly after, Mr. El-Hibri cashed out $42 million in shares and stock options.After the production debacle at Emergent became public, the company faced an uprising by shareholders, including a lawsuit accusing it of committing securities fraud by falsely claiming it was ready to produce the vaccine in order to boost the value of its stock.Mr. El-Hibri stepped down as chairman of Emergent BioSolutions on April 1.

Invited by George Balanchine to be the in-house orthopedic surgeon at City Ballet, he laid the groundwork for the field of dance medicine.Dr. William G. Hamilton, who as the attending orthopedic surgeon for New York City Ballet spent more than 40 years fixing bone spurs, tendinitis, bursitis, torn ligaments and what he called “the Nutcracker Fracture,” died on March 29 at his home in Croton-on-Hudson, N.Y. He was 90.His wife, Linda Hamilton, said the cause was congestive heart failure.Ballet dancers may be the “athletes of God,” as Albert Einstein supposedly said. But until Dr. Hamilton came along, they were treated more like ethereal beings than physical bodies that could crack, tear and otherwise fall apart under the extreme and often unnatural pressures of repeated pliés and grand jetés.In fact, it was George Balanchine, the choreographer who famously insisted that his dancers stoically work through their stubbed toes and sprained ankles, who asked Dr. Hamilton to become the first in-house doctor for the 100-plus members of New York City Ballet, in 1972.Dr. Hamilton immediately said yes, though he knew nothing about ballet. He immersed himself in the art, attending weekend classes and becoming close to Balanchine and, later, the dancer and choreographer Mikhail Baryshnikov, who in 1980 hired him to be the attending surgeon for American Ballet Theater as well.A courtly 6-foot-3 Southerner, Dr. Hamilton became a favorite and even revered figure around Lincoln Center. He had a disarming bedside manner that put young dancers at ease when they came to him worried that a sprained ankle might end their career.He kept a ballet barre in his examining room, and he was renowned for catching early signs of chronic, potentially debilitating problems just by asking a dancer to go through a few routine motions.Early on, he realized that while dancers suffered the same kinds of injuries athletes did, they got them in obscure ways and places. He saw, for example, that the rapid movements required by Balanchine’s ballets came with the risk of foot and ankle injury, while the leaps and bounds more common under Mr. Baryshnikov were more threatening to the hips and knees.“From the very beginning, I learned that although they get the same injuries as athletes, dancers are artists first,” he told Dance Magazine in 2011.When Dr. Hamilton started, in the early 1970s, there was no such thing as dance medicine, and indeed foot and ankle injuries were a largely understudied field of orthopedic medicine.He built up both fields through lectures and journal articles in which he diagnosed previously understudied injuries — he was among the first to describe the Nutcracker Fracture, for example, which involves multiple breaks in the cuboid bone in the foot. He served as the president of the American Orthopaedic Foot and Ankle Society from 1992 to 1993, and today every sizable dance company in the country has an orthopedic surgeon on call.“Bill was the king of orthopedic dance medicine,” Glenn Pfeffer, the co-director of the Cedars-Sinai/USC Glorya Kaufman Dance Medicine Center, said in a phone interview.Dr. Hamilton continued to perform surgery until he was 81 and consulted until a few years ago, long after most physicians would have hung up their scalpels.“I would have retired a long time ago if it wasn’t for the dancers,” he said in a 2016 interview with the magazine Princeton Alumni Weekly. “It’s very rewarding because they love what they do. They just want to dance; they wouldn’t want to do anything else.”William Garnett Hamilton did not set out to be a Manhattan doctor, let alone a balletomane. He was born on Jan. 11, 1932, in Altus, Okla., where his father, Milton Hamilton, was a salesman and his mother, Elizabeth (Garnett) Hamilton, was a homemaker.The family moved to Shreveport, La., when he was very young. After his parents divorced, his mother remarried and moved to Portage, Wis., where her new husband owned a plastics manufacturing company.William graduated from Princeton in 1954 with a degree in engineering, and after two years in the Army he joined his stepfather’s business in Wisconsin. He married and had a child; by his mid-20s, he said, he could see his entire life unfolding before him. He didn’t like what he saw.Against his parents’ wishes that he stay to run the family company, he applied to medical school. He was accepted at Columbia, one of the few schools that took older students (he was 28 when he enrolled). He decided to focus on orthopedics — a field that he said was not unlike engineering, with muscles and joints standing in for ropes and levers. He graduated in 1964 and, after several years of residency, opened a practice in Midtown Manhattan in 1969.In addition to his work with the two ballet companies, he provided the same services to the companies’ affiliated schools, the School of American Ballet and the Jacqueline Kennedy Onassis School, and he consulted for numerous Broadway shows and New York sports teams, including the Knicks and the Yankees.His first two marriages ended in divorce. He met his future third wife, Linda Homek, when she was a dancer with New York City Ballet. She later received a doctorate in psychology from Adelphi University. In 2000 she and Dr. Hamilton created a multidisciplinary wellness team, including a dietitian and a gastroenterologist, to care for the company’s dancers, a model that has since been adopted by other ballet companies.Along with his wife, Dr. Hamilton is survived by his sister, Ann Kirk; his sons, William Jr. and Lewis; and three grandchildren.

By advocating for acupuncture and other treatments, she helped countless patients weather the pain of chemotherapy and radiation.Barrie R. Cassileth, whose efforts to bring treatments like acupuncture and massage into mainstream cancer care helped countless patients weather the pain of chemotherapy, radiation and terminal illness, died on Feb. 26 at an assisted-living home in Beverly Hills, Calif. She was 83.Her granddaughter Rachel Greenspan said the cause was complications of Alzheimer’s disease.Dr. Cassileth, who founded the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center in New York City, drew a bright line between alternative medicine, which she often dismissed as quackery, and what she called complementary medicine, which attempts to alleviate the symptoms of cancer and its treatments.Such care might also be casually considered “alternative,” like acupuncture, massage and herbs, but Dr. Cassileth insisted that the difference lay in the science: The approaches had been rigorously studied, and they showed actual medical benefits.And, just as important, she never offered them in place of conventional medicine, let alone as a cure, a practice she called “grotesquely outrageous” in The New York Times in 1998. “It is malpractice on the part of public health services to offer an untested, unscientific method as a real alternative.”Dr. Cassileth first came into the public eye as a sharp critic of alternative medicine in the late 1970s and ’80s, when nontraditional approaches to cancer were the stuff of best-selling books and daytime talk shows.A study that she and several colleagues published in The New England Journal of Medicine in 1985 showed that differences in personality among patients with advanced cancer did not change outcomes. Patients who showed grit and determination, they found, died just as quickly as patients who showed stoic resignation to the disease.“For every anecdote about a cancer patient with a good attitude who lived, I can give you 200 about those who had good attitudes and died,” she told The Los Angeles Times that year.She was especially concerned about licensed medical practitioners who advised their patients to seek treatment outside the mainstream. She raised the alarm when a survey conducted in the early 1990s showed that 9 percent of cancer patients did not pursue conventional treatments — a number that later included Steve Jobs, the co-founder of Apple, who at first tried to fight the disease with dietary supplements and juices.“He had the only kind of pancreatic cancer that is treatable and curable,” she told USA Today in 2013. “He essentially committed suicide.”But Dr. Cassileth was also quick to note the limits of her own research, and to assert her openness to the possible efficacy of treatments outside the mainstream. She was both a member the American Cancer Society’s Subcommittee on Questionable Methods of Cancer Management and an adviser to the National Institutes of Health’s Office of Alternative Medicine, now called the National Center for Complementary and Alternative Medicine.She took a historical perspective. Cancer was once considered incurable, and so the focus of treatment was limited to palliative care, helping ease a patient’s pain. But with the rise of chemotherapy and radiation and the growing possibility of survival, comfort and quality of life took a back seat. Her mission, she said, was to bring that back, using evidence-based, noninvasive treatments.“She was a legend in our field,” Dr. Ting Bao, the director of integrative breast oncology at Memorial Sloan Kettering, said in an interview.Barrie Joyce Rabinowitz was born on April 22, 1938, in Philadelphia. Her father, Albert Rabinowitz, owned a company that manufactured socks; later, he and her mother, Rosalind (Kaizen) Rabinowitz, ran a company that designed and installed kitchens.She is survived by her siblings, Stephen Rabinowitz and Ruth Rabinowitz; her daughters, Jodi Cassileth Greenspan and Wendy Cassileth; her son, Gregory Cassileth; and six grandchildren.She attended Bennington College in Vermont and spent a summer teaching art in Pownal, a village near the Massachusetts border. Working out of a one-room schoolhouse, she befriended the parents of two of her students. The mother, Ms. Rabinowitz soon learned, had terminal cancer, and the experience of watching her suffer focused her interests on helping alleviate such pain.She graduated with a degree in social sciences in 1959, a year after marrying Peter Cassileth. They later divorced. Her second marriage, to H. Taylor Vaden, a communications executive, also ended in divorce. Her third husband, Richard Cooper, a hematologist, died in 2016.Dr. Cassileth received a master’s degree in psychology from Albert Einstein University and a Ph.D. in medical sociology in 1978 from the University of Pennsylvania, where her husband, Peter, was an oncologist.As part of her doctoral program, she worked closely with adult leukemia patients. After being hired at Pennsylvania as an assistant professor, she helped establish one of the first palliative cancer care programs in the country.She later taught at Duke, Harvard and the University of North Carolina before being approached in 1999 by Memorial Sloan Kettering, where one of the benefactors, Laurance Rockefeller, was leading an effort to create an integrative care program.What started as a one-woman show in one small office grew to a staff of about 60 people, with its own four-story building, largely thanks to Dr. Cassileth’s leadership. In 2003, she was the founding president of the Society for Integrative Oncology.Today, thousands of cancer patients at Memorial Sloan Kettering, and in similar programs nationwide, benefit from complementary care — the result, Dr. Cassileth always insisted, of advances in conventional medical care.“Quality of life has only become an issue,” she told The Washington Post in 2000, “since enough patients have been around long enough to worry about quality of life.”

The disease was once a virtual death sentence for children. Today, his aggressive treatments mean that almost everyone survives it.Dr. Donald Pinkel, a pediatrician who, starting in the early 1960s, developed an aggressive treatment for childhood leukemia that transformed the disease from a virtual death sentence to one that almost every patient survives, died on Wednesday at his home in San Luis Obispo, Calif. He was 95.His son John confirmed the death.Acute lymphocytic leukemia, a type of cancer that overwhelms the body with misshapen white blood cells, was once the No. 1 killer of children in the United States between the ages of 3 and 15, causing about 2,000 deaths a year. It had a 96 percent fatality rate — and doctors say that number might have been low, because the remaining 4 percent of cases were probably misdiagnoses.When Dr. Pinkel began his research as a pediatrician in Buffalo, in the 1950s, there were already several medications that could push the disease into remission. But almost invariably the cancer would return. Doctors would then try a different drug, only to get the same results.“At that time, with A.L.L., the idea was to try to prolong life in comfort — that was it,” Dr. Pinkel told Smithsonian magazine in 2016. “We called it ‘palliation.’ No one thought you were going to ‘cure’ anybody. That was almost a forbidden word.”In 1961, shortly after moving to the newly founded St. Jude Children’s Hospital in Memphis — he was its chief executive, medical director and first employee — he set on a radically different course. Instead of one drug or treatment at a time, he would use them all, pushing patients’ bodies to the limit in the hope that the cancer would die first.“Dr. Pinkel and my father had the same unyielding hope and were equally audacious in their determination that childhood leukemia could be vanquished,” the actress Marlo Thomas, whose father, the comedian and actor Danny Thomas, founded St. Jude, said in a statement.Dr. Pinkel combined multiple chemotherapy drugs to drive the disease into remission. Then, when the patients were healthy enough, he and his team bombarded their skulls with radiation and injected drugs directly into their spinal columns, attacking places where Dr. Pinkel suspected the cancer was hiding during remission.This would go one for months, even years. Children would lose their hair, their appetites. Some died. But by 1968 Dr. Pinkel’s regimen, which he called Total Therapy, was achieving remarkable results: Out of 31 patients in one study, 20 were in complete remission after three and a half years.A decade later, after continued refinements to the protocol, the five-year survival rate was up to 80 percent. Today, still using Dr. Pinkel’s framework, it is 94 percent.“He really is the man that cured leukemia,” James R. Downing, the current president of St. Jude, said in a phone interview.Dr. Pinkel, right, with the comedian and actor Danny Thomas, the founder of St. Jude, in 1962.St. Jude Children’s Research HospitalDonald Paul Pinkel was born in Buffalo on Sept. 7, 1926. His father, Lawrence, was a hardware salesman, and his mother, Anne (Richardson) Pinkel, was a homemaker.He joined the Navy in 1944 and went to Cornell University as part of the service’s V-12 program, which gave college coursework to promising recruits. There he developed an interest in biology and medicine; after returning home and graduating in 1947 from Canisius College, in Buffalo, he went directly to medical school at what is now the University at Buffalo, covering some of the costs by joining the Army Reserve Medical Command.He quickly found his calling in pediatrics, and childhood cancer in particular. At the time it was considered a lost cause — a field of research so forlorn that one mentor said he would be throwing away his career.Dr. Pinkel persisted, earning his medical degree in 1951 and holding a series of residencies and fellowships in pediatrics and oncology across the Northeast. He was preparing for another fellowship, in New York City, when he was called up by the Army and sent to a military hospital outside Boston.A polio epidemic was in full swing in the region, and Dr. Pinkel, overworked as the hospital’s only pediatrician, soon caught the disease himself. It took him a year to recover — coincidentally just as Jonas Salk’s new polio vaccine was being rolled out, turning what had once been a scourge of childhood into a largely preventable disease.Dr. Pinkel dreamed of doing the same with leukemia. He worked with the famed oncologist Sidney Farber in Boston and then returned to Buffalo, where he opened a pediatrics department at the Roswell Park Cancer Institute (now the Roswell Park Comprehensive Cancer Center) and worked alongside James Holland, another pioneer in cancer research.One day in 1961 Dr. Pinkel got a call asking if he would be interested in a job as the head of St. Jude. During a period of emotional and professional distress, Mr. Thomas, the hospital’s founder, had prayed to St. Jude, the patron saint of lost causes, for help. When he recovered, he decided to build a hospital to help children in similarly dire straits.Dr. Pinkel was tired of the cold, wet Buffalo winters, but he wasn’t sure about the offer: Memphis was a segregated Southern city, and many in the medical community said Mr. Thomas’s status as a television comedian made it hard to take the idea seriously.Still, he met with several members of the hospital board and came away impressed. They, like him, believed in focusing their efforts on childhood cancer, and they agreed that the hospital should be need-blind, and that both its staff and its patient population should be completely desegregated.Dr. Pinkel drove to Memphis in his Volkswagen Beetle, arriving to find a hole in the ground where the hospital would one day be. He made himself an integral part of the planning process, insisting, among other things, that the hospital have integrated bathrooms.He also insisted on as much common space as possible, including a single cafeteria for all —- doctors, scientists and administrators — to encourage creative cross-pollination. He also opened the cafeteria to patients and their families, to give staff members a visual reminder of their collective mission.“It was a civil rights culture,” Jackie Dulle, one of his first executive assistants, said in a phone interview. “He wanted everyone to be equal.”Dr. Pinkel in 2015. After leaving St. Jude in 1973, he worked at children’s hospitals in Wisconsin, California, Pennsylvania and Texas before retiring to California in 1994.Timothy ArchibaldWith Mr. Thomas’s blessing and the board’s support, Dr. Pinkel hired the best researchers and doctors he could find, attracting them with his bold vision and St. Jude’s progressive culture. His wife, Marita (Donovan) Pinkel, would help by hosting recruits at their house and lobbying them over dinner.That marriage ended in divorce. Along with his son John, Dr. Pinkel is survived by his second wife, Cathryn Howarth; six daughters, Rebecca Amthor, Nancy Pinkel, Mary Pinkel, Noelle Greene, Sara Pinkel and Ruth Pinkel; two sons, Thomas and Michael; his sister, Eileen Pinkel; 16 grandchildren; and five great-grandchildren. Another son, Christopher, died before him. Dr. Pinkel and his team found early success with his Total Therapy approach but kept the results unpublished until the late 1960s, to ensure that the data was solid. Still, when he did publicize his findings, he was met with skepticism, even derision; other doctors said he was cruel to give patients and their families hope in the face of what everyone knew was an incurable disease.But after he invited a few of his most prominent critics to visit the hospital, they changed their tune; one of them, Alvin Mauer of Cincinnati Children’s Hospital, took over as the president of St. Jude when Dr. Pinkel left.During their studies, Dr. Pinkel and his colleagues noticed something strange: The children from lower-income families, most of them Black, tended to have worse results than children from higher-income families. After investigating, they concluded that pervasive malnutrition was to blame.Dr. Pinkel helped launch a program to provide families with supplemental nutrition. That effort provided the model for the federal government’s Special Supplemental Nutrition Program for Women, Infants and Children, known as W.I.C.But those efforts put Dr. Pinkel at odds with some in the city’s white leadership, who felt he was giving Memphis a bad name. Several of the hospital’s donors threatened to withdraw support if he continued.Dr. Pinkel left St. Jude in 1973. He later worked at children’s hospitals in Wisconsin, California, Pennsylvania and Texas before retiring in 1994. He moved to San Luis Obispo to be near some of his children, and later taught as an adjunct at California Polytechnic University.He won most of the major awards given in the medical field. In 2017 St. Jude named its new research tower after him, a testament to his persistence in the face of what everyone else said was an impossible task.“I’m a very stubborn person,” Dr. Pinkel told Smithsonian. “A coach once told me, ‘Never run from a fight — the farther you run, the harder it is to fight back.’”

A cardiologist and best-selling author, he was initially a skeptic before finding that a person can influence bodily health through Eastern-style meditation.Herbert Benson, a Harvard-trained cardiologist whose research showing the power of mind over body helped move meditation into the mainstream, died on Feb. 3 at a hospital in Boston. He was 86.His wife, Marilyn Benson, said the cause was heart disease and kidney failure.Dr. Benson did not set out to champion meditation; in fact, even after his first pioneering studies, he remained a skeptic, picking up the practice himself only decades later.He was, however, open to the possibility that state of mind could affect a person’s health — common sense today, but a radical, even heretical idea when he began researching it in the mid-1960s.During a stint working for the U.S. Public Health Service in Puerto Rico, he noticed that island residents often had significantly lower blood pressure than their mainland counterparts, all else being equal. He began to wonder if part of the cause lay outside the usual explanations of diet and exercise, a question he took up when he returned to Harvard as a researcher in 1965.Working in a lab at Boston City Hospital (now Boston Medical Center), he and his colleagues devised a way to train monkeys to raise and lower their blood pressure, based on a reward system. The work was low-key; many medical researchers took it as fact that while a stressful situation could raise heart rates thanks to the fight-or-flight response — discovered, coincidentally, in the same lab where Dr. Benson worked — the mind itself had no control over it.Word got out, though, and one day he was approached by several followers of the founder of transcendental meditation, a technique that claims to allow practitioners to enter a higher state of consciousness through the repetition of a mantra. Why teach monkeys, they told him, when we have already perfected the practice?“At first I didn’t want to get involved with them,” Dr. Benson told The New York Times in 1975, referring to the meditation practitioners. “The whole thing seemed a bit far out and somewhat peripheral to the traditional study of medicine. But they were persistent, and so finally I did agree to study them.”To avoid attention, he insisted they come after hours, and through a side door. He attached sensors to their chests and masks to their faces, to measure their breathing, and then had them switch between periods of normal thinking and focused meditation.The meditators were right: Across a variety of metrics — heart rate, oxygen intake — they showed an immediate and significant drop during their contemplative moments, akin, Dr. Benson said, to entering a sleep state while still awake.“I wasn’t so shocked as I was wary because I knew what was ahead of me because the negative mind-body bias was so strong,” he told Brainworld magazine in 2019. “I remained a cardiologist and also being head of cardiovascular teaching at Harvard Medical School, but I sustained two professional lives. I kept respectability within cardiology while I also did work in the mind-body field.”Working with Robert Keith Wallace, a young physiologist at the University of California, Los Angeles, he published his first findings in the early 1970s. Press reports called him a renegade and a maverick, and many in his profession shunned him.But others were impressed by the strength of his research, and by his objectivity. Unlike some researchers at the time, including Dr. Wallace, Dr. Benson was not an advocate of transcendental meditation; in fact, he split with Dr. Wallace when he insisted that there was nothing special about the practice or the use of mantras — any word or phrase, repeated over and over, will do, he said.Dr. Benson called his approach the relaxation response — the opposite of the fight-or-flight response. But whereas a stressful situation will cause the body to automatically raise its heart rate and release adrenalin, the relaxation response has to be asserted consciously.He demonstrated just how to do that in his 1975 book, “The Relaxation Response.” It hit at the right time: That same year the transcendental meditation movement claimed more than 400,000 adherents, studying at more than 300 centers around the United States alone.Millions more Americans, if skeptical about alternative medicine and Eastern spirituality, were still meditation-curious, and Dr. Benson, with his Ivy League pedigree and clinical approach to research, gave them license to indulge. The book sold more than four million copies and was a New York Times best seller.Over time, Dr. Benson’s insistence on the connection between the mind and the body became accepted, even standard fare among establishment researchers. In 1992 he founded the Mind-Body Institute, which in 2006 moved to Massachusetts General Hospital and, with an infusion of money from the investor John W. Henry, changed its name to the Benson-Henry Institute for Mind Body Medicine, with Dr. Benson as its director emeritus.Dr. Benson was the first Western doctor allowed to interview Tibetan monks about their practices, and he became friends with the Dalai Lama, right, when that Buddhist spiritual leader visited Boston in 1979. via Benson-Henry Institute for Mind Body MedicineHerbert Benson was born on April 24, 1935 in Yonkers, N.Y. His father, Charles, ran a series of wholesale produce businesses, and his mother, Hannah (Schiller) Benson, was a homemaker.He graduated from Wesleyan University in 1957 with a degree in biology and received his medical degree from Harvard in 1961.Along with his wife, he is survived by a son, Gregory; a daughter, Jennifer Benson; and four grandchildren.Dr. Benson wrote 11 books after “The Relaxation Response,” several of which delved further into the physiological effects of spirituality and faith. He was the first Western doctor allowed to interview Tibetan monks about their practices, and he became friends with the Dalai Lama during that Buddhist spiritual leader’s visit to Boston in 1979.Dr. Benson found, among other things, that Buddhist monks could, during meditation, raise their body temperature enough to completely dry damp sheets that had been draped over their bodies.Such findings were later disputed, and Dr. Benson was rarely without his critics. But he was undeterred, comparing himself to William James, a Harvard predecessor and another pioneer at the intersection of the mind and the body.Dr. Benson was not a praying man himself, but by the 1990s he was convinced that prayer, and faith in general, had a physiological impact. For him, the explanation lay in a version of the placebo effect: If we believe something is helping us, our bodies will work harder to heal.With a $2.4 million grant from the John Templeton Foundation, in 1996 he undertook a decade-long study on the healing power of prayer — specifically, whether one person’s prayers could help another.The conclusions, released in 2006, were definitive, and disappointing (at least to believers): Intercessional prayer not only had no impact, but in some cases where people believed they were being prayed for, they got worse — a result, Dr. Benson said, of their conviction that if someone was praying for them, they must be very ill, with their body trying to match that impression by getting sicker.Still, Dr. Benson believed that prayer could help at least a sick person doing the praying. And he always took care to say that even if his research was 100 percent accurate, meditation and prayer could never replace drugs and surgery completely.Both medical treatment and spiritual care, he said, were necessary — a fact that Western medicine had long tried to ignore, and one that he spent his career trying to correct.

An iconoclastic thinker, he greatly influenced the evolution of psychiatric ethics, and guided the decision to take homosexuality off the list of mental disorders.Alan A. Stone, an iconoclastic scholar who used his dual tenured appointments at Harvard’s law and medical schools to exert a powerful influence on the evolution of psychiatric ethics over the last half-century, died on Jan. 23 at his home in Cambridge, Mass. He was 92.His son Douglas said the cause was laryngeal cancer.Dr. Stone trained as a psychiatrist and as a psychoanalyst and began teaching at Harvard Law School in the late 1960s, just as the foundations of both fields were coming under scrutiny.He was at the forefront of questions about how psychiatry is used as a tool of public policy; for example, he criticized the role psychiatrists played in laws that banned abortion based on claims about a woman’s mental health, and in the involuntary commitment of millions of Americans to public mental institutions.As psychiatrists began to build careers as expert witnesses in criminal trials, he made enemies by opposing the practice, and by refusing to take the stand himself. That didn’t stop him from becoming the president of the American Psychiatric Association in 1979, a post where, among other things, he guided the decision to remove homosexuality from the profession’s list of mental disorders.Despite his lack of a law degree, Dr. Stone was widely considered one of the best and most popular professors on Harvard’s legal faculty. He often taught courses with the criminal lawyer Alan M. Dershowitz, on subjects ranging from criminal insanity to Shakespeare.“They were this perfect yin and yang,” the former New York City schools chancellor Joel Klein, who took one of their courses as a law student, said in a phone interview. “Dershowitz was doing what every good Harvard Law School professor does, emphasizing the rational, and what Stone was doing was saying, ‘That’ll get you part of the way down the road, but what about X?’”Many former students, including Mr. Klein, cited Dr. Stone not just as an exemplary teacher but also as a profound influence on their careers, precisely because his approach differed from the legalistic thinking expounded by other faculty members. His colleagues tended to agree.“For him the world was never right or wrong,” Mr. Dershowitz said. “It was always ‘why?’”In part because of his capacity for thorough, critical thinking, the Department of Justice invited Dr. Stone to join a multidisciplinary panel that would examine the 1993 raid by federal agents on a compound near Waco, Texas, that was occupied by a religious sect called the Branch Davidians. Four agents and 76 members of the sect were killed, and Dr. Stone’s panel was charged with assessing whether the tragedy could have been avoided.But very early on, Dr. Stone came to believe that their job was in fact to rubber-stamp the government’s own self-exculpatory assessment. He publicly criticized the Justice Department when it refused to give him classified material, and he refused to sign the final review until he was allowed to submit his own dissenting report.He remained a vocal critic of the government throughout the 1990s, and in 1999 he called for the surviving Branch Davidians, several of whom had been sentenced to prison, to be pardoned.“The Branch Davidians were more victims than culprits,” he wrote in The Wall Street Journal that year.Dr. Stone made more enemies in 1995 when he declared that Freudian psychoanalysis was no longer useful as a science and was best relegated to the humanities, where it could be used to evaluate works of art.“Psychoanalysis, both as a theory and as a practice, is an art form,” he said in a speech to the American Academy of Psychoanalysis. “I do not think psychoanalysis is an adequate form of treatment.”Though legions of psychoanalysts took exception, to Dr. Stone that assessment was no insult — he considered art and psychiatry to be closely intertwined, and mutually supportive. In addition to teaching classes on the law and literature, he was for years a film critic for Boston Review, using his professional insights to tease apart movies like “Million Dollar Baby” (2004), which he argued was a story about the ethics of euthanasia, and “The Tree of Life” (2011), which he hailed for its treatment of Oedipal conflicts.Later still, he decried his profession for its complicity in the so-called war on terror under George W. Bush, when psychiatrists were employed in “enhanced interrogation” sessions that, Dr. Stone said, amounted to torture.“What American law and American psychiatrists and psychologists need to do now,” he wrote in The New York Times in 2005, “is to reassert our basic norms of decent and ethical conduct, which seem to have collapsed in our response to 9/11.”Dr. Stone in 2017. He once argued that psychoanalysis was no longer useful as a science and was best relegated to the humanities, where it could be used to evaluate works of art.Dana SmithAlan Abraham Stone was born on Aug. 15, 1929, in Boston. His father, Julius, was a lawyer, and his mother, Betty (Pastan) Stone, was a homemaker. All four of his grandparents were Jewish immigrants from Lithuania.Along with his son Douglas, he is survived by his partner, Laura Maslow-Armand; another son, David; six grandchildren; and two great-grandchildren. His wife, Sue (Smart) Stone, died in 1996. His daughter, Karen Stone Zieve, died in 1988.His parents led a liberal household, taking in Jewish refugees during the 1930s while also weathering antisemitic prejudice; despite clear qualifications, his father struggled to get a low-level judgeship.He attended Boston Latin School and Harvard, where he majored in social relations. He also played right tackle on the varsity football team; among his teammates on the 1947 roster was Robert F. Kennedy.He graduated in 1950 and received his medical degree from Yale in 1955. He conducted his residency at McLean Hospital in Belmont, Mass., a suburb of Boston, and trained in psychoanalysis at the Boston Psychoanalytic Society and Institute.At one point, he made an exception to his refusal to testify as an expert witness. Justice Anthony Kennedy of the Supreme Court staged a “trial” for Hamlet in 1994, on the premise that he had survived the play’s bloody ending and was now charged with murdering Polonius, his uncle’s counselor.The question, as Justice Kennedy constructed it, was not whether Hamlet had killed Polonius — that’s clear in the play — but whether he was not guilty by reason of insanity. Mr. Klein, Dr. Stone’s former student, was working in the White House at the time, and he suggested his old professor as an expert witness for the prosecution.The mock trial was conducted several times (in most instances the jury deadlocked), including in 1996 at Boston University.When asked at that event whether he had made himself familiar with the “record” in the case — that is, the play itself — Dr. Stone responded, “Yes, and I agree with the justice that it’s well written.”

He showed that while a healthy lifestyle won’t help us live much longer, it can stave off chronic disease and disability until our final years.James F. Fries majored in philosophy as an undergraduate, so it’s no surprise that as a medical researcher he was obsessed with how to lead a good life, even though his interest was more about physical than moral well-being.His focus, starting in the mid-1970s, was on what Dr. Fries (pronounced freeze) and other scientists called the failure of success. They noted that one great achievement of the 20th century was the rapid increase in life expectancy, thanks to improvements in vaccinations and sanitation that dramatically reduced deaths from acute, transmissible disease.But that increase in life span did not mean an accompanying increase in “healthspan,” or the duration of one’s life free from chronic conditions like hypertension, diabetes and heart disease.Dr. Fries, who trained as a rheumatologist and spent his entire teaching career at Stanford University, was a data guy, long before large data sets became a common tool in medical research. He was among the first to create an international database of patients that tracked their health over time, an enormous effort that began in 1975 with a grant from the National Institutes of Health.“He was thinking about electronic health records and data mining in the 1970s,” Michael Joyner, a physiologist at the Mayo Clinic, said in a phone interview. “I wouldn’t call him an early adopter. I would call him a pioneer.”Early on, Dr. Fries noticed something strange in the numbers: While the average life span of patients didn’t change much depending on their lifestyle, the rates of morbidity — that is, affliction by chronic disease and disability — varied greatly between those who exercised and ate a healthy diet and those who smoked, overate and exercised infrequently, if at all.Put differently, exercise and a healthy diet don’t help you live longer, but they can help you postpone the onset of debilitating disease until close to the end of your life, a phenomenon that Dr. Fries called “compression of morbidity.”He died at 83 on Nov. 7 at an assisted living home in Boulder, Colo. His son, Greg, said the death, which was not widely reported at the time, was attributed to end-stage dementia.Dr. Fries outlined his compression of morbidity hypothesis in an article in The New England Journal of Medicine in 1980, then spent the rest of his career trying to prove it, using longitudinal studies of both large groups of people and so-called natural experiments, like a runners’ club, as measured against a control population.He practiced what he preached. In high school he ran the mile and pole-vaulted; as an adult, he took up jogging, running an average of 500 miles a year. An avid outdoorsman, he climbed the highest peaks on six continents, though at Mount Everest he had to turn back when a snowstorm endangered his crew just 3,000 feet from the summit.Dr. Fries was not without his critics. Some pushed back against his assumption that there was a limit to human beings’ natural maximum life span; others insisted that chronic disease was here to stay, and that lifestyle choices mattered little in the grand scheme of things.But he said he had the data to support his claims, and over time his core insight became a cornerstone of a new approach to healthy living, one that spilled out of the medical laboratory and into the pages of countless self-help books. Dr. Fries was the author of some himself; one, “Take Care of Yourself” (1979), which he wrote with Dr. Donald M. Vickery, has sold some 20 million copies.Another of his books, “Taking Care of Your Child” (1977), briefly made headlines in 1992. After an insurance provider announced that it would distribute copies to some 275,000 federal workers, President George Bush’s administration insisted that a chapter on contraception be removed lest it offend some parents.Dr. Fries took his approach to healthy living out of the laboratory and into the pages of self-help books, including this one from 1979, written with a colleague. It has sold some 20 million copies.Dr. Fries was careful to insist that the compression of morbidity was not inevitable, and he urged policymakers to develop tools to encourage healthy living and to make it easier for people to pursue interventions like statins and joint-replacement surgery, to help them stave off chronic disease and disability.But, ever the philosopher, he also recognized that staving off morbidity was ultimately a personal choice, and those who failed to follow his advice would have to live with the results.“Anguish arising from the inescapability of personal choice and the inability to avoid personal consequences may become a problem for many,” he wrote in a 2011 paper. “For others, exhilaration may come from recognizing that the goal of a vigorous long life may be an attainable one.”James Franklin Fries was born on Aug. 25, 1938, in Normal, Ill., the son of Albert and Orpha (Hair) Fries. His mother taught middle school English, and his father was a college business professor. The family soon moved to Evanston, Ill., where Albert Fries taught at Northwestern University, and then to California, where he taught at several institutions, including the University of Southern California.Jim Fries attended Stanford University and graduated with a degree in philosophy in 1960, the same year he married Sarah Tilden, whom he had met in a freshman history course.Weeks after their wedding ceremony, the Frieses drove east to Baltimore, where Dr. Fries attended medical school at Johns Hopkins University. He graduated in 1964 and stayed another four years as a resident before returning to Stanford, where he joined the faculty.His daughter, Elizabeth, died of breast cancer in 2005, the same year that his wife developed metastatic melanoma. She survived, but the disease left her disabled. Dr. Fries insisted that she remain active, and the two continued to travel extensively, taking cruises and walking tours around the world. At one point he carried her across a bridge in the Himalayas.Mrs. Fries died in 2017. Along with his son, Dr. Fries is survived by his brother, Ken, and five grandchildren.Dr. Fries retired in 2017, after his wife’s death and after he suffered a debilitating stroke. A few months later, he moved to Colorado to be near his son.

A clinical psychiatrist, she showed that suicide was often the result of mental illness, and that it could be avoided with the right treatment and public education.Early in her time as a medical student in the late 1950s, Paula J. Clayton watched a psychiatrist analyze a patient with clinical depression.The doctor, who had herself been analyzed by both Carl Jung and Sigmund Freud and now taught at Washington University, asked the patient to explain his dreams, and the two spent time discussing what they meant.But, when the session was over, the doctor did something that Freud would never do. She prescribed electroshock therapy.It was something of a revelation for Dr. Clayton: The old methods of psychiatry, steeped in Freudian theory, had their limits, and physiological treatments were needed too. She came to believe that a new approach was necessary, beyond analysis’s reliance on talk therapy, one based not in philosophy and speculation but empirical research and data and a conviction that mental illness, like any illness, can be diagnosed and treated.She was at the right place at the right time. Dr. Clayton was part of a generation of clinical psychiatrists who, in the decades after World War II, revolutionized their field by applying medical rigor to the diagnosis of mental illness — and nowhere was this revolution more apparent than Washington University. Her mentor, George Winokur, drilled into his students the commandment “Data Shall Be Your God.”Dr. Clayton joined the Washington University medical faculty in 1965, and in 1969 she and Dr. Winokur, along with their colleague Dr. Theodore Reich, published “Manic Depressive Illness,” one of the first books to study manic depression through a rigorous, outcome-based approach.“She was a very careful empirical researcher at a time when empirical research did not hold much sway,” Richard Friedman, a psychiatrist at Weill Cornell Medical College in New York, said in an interview.Dr. Clayton with colleagues at Washington University in the ‘70s. She and her colleagues were part of a generation of clinical psychiatrists who revolutionized their field by applying medical rigor to the diagnosis of mental illness.via Washington University in St. LouisDr. Clayton and her co-authors found, for example, that manic depression was likely hereditary, that it affected men and women differently, and that it had a high morbidity rate — that is, many patients, left untreated, died by suicide.The “untreated” part is important, because Dr. Clayton went on to become one of the leading voices for destigmatizing depression and suicide in America.She moved beyond the academy to become something of a public figure, adept at translating the latest research on mental illness for a broad audience at a time when issues like mania and suicide were still shrouded in mystery and myth.Dr. Clayton died on Sept. 4 in Pasadena, Calif., at 86. Her daughter, Clarissa Weirick, said the cause was complications from a non-Covid viral infection.First as a professor at the University of Minnesota — where she was the first woman to chair a psychiatry department in the country — and later as the medical director at the American Foundation for Suicide Prevention, Dr. Clayton worked tirelessly to show the public what medical researchers already knew: that suicide was almost always the result of an underlying mental illness.“When you’re feeling sick from cancer or heart disease, you certainly call your doctor first, and yet with suicide,” you don’t think of treatment as a solution, she said in a 2007 interview with a reporter for McClatchy. “I think it’s just that they don’t recognize it as a serious illness.”Dr. Clayton reveled in the role of mythbuster. Suicides do not peak around the holidays, she told reporters, audiences and congressional hearings — April and May see the highest numbers. Women attempt suicide twice as often as men, but men are four times as successful.“She was a pioneer and a force in suicide prevention in part because she believed people should know and understand that suicide can be prevented,” Dr. Jill Harkavy-Friedman, the vice president for research at the American Foundation for Suicide Prevention, said in an interview. “That didn’t happen before. People ran away from the topic.”Dr. Clayton in an undated photo. Even after she retired in 2015, she continued to write and speak, convinced that with enough public education, the country could start to lower its tragically high suicide rates. via Clayton familyPaula Jean Limberg was born on Dec. 1, 1934, in St. Louis. Her father, Oscar Limberg, worked for a clothing company. Her mother, Dorothea (Pflasterer) Limberg, was active in the women’s suffrage movement, something Dr. Clayton later cited as an inspiration for her own career.Her marriage to Charles Clayton ended in divorce. In addition to her daughter, she is survived by her sons, Matthew and Andrew, and seven grandchildren.She studied pre-med at the University of Michigan, graduating in 1956, and enrolled in medical school at Washington University, where she graduated in 1960. After joining the Washington University faculty, she moved to the University of Minnesota in 1980.Her work around bipolar disorder was especially groundbreaking. Though its broad contours were well understood, it was still seen as a mystery even by many psychiatrists. And too many people still saw manic outbursts of energy in somewhat romantic terms, as the seedbed for great art and ideas.“There was a bit of glamour attached to bipolar disorder, which was wholly inaccurate — there’s no glamour to that disease,” John Greden, a psychiatrist at the University of Michigan and the founder of the Eisenberg Family Depression Center, said in an interview.Dr. Clayton helped show that bipolar disorder and unipolar depression were two ends of a spectrum, a view that has led to breakthroughs in the diagnosis and treatment of both conditions.She also demonstrated that while bereavement and grief can trigger major depression, periods of grief, even ones lasting a year, were not in themselves depressive episodes. And she showed that grief, far from progressing along a neatly described five-stage process, was personal and idiosyncratic — an insight that changed the way doctors and the public understand how we deal with loss.Dr. Clayton stepped down as chairwoman at Minnesota in 1999, and after moving to Santa Fe, N.M., began teaching part time at the University of New Mexico.Just six years later, though, a recruiter contacted her: The American Foundation for Suicide Prevention needed a medical director, someone who could take the work of its network of researchers to the general public.Dr. Clayton jumped at the chance, leaving her life of semiretirement in New Mexico for New York. She created films for schools and parents and she became a constant presence at government hearings, from Congress to City Councils.She was especially vocal about suicide among members of the military and veterans, the rates of which spiked after the invasions of Afghanistan and Iraq, and among Native Americans. She urged insurance companies to improve mental health coverage. And even after she retired in 2015, she continued to write and speak, convinced that with enough public education, the country could start to lower its tragically high suicide rates.“Before her, people talked about suicide like it was this mystical, horrifying behavior,” Dr. Friedman said. “Her work destigmatized depression, and because of that, so many people owe their lives to her.”If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.