Dr. Rene Cailliet: Advancing the Field of Musculoskeletal Medicine by Making the Complicated Understandable

The 2 words that best describe internationally renowned physician, lecturer, and author Dr Rene Cailliet are gentleman and educator. His name is familiar to 3 generations of physiatrists and many other health care professionals. Many have used the textbooks on painful musculoskeletal conditions that he authored as foundational texts in their training and throughout their careers. Many have benefited directly from his mentorship and teaching. He had a special ability to make complex medical conditions understandable. For many, attending his lectures or reading his books was a first contact with a physical medicine and rehabilitation (PM&R) physician. Through his writing and his mentorship, his work lives on, long after his retirement. Rene Cailliet grew up in Philadelphia, attended public schools, and received an undergraduate degree from Villanova College, now Villanova University. Lucien Cailliet, Rene's father, arrived in Philadelphia from France with the French Army Band before World War I. While visiting, he saw an advertisement for a position as clarinetist in the Philadelphia Orchestra and successfully auditioned with Leopold Stokowski, the orchestra's internationally renowned conductor. The Cailliet family moved to Philadelphia in 1915, and Rene was born in 1917, becoming the first United States citizen in his family (Figure 1). As a child, Rene played the trombone and his older brother Marcel played saxophone. Jazz orchestras were the musical venues for the brothers Cailliet. However, Rene's father Lucien was adamant that his sons should not be professional musicians. During his teenage years, Rene developed a severe knee infection. The extensive wound draining and packing procedures were fascinating to him, and the treating physician taught young Rene at the bedside, thus started him on a path of life-long learning in medicine. Portrait of Rene Cailliet, ca 1935. Courtesy of Lois Cailliet. Lucien's brother, Emile, also immigrated to the United States and became a well-known scholar of philosophy and Romance languages. In 1937, Emile was offered a professorship at Claremont College in Southern California, and he and his family moved to California from France, setting the stage for Rene to also look westward. It was only natural that the Philadelphia Cailliets would visit their West Coast family members. During one visit, Emile arranged for Rene to meet the dean of the University of Southern California (USC) medical school and professor of anatomy, Dr Paul S. McKibben, and Rene was accepted for admission. In 1938, Rene and his family moved to Los Angeles. Rene needed a job to support both his family and his education and was soon hired by Sears, Roebuck, and Company to play the trombone in the company's jazz orchestra. Rene graduated from the USC medical school in 1942, and the following year he became a flight surgeon in the Army Air Corps (the forerunner of the United States Air Force.) Dr Cailliet was trained and assigned to one of the most dangerous jobs in Burma. Gliders without engines were attached to a bomber and released during the night to fly over enemy lines; the pilots would attempt to find a small clearing to land. A bulldozer and the infantry then emerged and went to work, making a functional landing strip so that cargo and fighter planes could land safely. Cailliet's job was to set up a Mobile Army Surgical Hospital (or MASH unit) at the site to treat wounded soldiers. The Japanese used prisoners of war to build a railway across Burma, and 13,000 men died during that period. (The plight of prisoners of war in Burma is depicted in the book and film, The Bridge on the River Kwai). That would have been Cailliet's fate if he had been captured, but he survived and was able to return to USC and complete his training in PM&R. He was board-certified in 1953. Cailliet met many physicians at USC who later became members of the Kaiser Permanente physician staff, and foremost was Dr Sidney Garfield, the first physician hired by Henry Kaiser to care for workers in the Mohave Desert and the head of The Permanente Medical Group for many years 1. Rene's interest in the recovery of severely injured soldiers also interested Garfield, who suggested that he should work with Dr Herman Kabat of the Kabat-Kaiser Institute in Washington, DC 2. The Kaiser Permanente medical model was considered by some physicians and some organized medical groups to be “socialized medicine” or even a Communist plot during the 1940s and 1950s 3. Cailliet was targeted in the early 1950s and called to testify before the House Un-American Activities Committee. It was serendipitous that one of his patients was the daughter of Senator Charles Tobey of New Hampshire. She received rehabilitation after an exacerbation of multiple sclerosis, and she was able to walk again after her rehabilitation. The Senator was very appreciative of Cailliet's contribution to her recovery. Shortly thereafter, his call to Washington to testify and the investigation into his “activities” were cancelled. While working in Washington with Dr Herman Kabat, Cailliet spent time training with Dr Howard Rusk at New York University and later successfully passed the certifying examination in the very new specialty of PM&R. Cailliet was named chief of the Kabat Kaiser Rehabilitation Center in Santa Monica when he returned to California, and he remained in that position until the facility closed in the late 1950s. (In the 1950s, the Santa Monica facility was one of only 2 free-standing rehabilitation hospitals in Southern California, the other being Rancho Los Amigos, in Downey, California. The former Kaiser Permanente facility was razed and is now the site for Shutters, an upscale hotel on the beach at the end of Pico Boulevard, south of Santa Monica Pier.) Dr Cailliet was not one to pass up opportunities for new adventures, and because he was working at an oceanfront facility, he took up surfing. He had a wooden surfboard engraved with his name; later it was featured in a surfing book and is now on display in a surfing museum in Monterey (Figure 2). He also played beach volleyball, usually with Dr Peter Lundstrom, husband of Ingrid Bergman. Rene Cailliet on the Santa Monica Beach next to an image of his surfboard. Courtesy of Lois Cailliet. After the closing of the facility in Santa Monica, Cailliet was appointed to the clinical faculty at USC in the department of PM&R, chaired by Ora L. Huddleston, who was director of the American Board of PM&R from 1947 to 1960 4. As Henry J. Kaiser built more hospitals in southern California, Cailliet was responsible for starting PM&R departments at these new facilities. His last Kaiser Permanente project was establishing the PM&R department at the West Los Angeles medical center in the early 1970s. He then retired from Kaiser Permanente to take a full time position as chair of the department of PM&R at USC. As his reputation spread, Cailliet began to be invited to lecture in the United States and other countries. In the early 1960s, he was giving one of his guest lectures and Sidney Licht, MD, physiatrist and author of many PM&R textbooks, was in the audience. After the lecture, Licht went up to Cailliet and suggested he write a book about the material in his lecture. Cailliet went home and wrote a manuscript and sent it to Dr Licht, but the manuscript came back with every page full of red marks for corrections. Obviously disappointed, Cailliet called Licht to thank him for his critique and tell him that he realized that he could not be an author. Licht said, “You have the wrong impression. I thought the book was great and should be published after you make the corrections!” He then put Cailliet in touch with F. A. Davis publishers, his first publisher 4. Cailliet has written and illustrated 18 books (Figure 3). A series of books he authored on painful conditions have had multiple editions 5-9. His books have been translated into 11 languages. Japanese physiatrist Dr Hideo Ogishima was so impressed with the usefulness of his books that he translated them himself and found a publisher. Cailliet has also written books for the layman, such as Understand your Backache: A Guide to Prevention, Treatment, and Relief 10. Illustration of functional units of the spine. From Cailliet, Low Back Pain Syndrome, 5th Edition. Copyright © 1988 by F.A. Davis. Reprinted with permission. In 1978, when he was honored to present the American Academy of Physical Medicine and Rehabilitation (AAPM&R)'s Walter J. Zeiter Lecture, Cailliet noted the large economic burden of chronic pain on the health care delivery system 11. He emphasized that the need for chronic pain management centers was the result of misguided interventions in acute pain management. He suggested that fewer patients would experience chronic pain if early care incorporated a careful, precise examination of the musculoskeletal system for diagnosis and relied less on the findings of radiologic and electrodiagnostic examinations. Then, he argued, more meaningful treatment could have been offered with less cost, greater patient satisfaction, and better outcomes; this was prescient of the concept of value-based care in 2013. In the early 1970s, Dr Franz Bauer was dean of USC's medical school. He had a vision of establishing a comprehensive clinical rehabilitation program that would include Rancho Los Amigos and other centers with a dynamic PM&R residency and research program. He wanted Dr Cailliet to run it. Unfortunately, 6 months after taking the position, Dr Bauer died suddenly and a new dean was appointed who did not have the same vision. In fact, on one occasion, he asked Cailliet “What exactly do you do?” Cailliet was a prominent and respected Southern California physiatrist in national and international spheres during this time. He received numerous international awards and citations throughout his career. Cailliet was an active member of the Scoliosis Research Society, the International Society for the Study of the Lumbar Spine, and the International Society for the Study of Pain Management. He was President of the American Congress of Rehabilitation Medicine (ACRM) in 1974. He received 2 prestigious awards from the AAPM&R: the Zeiter lectureship in 1978 and the Distinguished Clinician Award in 1981. In 1982, when Dr Cailliet reached retirement age, the department of PM&R at USC was closed, and PM&R became a division under orthopedics. (Today, the USC medical school web site does not even list a division of PM&R.) After leaving USC, Cailliet explored the possibility of developing a rehabilitation program at the University of California, Los Angeles (UCLA). He was appointed clinical professor of medicine in 1983, but there was not support at UCLA for a PM&R department or division, and the neurology department set up a “neurorehabilitation program.” Unfortunately, for the next 8 or 9 years, Cailliet left academic medicine (Figure 4). He developed a private consulting practice at Santa Monica Hospital, where he became director of the PM&R department. He was working 2 miles away from his first place of employment upon returning to Los Angeles from the East Coast. Portrait of Rene Cailliet, ca 1985. Courtesy of Lois Cailliet. In 1990, Dr Erika Scremin was recruited to take over as chair of the PM&R department and residency program in 1991, and she revitalized both. One of her first accomplishments was to bring in Rene Cailliet to UCLA to join the teaching faculty. He lectured regularly and provided clinical training in the outpatient department. Many current faculty members were Cailliet's former residents, and they were extremely grateful that they had the benefit of his excellent mentorship. In 2003, upon his retirement, the chief residents created the Rene Cailliet, MD Outstanding Senior Award. A senior resident is chosen by ballots from the other residents, not the faculty, and recognizes the resident as “an outstanding physician, colleague, friend and leader who teaches by example and inspires us to become better physicians with his/her humility, intelligence, and commitment to providing the highest quality patient care.” In 1992, Cailliet was honored as Physician of the Year by the California's Governors Committee for Employment of Disabled Persons. There are now physiatrists working at UCLA in the departments of orthopedics and pediatrics, and there is also an active teaching program for all first year medical students directed and managed by faculty from the Veterans Affairs/UCLA PM&R program. Cailliet fully retired in 2003, after an extremely successful 60-year career as physician, educator, and author. His books are as useful today for physicians and therapists in training as they were 50 years ago. His most recent publications, Medical Orthopedics: Conservative Management of Musculoskeletal Impairments 12, The Illustrated Guide to Functional Anatomy of the Musculoskeletal System 13, and Whiplash-Associated Diseases 14 were all published in the last 10 years, when he was in his 80s. On September 28, 2013, Dr Cailliet was honored at the 60th anniversary of the Southern California Permanente Medical Group, in front of an audience of 3000, honored as the last surviving Founding Partner and long-standing Chair of PM&R. At age 96, Rene Cailliet still enjoys going to French restaurants and attending concerts at Disney Hall. He and his wife Lois, a classically trained pianist and professor of music, live in the Los Angeles hills and enjoy a panoramic view of the Los Angeles basin and Pacific Ocean. He still swims almost every day and plans to attend 3 concert series of the Los Angeles Philharmonic this season. I first heard about Rene Cailliet when I was introduced to his books during residency at Thomas Jefferson University Hospital in Philadelphia. I read the books cover to cover many times. In 1974, Dr John F. Ditunno, Jr, MD, chairman of the department, sponsored my attendance at the combined assembly of the AAPM&R and the American Congress of Rehabilitation Medicine in San Francisco, where I was presenting 2 papers. I wanted to see Dr Cailliet in person and listen to his presidential speech before the ACRM 15. In his address, he argued that rehabilitation services should be rigorously evaluated with outcomes and cost-effectiveness research; this is turning out to be essential 40 years later. Medicare continues to limit the type of patients treated in inpatient rehabilitation hospitals, and the Recovery Audit Contractor audits are costly and time-consuming even for those programs that are mostly successful in their appeals. Dr Cailliet made a strong point, and influenced me to devote most of my research activities to outcomes research and the measurement of effectiveness. When I arrived in Los Angeles, I was introduced to the Southern California PM&R society. This organization included a remarkable group of physiatrists who met regularly 4 times a year for a predinner social hour, dinner, and lecture given by a member or guest lecturer. Attendees included leaders in many programs throughout Southern California from private and public facilities, the Kaiser Permanente health system, and private practitioners—from Santa Barbara to San Diego and east to Pomona. Academic physiatrists included Dr Robert Swezey of UCLA and Dr Jerome Tobis and Dr Herbert Kent of University of California, Irvine. I regarded Dr Cailliet from USC as the superstar of the group. Despite the fact that I was only 28 years old and fresh out of residency, he was welcoming and gracious towards me. During the next few years, I attended many of his lectures and courses that he organized with other faculty, including Dr Janet Travell, Dr David Simon, and Dr John Mennell. I learned many novel physical medicine approaches for the treatment of musculoskeletal conditions, including spray and stretch, and osteopathic and chiropractic manipulation. In 1978, I attended Dr Rene Cailliet's Zeiter Lecture in New Orleans. That single presentation defined my approach to the evaluation and management of acute and chronic pain for my entire career, up to the present day. From the 1970s to the present, I have been fortunate to maintain a close personal relationship with Dr Cailliet, beginning on that day decades ago when he was so gracious to a freshly minted physiatrist from out of town. The authors thank Lois Cailliet, Rene Cailliet's wife, for her contributions to this biography.