"I'm having a bad hair day,” Dr. Miller hollers to me as she waves and bolts toward thewashroom. Not the first words one might expect from a world-renowned scientist, researcher, and current head of the entire ophthalmology department at, none other than, Harvard Medical School.

As Dr. Joan WHITTEN Miller ’76 smoothes her impudent tresses, I am struck by the good natured, relaxed atmosphere of her offices in the hallowed reaches of the Massachusetts Eye and Ear Infirmary. Admittedly, on hearing the word “infirmary” I had pictured a smallish affair with doctors’ offices and patients milling about. I was unprepared for the bustling building towering above hospital central in Boston’s crowded health care core. This is Dr. Miller’s domain. She runs this hospital, along with her duties as chief of ophthalmology at Harvard Medical School, arguably one of the most prestigious and influential in the world.

“I didn’t realize you were doing pictures too!” Dr. Miller smiles warmly as she reemerges to lead me into an ordinary looking office, desk piled with files, photos and memorabilia scattered about on walls and shelves. On one wall there is a framed collage of pictures from various times in Dr. Miller’s life—rowing, beer drinking contests in college, getting a degree, playing with children—all she explains, with a laugh, put together by her husband when she got this job to ensure that all the fuss didn’t go to her head.

Of course, anyone who knows Dr. Miller would immediately see the humour. In her deep, velvety voice that betrays a hint of a Boston accent, Dr. Miller explains her rise to the top of her field with no trace of bravado. The “star doctor” ego, à la television’s House, is nowhere to be found. While she is the furthest thing from flamboyant, neither is she remote. She emanates warmth and even seems a little incredulous that she wound up in this office.

Were she inclined, she’d have a lot to brag about. With a 44-page resume, itemizing an exhaustive list of achievements, the 48-year-old Dr. Miller is perhaps most famously credited with being the lead scientist responsible for discovering a therapy that arrests the growth of macular regeneration, the leading cause of vision loss in people over 50 in western countries. Given where the baby boomers are in the life cycle, one can only imagine where the numbers are destined to go for this blindness-causing disease. Fortunately for all of us, Dr. Miller’s research can arrest or slow the development of the disease and save vision for untold numbers of people.

“Treating the first patient in the lab was incredible,” Dr. Miller explains, of the first clinical trial for the drug and laser therapy she was developing. This patient responded well to the treatment proving that the therapy would work. But because it had yet to be approved, they had to stop treating him after the trial and when the disease recurred they couldn’t help him. “During the active stage, when things [blood vessels] are leaking, the photo receptor cells responsible for seeing are unhappy and if you can control that process and get them back in a normal environment, they’ll do fine. But if you can’t, they’ll die off over time. Once they’re gone, that’s it.”

Such is the world of discovery in medical research. Until approvals are obtained, which can often take years, patients who might have been helped cannot receive treatment. The upside, of course, is that once the therapy is perfected and hits the market patient #1 will have helped thousands of others. It is clear that Dr. Miller is thrilled by the detective work involved in piecing together a breakthrough therapy that will have such a significant impact on society. But she is so matter-of-fact in explaining the process, one might be tempted to overlook the gravity of what she has accomplished.

Macular degeneration comes in two forms: the more common “dry” form which may never cause any problems with vision; or the less common but more severe “wet” form in which abnormal blood vessels grow in and under the retina leaking and causing scarring. It affects the macula, or the small part of the retina designed to give us fine resolution for things like reading, driving, or recognizing faces. Peripheral vision can remain intact, but central vision declines severely with this disease seriously impairing a patient’s ability to go about the day-to-day routines of normal life.

Dr. Miller began questioning the role of the abnormal blood vessel formation in macular degeneration caused by diabetes, which led her to the world-renowned cancer researcher, Dr. Judah Folkman, who discovered angiogenesis. This field examines the role of blood vessel growth in feeding cancer tumours, the reasoning being that if you could cut off the food supply to the tumour, you could either choke it off entirely or at least arrest growth. Seeing a parallel in the work she was doing, Dr. Miller joined Dr. Folkman as a Fellow and began studying angiogenesis as it relates to eye disease.

They came up with a therapy that basically injured the abnormal blood vessel intravenously so that it clots off thereby stopping the process. The resulting therapy is a combination of drugs and laser treatment called Visudyne. The drawback is you have to re-treat every few months.

That’s when Dr. Miller, persevering along this track, identified a particular growth factor called VEGF that causes the vessels to become leaky and abnormal blood vessels to grow. Her team worked on creating a drug that would block the VEGF growth factor. The drug has recently been approved for use and can signifi cantly slow vision loss and even improve it in about 1/3 of patients.

Dr. Miller’s pioneering work led to her increasing prominence in the field and, eventually, to the top job in ophthalmology.

“This department is probably the most complicated in the country because it’s big—135 full-time faculty and almost 300 part-time. I wear a couple of hats. I’m chief of ophthalmology, which is a department of Harvard Medical School, but I also run the hospital [Massachusetts Eye and Ear Infirmary]. As department chair, I run the ophthalmology areas of all the other Harvard teaching hospitals in addition, like Children’s Hospital and Brigham and Women’s.”

As an administrator, she must deal with boards, budgets, staffing and the mountains of paperwork and policy issues that abound in such positions. But to her, this was the deal she made so she could be in a position to mentor young doctors and, in a way, give something back to her community.

Her interest in science, and medicine, in particular, was sparked from a young age.

“I became interested in medicine because of my mother,” says Dr. Miller. “She wanted to be a doctor so she put that bug in my brain.”

BSS was also influential in encouraging her obvious talent for science. Here she encountered teachers who would have a great impact on her life and career choice. She cites physics teacher Stuart Don, biology teacher Charlie Hawks and Mrs. Strasser who taught her chemistry, as chief among them. In fact, Dr. Miller comes from a family of BSS graduates. Her mother, Mary CLARKSON Whitten ’44, joined the Navy in World War II and returned from duty to get a degree in English. Her grandmother, Beatrice SCHREIBER Clarkson ’16, was a nurse who worked throughout the influenza epidemic. Her aunt, Joan CLARKSON ’48, also attended BSS.

Left: An eye with "wet" macular degeneration. Right: What you might see with the disease.

“I was going to go to Havergal because we lived right there, but my mother said, ‘no, she must go to BSS.’” Judging from her recollections of her experience at BSS, it was the right choice for her and a wonderful period in her life.

After graduating, Dr. Miller visited the Massachusetts Institute of Technology (MIT), with a girlfriend and decided to go there. Although the gender demographics were striking—seven to one male-to-female ratio—she did not sense there was any real problem in being a woman in a male-dominated field. “Once you got in they assumed you were smart enough. It was tough for everybody.” After earning her degree in science, she went on to Harvard Medical School.

It was at MIT where she met her future husband who, as she describes mischievously, was her rowing coach at the time. Perhaps a little “politically incorrect” she says, but love was in bloom and they got married while Dr. Miller was in her first year of medical school. John B. Miller, her husband, was a lawyer and part-time rowing coach who later went on to earn a PhD in engineering.

They soon started a brood of three children—all born while Dr. Miller was in various stages of earning her medical degree. The first, John, 23, was born while she was in medical school; the second, Doug, 18, while doing her residency at Harvard, and the third, Mary, 17, while a Fellow in retina training. Now John is in his second year of medical school at the University of Michigan; Doug is a freshman at Harvard where the 6'8" athlete is playing basketball and considering pursuing economics. Mary is off to Harvard next year as well.

So, three children, all exceptionally successful products of a close-knit, loving family life, raised while mom was on her way up an inconceivably challenging professional ladder towards a major leadership position in the Harvard medical community. Not possible one might think. Surely the late nights, the studying, the legendary stories of sleep deprivation for young residents, the constant pressure would lead to potential disaster on the home front. But not so in Dr. Miller’s case. According to her, she married a “great guy” who came through as a parent and husband during those tough years, a time when it was still considered unusual for men to be pulling as hard on the domestic oars as women were. She also attributes her family’s success to the plain old luck of having three great kids. But one might suspect that Dr. Miller’s calm demeanor, intelligence and cheerful outlook on life had something to do with it as well.

“We always tried to eat together as a family which a lot of families don’t manage to do,” she explains. “We had a lot of fun and argued about things, but we probably talked about sports as much as anything academic.” As she talks about her family, a smile spreads across her face and her eyes light up. Her description of her home life is that of a group of bright, motivated, active people who genuinely like each other and enjoy spending time together. “My son’s friend calls us The Waltons,” she says with a grin.

Now that her kids are successfully launched, and her husband is temporarily located in Abu Dhabi on a consulting contract, Dr. Miller is focused on the Herculean task of running her department and her hospital.

“This department should be the best in the world—it’s Harvard!” she says of the expectations placed on her in this position. “That’s a big goal, but I haven’t worried about it. I’ve looked at it as an opportunity. It’s a terrific place—we have a great training program and we attract great people. The history is here too. For example, we identified retinopathy prematurity here and came up with new treatments for macular degeneration and for melanoma in the eye. The first gene for retinoblastoma was discovered in our department. In fact, I didn’t realize that Brenda GALLIE ’63 [a leading Canadian researcher in retinoblastoma] was a BSSer until I read your article!” [see The Link, Spring 2006]

The expectation is that Dr. Miller will continue that tradition of discovery and contribution to the medical community as a world leader in the field.

On the ascent of women in science and medicine, Dr. Miller hasn’t considered gender stereotypes as a factor in her own attitude towards the work or that of her colleagues in the community. “It certainly didn’t worry me at the time I took the job, but now we have the first woman president at Harvard and still among department heads, we have only four women, so you’re sort of a novelty. More recently it occurred to me that if I really screw up in this job, it will be seen as ‘woman department head in a big institution ... bad idea,’” she says with a laugh. “I could set the field for women back for a long time. Hopefully I won’t do that.”

After three successful years in the top job, there is no evidence to suggest she will. If anything, her pioneering research and her leadership position in the Harvard medical community make Dr. Miller a trailblazer for women and a superb role model for the girls at BSS.

So what’s her advice to current BSS students with dreams of a career in medicine? “Follow your passions. If you really want to do something there’s nothing that should prevent you. Anything is worth trying. I think there are still issues that women aren’t always trained as well in and need to be coached. Going through a career in science or medicine, things like making sure you meet with your supervisor, lay out what you’ve done and what your goals are, what you’re earning and whether it should go up. There are lots of studies to support the fact that women are reluctant to do that. It’s important to ask for what’s fair.”

Clearly her quiet assertiveness and straight-talking approach have served her well, both professionally and personally. She’s managed an incredibly complex and challenging lifestyle and come out on top in all areas. Dr. Miller is proof to ambitious women everywhere that it is possible to have it all.

Posted January 24, 2008 at 12:18pm

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