Russian and American Collaboration: Our History, Our Future

Keynote Speech Russian American Neurosurgery Symposium July 2005

Mark R. McLaughlin, M.D.

In 1997, on a cold and rainy September day in Pittsburgh, Pennsylvania, I left my pregnant wife, Julie, and our three young children.  I boarded a plane bound for St. Petersburg, Russia. Knowing only a handful of Russian words, and no one at my destination, I was nervous and anxious.

Russia fascinated me. The trip was intriguing: a fleeting, once in a lifetime opportunity that I just couldn’t resist. It was a chance to see a foreign land and to get a glimpse of how neurosurgery was performed there. Even though I was under the shackles of residency, my chief, Dr Jannetta, had the generosity and foresight to say, “Mark, I want you to go.”  I had no idea that this opportunity would turn into a lifelong connection that would ultimately lead to this historic event.

Celebrating my 40th birthday this year, I have spent a great deal of time in reflection about my past and the lessons I have learned.  One of the most valuable lessons I carry with me is that friendship is like a bridge. Consider what a bridge does. It allows us to cross barriers, to make a connection in a new way, to overcome obstacles, and to look at something from a different perspective. Perhaps my favorite fact about bridges is this:  the deeper the foundation, the wider and stronger the bridge can span.

My favorite is the Brooklyn Bridge.  This iconic giant, built in 1883 by a man from my home state of New Jersey, is arguably the most important structure built in America during the 19th century. Its builder, Washington Roebling, was the Union bridge architect during the US Civil war and was an engineering genius. The thing that made Roebling’s bridges the strongest in the world was that he and his father perfected and utilized a method of making rope from iron wires and anchoring these rope cables to towers sunk into the deepest of bedrock.

Although our countries and citizens have many differences, including politics, language, culture, and geography, they can be overcome through a focus on common goals and through the cultivation of relationships. Indeed, our nations have much more in common than we have different, and we have worked together many more times than apart from or against each other.

Our collaborations have been broad, and have transcended time, distance and differences in ideology. They have encompassed many spheres including theology, diplomacy, warfare, and the sciences. All of these collaborations were based on two key virtues: friendship and a common interest to make a better and safer world.

Our first exchange was in theology, appropriately beginning with Peter the Great, one of my favorite characters in time. He was your first bridge builder and pioneered the integration of Russia with the rest of the world. In 1698, Peter met William Penn, the founder of the Pennsylvania colony. This was the first formally documented meeting of prominent Russian and American personalities and took place outside of London in the small town of Deptford. Peter was staying at the home of John Evelyn, a British writer and diarist, where he was learning to build boats at the local dockyard. During his visit to Deptford, Peter attended several of Penn’s Quaker meetings and there they had many discussions and exchanged views on religion.

Our Military collaboration was critical in World War II. It was our combined forces in this conflict that rid the world of the Nazis. I can still vividly remember my grandfather, a World War II Veteran, telling me the story of the siege of Berlin, and that, without the sheer grit of the Russian army, the Allied forces would never have won the war.

Diplomatic exchanges have abounded since the very beginning of my nation. Russia helped the American colonies and young nation survive with several key displays of support. The first significant diplomatic support was in September of 1775, when Catherine the Great sent a letter to British King George III, denying him military assistance to crush the revolt in the British colonies of America. Russian backing of the United States continued during the U.S. Civil War, where again Russia, led by Tsar Alexander II, sided with America and Abraham Lincoln by not endorsing Jefferson Davis and his Confederate government. Russia led Europe in this diplomatic action and quelled foreign support for the rebel government. Alexander II’s choice was pivotal in staving off the early successes of the southern army and sealed the fate of the Confederacy’s demise, thus ensuring the preservation of the United States Union.

What an amazing coincidence that these great men shared similar ideals, and ultimately a similar fate. They both recognized the sanctity of the individual and decreed the abolition of slavery in their respective countries in the same year, 1861. Both men paid for their beliefs and actions with their lives. Abraham Lincoln met his fate in Washington D.C., and Alexander II in St. Petersburg, not far from where we sit today.

Our Scientific exchange and collaboration has a long and distinguished history. In 1775, American scientist Ezra Styles sent a letter to Mikhail Lomonosov, an act that established the first contact between Russian and American scientists. This was followed shortly thereafter when Benjamin Franklin, our first Ambassador to Russia, began correspondence with Russian Scientist Franz Epinus. They shared views regarding theories of electricity and magnetism and established a foundation of exchange between Russian and American scholars. 

In this post-Cold War era, Russian-American scientific collaboration abounds in chemistry, astronomy, and aeronautics. We have learned much from each other in science. The world has benefited greatly from Russian ingenuity in medicine and the neurosciences. The Iliserov device revolutionized the treatment of tibial fractures, while Dr. Fyodorov’s contributions in refractive lens surgery set standards of care around the world in ophthalmology. Dr. Ivan Petrovich Pavlov, St. Petersburg’s son, led the scientific world to new heights with conditioned response research, blazing a trail for neurophysiololgists around the world on his way to winning a Nobel Prize.

In 1929, Dr. Pavlov came to the United States for the 13th International Physiological Congress held at Harvard Medical School in Boston, MA.  The conference was organized, in part, by Dr. Harvey Cushing, a leading American neurosurgeon at the time. Cushing and Pavlov met and established a foundation of friendship during this conference. Pavlov had a keen interest in Cushing’s new electrocautery device that was developed with physicist William T. Bovie, and was eager to see the instrument in use. 

Upon learning of this, Cushing arranged for Pavlov to observe a craniotomy and to see this instrument in surgery. A black and white photo from this historic moment shows Pavlov standing to the right of Cushing above the operative field. After the operation the two retired to the hospital kitchen where Pavlov experimented with the electrocautery device, signing his name on a calf’s liver. This preserved specimen sits in the Harvey Cushing/John Hay Whitney Historical Medical Library at Yale University and still bears some of Pavlov’s experimental markings.  Ultimately Cushing sent one of these electrocautery units to Pavlov as a gift for his laboratory.

These two icons met only a few more times but went to great lengths to follow each other’s careers and lives from afar. Barriers of language, distance, and politics did not keep these two from recognizing the importance of friendship and collaboration. Their alliance was the first Russian American bridge in the neurosciences.

This brings me back to why we are here today. The world is a small community. We have much in common. Neurosurgeons and medical scientists across the world share an intense desire to improve the lives and care of our patients. We are all lifelong learners and we understand that scientific inquiry, collaboration, and surgery must go hand in hand to further our fields. We constantly strive to improve ourselves, learning new technologies and techniques, as Cushing and Pavlov did 75 years ago. 

It may not be readily apparent to busy neurosurgeons such as you and I that opportunities already exist among us for collaboration, but there are several already in place. Fellowships are available for young neurosurgeons to study in the United States. Financial support from industry is growing. The AANS/CNS joint spine section offers three international fully-funded fellowships for advanced training. The American Association of Neurological Surgeons has recently offered a reduced membership fee for all international residents in training and for young neurosurgeons. Dr. John Jane and The Journal of Neurosurgery extend a personal invitation to Russian neurosurgeons and offer all participants of this meeting a complimentary three-month subscription to their journal and its archives. We have had many elite neurosurgeons from the U.S. and abroad visit Dr. Shulev’s outstanding neurosurgical center over the years.

I foresee that our work here at this symposium may very well be the seed for future U.S. neurosurgeons and residents to travel here to Russia. U.S. residency directors know there are increasing regulatory constraints on resident education. The increasing demands for restricted resident work hours could deter or prohibit the opportunity for an experience such as mine eight years ago. I challenge the leaders of American Neurosurgery – some of whom are sitting here today – I challenge you to find a way, despite the regulations, the financial constraints, and the obstacles, to give your residents international opportunities for education such as the one Dr. Jannetta gave me here in 1997. Say to your residents, “I want you to go.”

As this symposium nears an end, I can’t help but reflect on how improbably it all started, and what it has now grown into…and what the future might be.

Eight years ago I arrived in St. Petersburg alone, a father of three, with no Russian friends, and anxious about what my visit would bring.  Today, I stand before you, my wife at my side, and a father of four, in one of the finest hours of my young career.

Eight years ago my correspondence with Yuri and his team was infrequent and by fax or postal service. Today, we converse weekly, and soon, with the help of Spine Universe, we will create further opportunity for communication via an interactive live feed for video conferencing and intra-operative consultative services, with images under the microscope.

Eight years ago, Yuri, you and I began to build a bridge of friendship and collaboration; a bridge dividing differences, overcoming obstacles, and, in some small way, unifying countries. I believe that our connection here in St. Petersburg is like one of Mr. Roebling’s bridges: its foundations are deep and solid

I thank you all for your generous hospitality. I thank all of the planners of this meeting, including Kate Laney from Broadwater, who worked tirelessly to coordinate the details of the US faculty. I thank our industry sponsors, whose support made this meeting possible. I especially thank Mr. Brad Coates from Medtronic who has been a long time supporter of this project. I thank Mr. Matt Slater from Stryker and Ms. Terri Hanesco from Integra for their support. I thank Dr. Alexander Sakalovski for his vision and promotion of Hospital #2’s neurosurgical center. I thank our faculty for giving up their precious family time to support this project. I thank my wife Julie for her unwavering love and encouragement through all of my training and career. She also was the one who “let me go.” I thank Dr. Peter Jannetta for always believing in me and also for promoting my career. And I especially thank Dr. Yuri Shulev, my co-director, my colleague, my good friend (myi doragea druzia).

A neurosurgical and spinal bridge now exists between Russia and the United States. Its underpinnings began with Cushing and Pavlov.  With careful nurturing, determination, and through good will this connection has been solidified. As time marches forward, this bridge needs to be strengthened and reinforced through continued exchanges in training, scientific collaboration, and friendship. Our bridge is as long and wide as our opportunities are to cross and re-cross it, for many generations to come.

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