David Sachar
(March 2, 1940 - )
Born in the United States
Year of Discovery: 1966
Discovered the Basic Science Behind Oral Rehydration Therapy

Sachar, like many medical pioneers, was among the best and brightest of his generation.  An honors graduate of Harvard Medical School, he could have simply turned to a lucrative private practice.  But he felt the call of public service and joined a team of cholera researchers in Dacca, East Pakistan (Bangladesh) in 1965.  The team was studying cholera’s interference with the body’s ability to transport sodium and water across the cells of the gut, resulting in potentially deadly dehydration. The insights gained through these studies led to the development of a new therapy known as Oral Rehydration Therapy (ORT).  The only current available treatment to combat the dehydration resulting from cholera was IV therapy, a costly and highly technical protocol.  ORT proposed to treat patients with a simple fluid mixture they would drink.  Sachar played a key role in advancing the therapy.  He developed a device to test a cholera patient’s ability to transport sodium, a key factor in the body’s ability to retain fluids.  His work proved even a cholera patient’s body retains the ability to transport sodium, and that the process is enhanced by glucose.  This foundational knowledge allowed for the insights that led to Oral Rehydration Therapy, a treatment protocol credited with saving over 50 million lives.

Cholera is a deadly disease that spread from the Ganges delta in India in the 1800s to the rest of the world. It's been responsible for seven pandemics worldwide, resulting in millions of deaths. One of the primary means by which it kills is dehydration, as a result of severe diarrhea and vomiting. In fact, cholera can take someone's life in as little as four hours following onset of symptoms. Undeveloped nations are particularly at risk, as lack of pure drinking water combined with inadequate sanitation facilities allows the disease to spread rapidly. Until the mid-1960s the only accepted treatment was intravenous therapy, a costly and highly technical method. Oral Rehydration Therapy (ORT) burst onto the scene as a lifesaving alternative thanks to the efforts of David Sachar, Norbert Hirschhorn, David Nalin, and Richard Cash. Sachar and Hirschhorn expanded upon the work previously completed by Robert Phillips. Though Phillips had come painfully close to coming up with ORT several years earlier, he became disillusioned when a clinical trial he directed resulted in the death of several patients. Ironically, it was under Phillip's directorship that Sachar and Hirschhorn proved Phillip’s conclusions false, clearing away incorrect assumptions that allowed ORT to be born.

When Sachar arrived in Dacca, the clinical director of the project was wrestling with a complex issue.  Though Phillips’ previous work had shown that a glucose mixture enhanced sodium absorption, he still held to the “poisoned sodium pump” hypothesis.  This was the prevailing belief that cholera inhibits the mechanisms by which the body transports sodium and water across the cells of the gut and into the bloodstream.  This results in the body’s inability to properly absorb water and other fluids, a critical factor in combating the severe dehydration caused by the diarrhea associated with cholera.  It was a complex issue, which had been debated for many years, and Sachar was given the assignment to devise a means to test the hypothesis.  He traveled to Copenhagen to consult with zoologist H. H. Ussing, who had been working on a similar issue. Dr. Ussing had developed a special device, the “Ussing Chamber,” to conduct in vitro experiments using frog skins. Sachar adapted the apparatus for his own purposes and returned to Dacca, where he completed the first definitive experiments to test sodium transport in humans.  The results spoke volumes – the prevailing theories about sodium and cholera were wrong.  The body actually retained the ability to transport sodium when afflicted by cholera, and the process was enhanced by glucose.  Sachar’s work provided the base to move the ORT development process forward.

When the apparatus Sachar developed actually worked he and his colleagues were overjoyed, "...dancing around the test lab." But, the real significance of the moment escaped them. Their celebration was simply technical - the device functioned properly, allowing them to detail the sodium transport process. It was only later, in consultation with Hirschhorn, they realized the importance of what they'd found. Their tests disproved the "poisoned sodium pump" hypothesis once and for all, providing a clear direction for further research to follow.

Written by science writer, Tim Anderson

Lives Saved:  Over 57,500,000

Snippets
"No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period of time and at so little cost"
                                         -UNICEF 1987

"Potentially the most important medical advance of this century."
                                 -The Lancet

Landmark Academic Papers
Sachar DB, Taylor JO, Saha JR, et al. Intestinal transmural electric potential and its response to glucose in acute and convalescent cholera. Gastroenterology 1969;56:512-21.
Hirschhorn N, Kinzie JL, Sachar DB, et al. Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions.  N Engl J Med 1968;279:176-81.

Key Contributors
David Nalin
Richard Cash
Norbert Hirschhorn
Robert Phillips
David Sachar

Sachar doing hurricane relief work in Texas in 2005

ScienceHeroes.com's December 2009 Interview With David Sachar

Just the Facts
Home: Englewood Cliffs, New Jersey (USA)
Career: Clinical Professor of Medicine, Mount Sinai School of Medicine, New York, NY (USA)
Field: Gastroenterology
Wife: Joanna
Children: Mark, Kenneth

Childhood and Schooling
Describe your family life, growing up
Constant movement from one part of the country to another in the wake of my father’s work, and growing up in a family where my father—while an inspiring role model—was absent more than he was present
What was delightful about your childhood?
Meeting famous people in connection with my father’s university life
What was challenging about your childhood?
Being intellectually precocious but socially awkward and immature
What were your favorite subjects in high school and college, and why?
History and literature were always my favorite subjects, even though I was destined for a career in medicine
What was your worst subject in school?
Although I was generally very good in math and science, and even won a physics prize in college, for some unfathomable reason I had terrible trouble with high school physics.
When did science first spark your imagination and arouse your passion?
In elementary and junior high school in the few years preceding teenage
Who is your scientific (or other) hero and why?
Scientific heroes would include John Snow for his epidemiologic observations regarding cholera and Lister, Pasteur, Koch, and Semmelweiss for their insights regarding communicable infectious disease. But my three “life heroes” are (1) my 11^th grade English teacher, Mr. M. Roland Heintzelman, for teaching me high standards of writing; (2) my late older brother, Edward, for teaching me how to balance the demands of work with the pleasures of life; and my father, A. L. Sachar, for inculcating the highest standards of academic achievement welded to public service.
What would you change about the way science is taught, from elementary school through the university level?
More excitement, more relevance to different varieties of student, more passion, more imagination.
What is one thing not taught in school that you believe should be?
Critical thinking
What was your very first paying job?
Hospital laboratory technician during medical school
What is one thing about you that people would be most surprised to find out?
That I have ADHD
What two suggestions do you have for students to prepare them for life?
Don’t over-plan. Be prepared to accept the unexpected.
What message would you pass on to today’s youth?
Do not try to be too clever in over-planning your career moves. So much will depend upon chance and unpredictable circumstance that you should let your passions and your instincts be your guide.

For Fun
What are your favorite non-scientific interests and activities?
Reading, playing piano, and learning Italian
What three items would you take to a deserted island?
A digital reader (like a Kindle or Nook) loaded with books I hadn’t yet read; an MP3 player loaded with music that I had already heard and loved; an inexhaustible supply of writing materials
Imagine yourself on a leisurely journey with plenty of time for long conversation. Which famous people would you like to accompany you, and why?
Thomas Jefferson, James Madison, and Benjamin Franklin. Their concepts of government, society, politics, and philosophy will continue to enrich us for the foreseeable future.
If you could interview any of the lifesavers on the website, who would it be and what would you ask them?
On a strictly personal level, I would be interested in Alfred Sommers’s (on ScienceHeroes.com’s List!) recollections about what role if any our early contacts with each other as medical residents in Boston had on his subsequent illustrious career in international public health.
A funny anecdote?
One day as a medical student I was examining a patient who was about to undergo exploratory surgery for a mysterious lump in her axilla. Noticing a Band-Aid® on her hand, I asked her what happened and she told me that her cat had recently scratched her there. My failure to make the connection between that injury and her ipsilateral axillary adenopathy robbed me of the chance to achieve early fame by making a correct preoperative diagnosis of cat-scratch fever (feline granulomatosis)!

Favorites
Food: Ice cream and cookies
Scientific instrument: The stethoscope
Science periodical journal: Inflammatory Bowel Diseases
Author and/or book: A Suitable Boy by Vikram Seth
Artist: Claude Monet
Music: Beethoven’s Seventh Symphony
Movie: Casablanca

About the Research
David Sachar’s research overturned the prevailing paradigm, that cholera inhibits the body’s ability to transport sodium and water across the cells of the gut and into the bloodstream, thus producing dehydration and death. His basic science discovery meant that cholera and other diarrhea diseases could be treated with liquids to overcome the dehydration.
How much of your discovery was inspiration/perspiration?
70% Inspiration and 30% Perspiration
Did the insight(s) that led to your discovery occur in an instant as an ‘aha,’or did it unfold over time?
Step one: a particular day when I read a relevant article in a journal
Step two: a particular instant when we saw the transmural electric potential in a cholera patient respond vigorously to glucose infusion
Step three: a particular moment when Dr. Hirschhorn proposed applying our discovery to oral therapy
Can you describe your scientific thought processes?
The key to the creative thought process is the application of a principle or an observation from one sphere to a process or a phenomenon in another previously unrelated sphere.
Describe your office/desk. Is it tidy or messy?
The desk tends to be messy. The personal items are primarily family pictures.
What's the coolest thing about your work – what excites you the most?
Entering the bodies and spirits of people in need of assistance and applying medical knowledge and empathetic communication in ways to give them help and hope.
What thing most frustrates you about your work?
It is not the work itself that frustrates me most, but rather the difficulties in keeping my thoughts and activities sufficiently well organized to accomplish the work with optimal efficiency.

Philosophical Questions
Are you religious?
I am steeped in the historical, cultural, and ethical precepts of Judaism without adhering to most of its orthodox traditions
What would you like your tombstone to say?
He’s not here yet
What’s your motto?
“People will always forget what you tell them; they might remember some of what you show them; but they will never forget how you made them feel.”
What are Sachar’s Laws?
Sachar Law #1: You don’t always have to know what a patient has, but you always have to know what to do.
Sachar’s Law #2: Nothing in clinical medicine is about you; it’s only about the patient.
What was the most meaningful experience(s) in your life and why?
The two years spent in Dhaka, East Pakistan (now Bangladesh), because they helped me and my family grow in independence (and gave birth to our younger son), opened our eyes to the wider world, and had a measurable impact on the health of populations around the globe.
What is the meaning of life?
To spend it for something that outlasts it
A profound or moving experience in your science career?
The life of one of my patients as a first-year medical intern was transormed when I figured out that her easy fatigability and intermittent diplopia indicated a possible diagnosis of myasthenia gravis. The instant that an injection of physostigmine caused her drooping eyelids to fly up, leading her to say, “It’s like a veil has been lifted from my eyes!” we knew that a defining moment had occurred in our both our lives.