"Pécs is my home” – interview with János Pórszász

In Los Angeles, he works as the technical director of the Rehabilitation Clinical Trials Center at the Lundquist Institute, Dr János Pórszász, who is considered a world-renowned researcher in the field of exercise physiology and the study of obstructive airways diseases. We talked to a medical researcher who started his career in Pécs about his university years, his career leading from the mines in Pécs to Los Angeles and his UCLA professorship, and why he still considers Pécs his real home.

Written by Miklós Stemler

- Perhaps we can say that it was not by chance that you entered the medical research career, as your father, János Pórszász, was a renowned pharmacologist, to whom several important discoveries are associated to. But how inevitable was it for you to follow in his footsteps?

- It wasn’t a coincidence for sure, but I couldn’t say it was a pre-determined fact either. When I was in high school, my primary interest was music, and that’s what I wanted to deal with. My father suggested that before I embark on a career in music, I also get a civic degree - like a doctor. Well, that's how I got to the Medical University of Pécs.

- Your father and mother were already working here at that time, but the family had previously worked and lived in Budapest and Szeged. Didn’t it even occur to you trying your luck in these places?

- No, it didn’t. I only applied for POTE and luckily, I was admitted - even if not with the maximum score. By then, our family had moved to Pécs, and there was no question of me going anywhere else.

- If I guess correctly, there were pros and cons to having your parents work at the university…

- This goes a long way and it had a big impact on my entire academic career. I would start with my second-year experience when I applied for a scientific student job with Professor András Tigyi for molecular biology. For the first time, the professor handed me a scientific article in English saying, János, you will be referring from this next week. As a 19-year-old boy, I was so concerned that I didn’t dare talk about not being able to speak English at all. I took the article home - I still remember it was about ribosome activity - and showed it to my father, who jokingly said, "..I don't even understand that in Hungarian, so do what you can with it." I grabbed a dictionary, listed the translated words sentence by sentence, and tried to create meaningful sentences from them. After a while there were more and more words that I no longer had to write out. That's how I started learning English. Later, I could read articles and even used them a lot in education, but I didn't master the correct pronunciation and speech for a long time. In 2003, when I was already working in the United States with Professor Brian Whipp, one of the most respected experts in load physiology, I mentioned to him that I had never been part of formal English language teaching. He looked at me with his usual piercing gaze and said deadly seriously, “ maybe it wouldn’t have hurt,” then smiled.

Another case fundamentally determined my academic career choice.  After my graduation in 1976, I wanted to work at the Pharmacology Department, but since my mother worked there as an assistant professor, I was told that this was not possible. This is how I got to Professor György Bíró in Public Health, and thanks to that, I am here at the University of California in Los Angeles today.

When I applied to the position at Professor Bíró, he told me to meet him the following morning at six o'clock at the entrance to the Petőfi shaft in Vasas. When I asked why, he said, “Because I want to know what a physiologist can do in the mine”. It sounds murky, but it was actually a destiny-determining sentence. It was about that time we began to deal with occupational health and work physiology at POTE, which I later continued at the Pathophysiology Department under Professor Kovács. At that time, it was only clear that the ability of miners to work was highly dependent on their age. The older they are, the more people suffer from respiratory diseases and, as it turns out, cardiovascular diseases are also very common in their case. Both disease groups significantly limit physical performance and lead to serious complaints. Of course, to avoid symptoms and complaints, the patient reduces the work intensity to tolerate shortness of breath. I wanted to investigate this more closely, and so we established the first load physiology laboratory at the university in Pécs, where we examined about six or seven thousand miners in about eight years (out of about 12 thousand at that time). Incidentally, in the field of instrumentation, as it was not possible to buy a new gas exchange device (it only became possible financially later), one of my electrical engineer friends and I developed a measuring system, which became the basis of our spiroergometry laboratory at that time. In the attached photo, I point to this device on the bottom shelf. I wrote the graphics display software myself in Simons’ Basic on a Commodore 64 computer. This was a huge achievement back then.

- It’s a very exciting topic, but there’s one more seamless thread from the past, namely the ultimately abandoned musical career. When and why did you decide to choose medicine?

- It was a longer process, essentially my father infected me with science. Already during the years in Szeged, I visited the Institute of Surgical Research, where they were working on the treatment of paralytic ileus. As part of this, isolated intestinal loops had to be studied, and during the summer break, my father entrusted me with this. This experiment on isolated intestinal loops taken from guinea pigs demonstrated that intestinal motility increases not only under the influence of parasympathetic stimulants but also with sympathetic blockers. This was part of a complex series of experiments that resulted in a method of treatment that is still used worldwide today. My scientific interest can be traced back there - this includes the fact that practical medicine has never really brought me into a “fever”. It was very important that the Medical University of Pécs provided an opportunity to satisfy my scientific interest and so I could become a researcher. To this day, I am grateful to the university and to the rector back then, Professor József Tigyi, who directed me to the Public Health Department after I could not get into Pharmacology. The music hasn’t disappeared from my life either, I have a cello and a piano to this day. This is my lifeblood in addition to photography, which is also a family tradition, as both my father and mother were deeply involved in photography, they had several exhibitions. I also photograph to this day, and my son Áron is a professional photographer. Thus, science and the arts are intertwined in our family.

- Studying the health status of miners and introducing load tests at the turn of the seventies and eighties seems to me to be a highly pioneering line of research. Today, not least because of this research, we are aware of the health risks of working in mines, but at the time this was not obvious - and it could have been a politically sensitive issue.

- That's right, we couldn't freely talk about it. One of my best friends, who was a miner himself, was introduced to me through this very job during my mine rescue medical service, and to this day we talk almost on a weekly basis. The topic itself was very fruitful from a scientific point of view, as the respiratory problems of the miners in Pécs showed a mixed picture. Silicosis resulting from work in the mine is a restrictive respiratory disease, but smoking, together with dust exposure, also causes obstructive respiratory disease. Incidentally, smoking among coal miners was about twice the Hungarian average at that time, 72 percent. Thus, in addition to silicosis, chronic obstructive pulmonary disease (COPD) was present in most of them at the same time. The research was carried out with the support of the then Ministry of Heavy Industry, and the results were presented at the Mining Health Conferences held at the Headquarters of the Pécs Academic Committee. My first scientific lecture on the subject was given at the XLVII Congress of the Hungarian Physiological Society in 1982 (in Pécs), and the summaries were published in the publications of the Mining Health Conferences. However, it was not until much later, in the mid-1990s, that it appeared in the form of a summary in English in the Central European Journal of Occupational and Environmental Medicine, then edited by Professor Ungváry (CEJOEM 1: 252-261, 1995). From this, living relationships were born to this day, I am still in a working relationship with dr. József Varga with a mining engineer. As a result of this work, a paper was published in an international journal in 2016. József Varga has compiled a database of thousands of studies on the results of heart rate variability during work, and these are being processed in the form of a scientific article. It is no exaggeration to say that my work with miners has fundamentally defined my life and I am committed to them until my death.

- The scientific career, which began with the study of pathophysiology in Pécs and the miners in Pécs and Komló, then continued after minor detours at the University of California, one of the most recognized higher education institutions in the United States and even around the world. What led you here?

- It all started with a book. One of the pioneers of clinical load physiology, I would say his founding “grandfather” was Professor Karlman Wassermann, who did research in California. One of the most important works I managed to obtain was published in 1987, and after reading it, I told myself that 'Jesus! That's the way to do it'.  I was able to contact him in the late eighties and said that although he couldn’t pay me but he was happy to see me in his lab. My wife at the time received a postdoctoral fellowship at the University of California, so we moved to California. For three and a half years, I was Professor Wasserman’s technician in the experimental load testing laboratory, which meant that I was involved in all the research work, and in fact my software package for breath-to-breath gas exchange data processing is the basis of our current work as well. In doing so, I met the young researcher, Richard Casaburi, one of the most respected experts on chronic obstructive airways disease today. We spent four years there and were then asked to head the Physiology Department of the National Institute of Occupational and Occupational Health and that is why we came back to Hungary. In 1998, I organized the second European clinical workload physiology course at the hospital in Balatonfüred, based on the Wassermann model, and Professor Casaburi also came for this. We talked and then he asked for a pen and a piece of paper and started sketching a floor plan. I asked him what it was, and he said that he had been given this building to set up a laboratory for exercise physiology and respiratory function, all he needed was people; would I be interested? That's how I got here in early 1999. We created this lab from scratch, which has become one of the most important research institutions in this field in the past two decades.

- Prior to the life-changing book there was that certain scientific article in English that you had to deal with without any previous language knowledge. I think it says quite a lot about the spirituality that prevailed in POTE at the time, that it was taken as a basic expectation in the early 1970s that anyone who wanted to pursue science should be familiar with the current Western literature while the national political climate was very different.

- Knowing languages was not even an expectation during the training at the time (we even studied Russian at university, which fortunately I knew quite well at the time). I passed the language exams when I got my academic degree (in 1995), and of course you can’t even compare the level of English language skills at the time and today. At the same time, POTE was a truly active part of the international scientific bloodstream, commensurate with the political climate of the era. Professor Tigyi had just returned from England and brought with him the educational model in which we were the first grade. As far as I know, with more or less modifications, education continues according to that model to this day. Professor Kovács also came back from England at that time. The Western, Anglo-Saxon influence was very important, as the implementation of English-language training showed during my years in Pécs in the 1980s. As I hear, nowadays the former POTE, now the University of Pécs Medical School is probably the best Hungarian medical university, with a very appreciable performance.

- The name of József Tigyi has been mentioned several times, but besides him, who were the most important lecturers for you as a student, a young researcher?

- I could list a lot of names. One of the pleasant surprises of the recent past is related to Professor Károly Ozsváth, who is in his nineties. Before his university career he was a military doctor, a colonel at the Military Hospital, and he recently nominated me on Facebook. He had a huge impact on me in the field of social psychiatry: when I was a soldier, I worked in his ward at the Military Hospital. I really liked "Uncle" Béla Mess, as well as Gábor Czéh and Gyuri Buzsáki, who was in a few grades above me. I cannot miss out Professor Flerkó, nor my pathology professor, György Romhányi. They made an amazing impression on me with their teaching style and their way of conveying scientific thinking. In my work field, I must once more highlight Professor Bíró, who lured me down to the mines and showed that even a physiologist has something to do there. In this regard, I have to mention Professor Sándor Kovács, who made it possible for us and my friend Tamás Simor to create the laboratory and work that not only gave me (and others) a lifelong job, but also made it possible to take essential steps  in the field of load and respiratory physiology. Without them, I would not be who I am.

- As your career exemplifies, Hungarian, and even specifically, researchers and doctors from Pécs are well placed in the highly competitive Western scientific environment. What do you attribute this to?

- This is a complex issue. It is not necessarily politically correct to talk about “Hungarian genes”, but we still see that we are especially strong in the scientific field compared to the population. It is enough to look at the proportion of Hungarian Nobel laureates in the population. And this is still the case today, new talents are constantly appearing. The West Coast Hungarian Science Club operates here in Los Angeles, the youngest member of which, Tamás Dolinay, has just given us an extremely exciting lecture at the institute's scientific meeting. Answering the question more specifically, I think it is very important that Hungarian undergraduate education is much stronger than a lot of Western ones: a young doctor who has mastered the basics of medicine in Hungary has a much stronger foundation than any American university. I can see this very well myself when I work with specialist candidates here: there was also a case where one of them was unable to apply the ECG electrodes properly. A strong foundation is a significant competitive advantage, and anyone with the right ambition and diligence can run a successful career in the United States as well. In addition, of course, American universities play a leading role in areas that are very important in postgraduate education.

- For a successful career abroad, of course, one has to make a not necessarily easy decision: leaving the homeland and relatives, family and friends behind. How hard was that for you?

- It wasn’t easy, and it wasn’t meant to be final - not so much that I still don’t consider it final to this day, even though more than two decades have passed in the meantime. This is exactly what is very, very important in the decision I have to make. I’m entering my seventies next year and I don’t know yet how long I’ll work and how long I want or can work. We are currently involved in a large project, being the central base laboratory for cardiopulmonary load testing in three large clinical trials, i.e. we do all the data processing. I would definitely have to do this for as long as I feel the need, but then there’s a good chance I’ll move home, since everything binds me to Hungary.

- How much does this mean a live connection with the university?

- Not so much. I left the Institute of Pathophysiology in the early 1990s, and since then I have essentially ceased to exist there. I don’t know who is leading it currently and what happened to the lab I created. By the way, I think it creates tension when someone returns to a leading position somewhere after a career abroad, as it takes away the opportunity from someone else, a similarly skilled, similarly talented person. What would interest me is the transfer of the knowledge I have acquired without a formal position.

- We have talked about the Medical University of Pécs a lot, but not yet about Pécs itself. You came to Pécs around the age of 17 and lived there for more than two decades before moving to Los Angeles with a few years of interlude in Budapest. How important is the city itself to you?

- It means a lot to me. To this day, most of my acquaintances and friends live there, as do three of my four children. If I return to Hungary, it will mean going home to Pécs. This city is my home, much more so than Los Angeles, and I am very happy with its development. Unfortunately, I wasn’t able to get there during the pandemic, but that will hopefully change in the near future.

Photo:

Dr János Pórszász in the load physiology laboratory established by him in 1995 at the Medical University of Pécs.