Maverick Doctor Knows That Change is Good
Hospital and Health Care News - October 1999

Dr. Gerald J. Marks isn't the kind of person to sit back and wait for things to happen.

Marks is an internationally renowned pioneer of colorectal surgery and medicine. He garnered this global reputation over the past 50 years for colorectal cancer clinical research and innovative techniques in the field of colorectal surgery. Marks has trained surgeons around the world in the newest colorectal surgical methods.

His breakthrough contributions in multimodal sphincter preservation treatment of rectal cancer patients have affected the way surgeons worldwide treat the disease. He has always been a man willing to support a cause or mission, the kind of doctor who was not hesitant to challenge conventional wisdom. As a result, he has been considered a maverick by some of his peers.

Although his ideas haven't always found ready acceptance by his surgical colleagues, Marks has steadfastly stood by his dedication to do things better, particularly when aimed at providing patients with an improved quality of life, no matter how controversial his techniques were considered.

Time has more often than not proven him accurate. His major research focus led him to develop special surgical techniques that when utilized with preoperative irradiation, permitted normal bowel function to be preserved in patients with advanced and low-lying rectal cancer rather than condemning these patients to live with a permanent colostomy bag.

Countless numbers of patients operated on by Marks and the doctors he has trained have benefited from his visionary creativity, energy, and dogged insistence that physicians should not be married to the past.

In 1966, Marks founded the Comprehensive Rectal Cancer Center at Thomas Jefferson University, the first multidisciplinary approach to this site specific malignancy. The Center served to implement and promote the first program of preoperative irradiation and sphincter preservation surgery for select rectal cancers, a program that was initiated in 1976.

The striking beneficial results of this multimodal program eventually led Marks to fulfill a long-held ambition - organizing a rectal cancer consensus meeting. The event happened in May 1997 in Philadelphia, where 45 specialists from around the world convened for discussion and debate.

"The meeting was positively electric," recalled Marks. "It was an historic gathering of enthusiasts dedicated to the use of preoperative radiation for rectal cancer - a consensus that had never occurred before."

An outgrowth of the meeting was the formation of the International Network of Comprehensive Rectal Cancer Centers, a consortium of more than 35 prestigious medical centers and universities around the world.

"Our goal is to promote improved quality-of-life care for the rectal cancer patient, as well as to collect critical data", says Marks, who currently practices at Lankenau, Bryn Mawr and Paoli Memorial Hospitals, members of the Philadelphia-based Jefferson Health System.

Over the course of his career, Marks has witnessed and participated in many changes in surgical techniques and concepts, particularly the laparoscopic surgical revolution. The marriage of technology and creative techniques has transformed the state of surgery today. Laparoscopic surgery, which has only been widely practiced for the past decade, started out as a less invasive way to perform gallbladder surgery.

Ten years later, laparoscopic technology is used to perform surgery on liver, pancreas, colon, appendix, small bowel, uterus, kidney, adrenal gland, heart and lungs among others.

"The first time I saw a video demonstration of laparoscopic cholocystectomy in the spring of 1989, I didn't sleep for three nights," recalled Marks. "My mind raced with the possibilities. We have since proven that in the hands of a proficient laparoscopic surgeon, there are an infinite number of applications, and the patient operated upon laparoscopically experiences far less surgical trauma and recovers more safely and rapidly."

Developments in technology and practice cannot exist in an intellectual and organizational vacuum. Having pioneered flexible colonoscopy and sigmoidoscopy, a natural evolutionary step for Marks was to recognize the need to organize a professional society that could develop teaching programs, educational and practice guidelines, and systems for managing the incredible changes in patient care.

In 1981, Marks founded the Society of American Gastrointestinal Endoscopic Surgeons (SAGES). "It is still one of my proudest accomplishments," he said. "I saw a vital necessity to introduce an entirely new spectrum of practice standards and credentialling guidelines to safeguard the public. At the same time, I felt a mission to nurture the development of this mix of technology and art."

The success of SAGES propelled Marks into the global arena, and in 1992 he became the founding president of the International Federation of Societies of Endoscopic Surgeons (IFSES), with what is now an organization representing greater than 50,000 surgeons worldwide.

IFSES's presence was providential at a time when a century of surgery was turned inside out in an instant by laparoscopy. The Federation acted as a true shepherd during the endoscopic surgical revolution, helping to bring a measure of order to chaos.

"To have been a part of this historic surgical mission has been a rewarding journey. I feel privileged to have had the opportunity to play a role in this exciting and romantic period as I stood next to and worked with so many surgical giants and brave, creative heroes," said Marks.

As yet another example of his willingness to embrace a cause, Marks recognized another need. In 1970, when academic medical centers were being torn apart by the "town and gown" war, it was time to create an organization that would help resolve the conflict and assure a fair sharing of responsibilities and privileges among salaried and non-salaried faculty alike.

Thus was born the Volunteer Faculty Association at Thomas Jefferson University Hospital. The Association became prototypical nationwide and served to help preserve the ability of non-salaried faculty to pursue their academic goals with a measure of professional dignity. Jefferson flourished as a result.

Whether devising new surgical techniques, new surgical concepts or new organizational models, Gerald Marks continues to act as a catalyst for change five decades after his graduation from medical school.