An Interview with Dr. Edward Laws, Director, Neuro-Endocrine/Pituitary Program, Interim Director Neurooncology, Brigham and Women’s Hospital

(from left to right) Drs. Peter Black, Edward R. Laws and Arthur Day (In background: portrait of a young Dr. Harvey Cushing. Regarded as the "Father of Modern Neurosurgery," Cushing established surgery of the nervous system as a viable enterprise during his tenure as Surgeon-in-Chief at the Peter Bent Brigham Hospital.

The Brain Science Foundation recently had the chance to talk with the esteemed Dr. Edward Laws, who joined the Department of Neurosurgery at Brigham and Women’s Hospital this past April. Dr. Laws is one of the world's experts in the treatment of neuroendocrine disorders, and he brings to BWH his vast experience both in the management of pituitary tumors and related diseases and the use of intraoperative endoscopy to safely and effectively excise these tumors.

Dr. Laws is the past president of the American Association of Neurological Surgeons, the World Federation of Neurosurgical Societies and the American College of Surgeons Foundation. He has been the Honorary Fellow of the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Surgeons, Edinburgh, and an honored guest and speaker of organizations throughout the world. Dr. Laws received his MD from Johns Hopkins and completed his residency training in neurological surgery at Johns Hopkins.

BSF: Can you share with us a bit of your journey to the Brigham and Women’s Hospital’s Department of Neurosurgery?  What attracted you to the Brigham and Women’s Hospital? 

Laws: There are few Neurosurgeons with an interest in the history of our field who could resist an opportunity to work where it all began and to join the group of outstanding Clinical and Basic Neuroscientists at BWH. My previous neurosurgical experience has been with the outstanding institutions of Johns Hopkins, Mayo, UVA and Stanford – now the Brigham.

BSF: You are recognized as the world’s most experienced pituitary surgeon. Why have you dedicated so much time to this particular tumor?

Laws:  Pituitary physiology is basic to human life in almost every one of its aspects. The study of disorders of pituitary function gives us insights into these scientific secrets.  Pituitary tumors are actually very common and are almost always benign lesions.  Their successful treatment brings to bear many of our contemporary technical and conceptual advances in Medicine, Radiation Oncology and Surgery.

BSF: You have said that most patients with pituitary diseases have seen up to six doctors before getting the right diagnosis, what is your advice for readers who may be suffering with symptoms of this disease?

Laws: Not most, but many.  My advice would be to be persistent, use resources judiciously to become more informed and seek advice from an experienced Pituitary Center.

BSF: What is known about the origin of the pituitary tumor? How can we prevent its apparition and growth?

Laws:  Except for a small minority of genetically determined cases, most of these tumors arise by chance.  They develop from cells that are working hard to produce hormones and therefore may be more likely to develop the “hits” in their metabolic processes that lead to tumor formation.  There are no known precipitating or environmental factors involved.

 BSF: Can you tell us about the Pituitary Center of Excellence at the Brigham?

Laws:  We are dedicated to being efficient, comprehensive and user-friendly for our patients, who come from all parts of North America and overseas.  In one appointment, focused Pituitary Endocrine and Neurosurgical evaluations, laboratory tests, imaging studies (MRI) and appropriate consultations are arranged.  Treatment as indicated can then be promptly recommended and offered.  Our group has unequalled experience, superb outcomes for our patients, and a wonderful up to date therapeutic environment at the Brigham.

BSF: Dr. Laws, earlier this month, you performed your 5,000th surgery!  Explain to us the significance of this achievement for the patients you have treated and for patients you have yet to treat?

Laws:  I would rather say 5,000 transsphenoidal operations for pituitary disease.  We have used this experience not only to help patients with ever-increasing technical expertise and adoption of new technology and surgical concepts, but also to heighten the awareness, in the public and among physicians in general, of the importance and impact of pituitary disorders.

BSF: How has surgery and subsequent treatment changed from your first case to your 5,000th?

Laws:  In so many ways that they are difficult to catalog:

• Advances in the testing for hormones and pituitary/hypothalamic physiology;
• Advances in Neuro-imaging, from pneumoencephalogram to tomography to angiography, to CT, to PET, and ultimately to very sophisticated MRI;
• Advances in Radiotherapy, Radiosurgery and Radiobiology;
• Advances in medical therapy with the introduction of dopamine agonists, somatostatin analogues, hormone receptor blockers, and precise ways of providing hormone replacement therapy; and
• Surgical advances, including new instrumentation, better operating microscopes, endoscopy, and computerized image guidance.

Along with these advances [we’ve seen] improvements in Medical and Anaesthetic management that allow for better and safer patient care, particularly related to the many side effects of pituitary disease.

BSF: In your opinion, on a national and even international level, what needs to occur in the brain tumor community to improve the understanding of these and other tumors considered “benign” and to eventually reduce their incidence level?

Laws:  Early detection and expert treatment are the keys to success.  Encouragement of basic and clinical research will shed light on the origin of these tumors and may tell us why they usually remain benign, an important clue for Cancer management in general.

BSF: If you hadn’t become a neurosurgeon, what other field would you have pursued?

Laws:  Aviation, in one or another of its exciting aspects.