The best friend a baby could have

As the American Association for the Advancement of Science's annual meeting begins, we talk to the society's outgoing president and survey some hot topics

From pioneering treatments for newborns to lobbying on health inequities, Mary Ellen Avery has made a career of looking after other people's children. Stephen Phillips reports

In 1963, neonatal respiratory distress syndrome claimed the life of John F.

Kennedy's two-day-old son Patrick, who was born six weeks prematurely. At the time, RDS was the leading cause of death of premature babies.

Mary Ellen Avery, who ends her term as president of the American Association for the Advancement of Science at this week's annual conference in Seattle (February 12-16), recalls helping staff tending the stricken infant at Children's Hospital Boston, giving advice by telephone from Johns Hopkins University in Washington DC.

Her pioneering research at Johns Hopkins led to her breakthrough finding, published in 1959, that lack of surface active agents in the lungs of some premature newborns left them unable to inflate. Avery helped in subsequent research leading to the discovery that minced cow lung could act as a substitute.

She estimates that the treatment, which is administered in liquid form and was not widely available until the 1980s, has saved millions of lives.

"There's a long time (between) saying something's missing and finding out how to do something about it," says Avery, who is now emeritus professor of paediatrics at Harvard University.

Her latest project involves mapping, week by week, what nutrition a baby in the womb receives. This could help with future treatments for premature babies. She says: "If a baby's born early, we (recommend giving) mother's milk because this has antibodies in it, but no one knows what else a baby can take based on what they (would have been) drinking in utero ."

At 77, Avery casts herself as an intellectual mentor to younger peers.She is the author of Avery's Diseases of the Newborn , a standard reference work entering its eighth edition this summer.

She is, however, no shrinking lab-bound researcher. Before being elected president of the AAAS, Avery used her positions on leading US science policy advisory groups - the Institute of Medicine and the National Academies of Science - to promote awareness of humanitarian paediatric issues. Between 1974 and 1985, she was also physician-in-chief at Children's Hospital Boston. In 1991, she won the National Medal for Science from George Bush senior.

She says her career was inspired by Emily Bacon, a neighbour and a paediatrics professor who used to take her to see premature babies.

Although her parents had not been to university, Avery was encouraged to follow her intellectual curiosity.

She enrolled at Wheaton College, Massachusetts, for her undergraduate studies. The private women's liberal arts institution proved an unlikely setting for a "simply superb" chemistry department, she says.

She proceeded to Johns Hopkins for her medical training because it was Bacon's alma mater and - as a co-educational institution co-founded by a woman - it had a long tradition of accepting women. Even so, she was one of just four female medical graduates in 1952.

"I knew (my being a woman) would be an issue, and at times it was," Avery says. "But I just bypassed it and went ahead. When I began to write papers that interested people, there were some whose noses were put out of joint. (But) you can sense who you can and can't work with."

Her achievement in winning a scholarship to the Harvard School of Public Health in 1957, however, "cut through the possibility of discrimination" and made her believe she "would never be pushed aside" again.

The two-year research fellowship was the platform Avery needed to work on her hunches about RDS. Her supervisor, Jerry Meade, was the foremost expert on breathing mechanics and the role of surface forces on pulmonary function, although the focus of his research was adults with wounds caused by exposure to toxic substances.

Her other main adviser was John Clements, then at the US Army Medical Center in Maryland, who was studying the impact of toxic substances such as phosgene on the lung.

The experience opened Avery's eyes to the benefits of collaboration with investigators beyond her immediate specialism.

At Johns Hopkins, meanwhile, she assembled a diverse team of researchers, specialists in electromicroscopy and lipid and protein chemistry (many of whom followed her to Montreal's McGill University in 1969) and allowed them to pose questions they may never have dreamt of asking within departmental boundaries.

Avery, a prolific publisher and editorial adviser to learned journals such as the New England Journal of Medicine , is just as passionate about sharing research as she is about conducting it. "Work not published is work not done," she states.

Recently, she has sought to focus attention on social medicine issues and has used her AAAS presidency to raise their profile. Particularly pressing, she says, is the gaping inequity in infant mortality rates across black and white communities in the US.

"The death rate among black populations is more than double (that among whites) - it's a scandal. This is not biology, it's sociology," says Avery, noting that the highest infant mortality rate in the US is to be found in the black inner city of Washington DC.

Amid such a busy academic and public life, Avery never found time for children of her own or to marry. "I loved what I was doing and didn't want to take any more on," she says. "I've enjoyed taking care of other people's children."