During his childhood in Wolcott, Conn., Karl Insogna’s parents instilled in him a few life lessons. Insogna, MD, FACP, Ensign Professor of Medicine (Endocrinology); director, Yale Bone Center; and associate director, Yale Center for X-Linked Hypophosphatemia; was taught to strive to leave the world a better place than you found it, and to do something to help others.
“So I went into medicine. My brother went into dentistry. My youngest brother went into occupational health; and my sister's a physician's assistant,” explained Insogna.
Insogna attended medical school at the University of Connecticut, graduating in 1976. He then left New England for his residency at the University of Rochester. During his chief resident year in Rochester, Insogna encountered a patient with unusual symptoms, which would focus his medical interests.
“While I was rotating on the neurology service, I admitted a woman who was severely disabled. She had been planning a cruise to the Caribbean with her husband but became so profoundly weak that she couldn't walk so she couldn’t go on the cruise. She was hospitalized. It turned out that she had been taking an antacid that bound all her dietary phosphate. She had a phosphate depletion syndrome and osteomalacia,” Insogna said.
The case would be Insogna’s first published paper, “Osteomalacia and weakness from excessive antacid ingestion” in JAMA in 1980 and piqued his interest in metabolic bone disease.
Insogna also became intrigued with kidney stones after working in a different clinic in Rochester where he saw many fascinating cases, he explained.
“Up to that point, I thought that kidney stones were the most boring things on the planet. But while I was rotating through Dr. Christine Waterhouse’s clinic in Rochester, I read a paper by Arthur Broadus, MD, PhD, and Samuel Thier, MD, called the ‘Metabolic Basis of Renal-Stone Disease’ in the New England Journal of Medicine and thought, ‘Holy cow! There's actually some interesting physiology here.’ I decided that I wanted to go into endocrinology because of those two experiences.”
He applied for fellowships in Seattle, Boston, St. Louis, and New Haven, but being from “a close extended Italian family” his strong preference was to return to Connecticut. When his wife, a gynecologist also from a close Wolcott family, received a job offer at the Yale Health Plan, he chose to do his fellowship at Yale. He intended to complete his fellowship and move into private practice, but his plan didn’t work out like he thought.
During his fellowship, Insogna started his work in clinical research with Broadus and Howard Rasmussen, MD, PhD, through a special training grant, a Clinical Associate Physician Award from the National Center for Research Resources at the National Institutes of Health. From that point on, he “spent the rest of my career seeing patients with metabolic bone disease, doing clinical research, and doing bench research. I'd say the most interesting and accurate characterization of my career has been that people on faculty who are clinicians always thought I was a basic scientist. And basic scientists on the faculty always thought I was a clinician,” he joked.
During these early years, Insogna crossed paths with Thomas Carpenter, MD, professor of Pediatrics (endocrinology) and of orthopaedics and rehabilitation. “I was in pediatrics and he was in medicine, so I tried to sniff him out a little bit. I could see him doing the same thing. And then we hit upon a few common experiences that were so remarkable that we became very close friends very fast.”
“It was really interesting that despite the fact that our lives had been in completely geographically disparate places, we had a lot of common experiences, and we had a lot of similar attitudes. We had ended up getting interested in the same areas of medical research, although he was in medicine and I was in pediatrics. This certainly led me to a depth of understanding him and seeing what a wonderful individual he is. Not only bright and giving, in terms of the academic environment, but also in a wider swath of the way one lives one's life,” said Carpenter.
In addition to rising through the academic ranks, Insogna became director of the Yale Bone Center in 1987. John Wysolmerski, MD, professor of medicine (endocrinology) and section chief, endocrinology and metabolism, met the calcium and bone metabolism expert with “jet black hair and a bushy moustache” during this time. Wysolmerski was a clinical fellow at the time and recalls lab meetings with Insogna’s lab.
On the clinical side, Wysolmerski was taken by Insogna’s expertise, so much so that he sent family to be cared for by him. “Karl grew the Yale Bone Center into a subspecialty clinical practice rather than just seeing some patients. He was the go-to person to learn about metabolic bone disease. When I was a fellow, we interacted quite frequently in clinic seeing patients. And then he would be the person who ran the conferences and all the academic activities and journal clubs, associated with the bone center. I even sent my mother-in-law and other relatives to see him. He was a person I always looked up to for being the master clinician and teacher of metabolic bone disease and osteoporosis,” said Wysolmerski.
Insogna is credited with several advances in the treatment of several skeletal diseases including osteoporosis and X-Linked hypophosphatemia.
In addition to his personal achievements throughout his 40+ year career, Insogna touched many lives through his lab and clinical practice. Carpenter was struck by his inclusivity. “I can remember very early on when he was building his laboratory. He held a cookout in his backyard. He extended invitations to people beyond the Department of Medicine. You could see the way everyone that he worked with, and that all the lives that he touched, there was an element of a sense of community with them all. It was so immediate at the beginning that he isn’t a guy that just goes through the motions. He's engaged with people at a really substantive level,” said Carpenter.
For many years, Insogna cultivated a relationship with a multi-generational family who had high bone density. Dinah Foer, MD, assistant professor of medicine at Harvard Medical School, worked closely with Insogna and the family while she was a medical student at Yale.
“Karl would send them updates every year about the study, to maintain their connection to our work and their contribution to it. As part of our work, we went to Alabama together to meet the family and I saw how they treated him like he was part of their family. That relationship is exemplary of how Karl connected with his patients and is why he has been so extraordinarily successful,” recalled Foer.
Insogna’s passion for his patients and his work made a lasting impression on Foer, who is now a physician-researcher at Brigham and Women’s Hospital in Boston, Mass. “It was clear to me from the start, that he was invested in the most genuine way in making sure that his research could directly impact that likelihood of improving his patients’ health and quality of life.”
Insogna mentored many students throughout his clinical and research endeavors. Jessica Bihuniak, PhD, RD, assistant professor of clinical nutrition at NYU Steinhardt School of Culture, Education, and Human Development, credits Insogna for her career trajectory.
While earning her dietetics degree at the University of Connecticut (UConn), she started a rotation in the Insogna lab. “Part of my rotation as a dietetic intern was to go to his lab meetings to learn about feeding studies. I remember we had a journal club and he asked me a question about the article we were to read. I was so nervous and I got it right. He came up afterwards and he said, ‘You got it right. Good job.’”
“He was very good at being supportive, yet challenging. He pushed us, but in a good way, to want to read more, learn more, be able to answer questions at our lab meetings, contribute, present. It was this good balance of a supportive environment,” recalled Bihuniak.
She continued to train with Insogna, earning her master’s degree and PhD in the process. Her goal was to earn a tenured track position, which is what took her to NYU. During the interview process, Insogna continued to mentor Bihuniak, helping her prepare for the interview and build her CV.
“I wouldn’t be at NYU if it wasn’t for him,” Bihuniak said. “He helped me understand academia. When I entered my position, I understood the politics involved in academia. I understood expectations of a tenure track faculty. And that's because he shared those things with me. He shared his experience at Yale. He helped me understand what the job was going to be like.”
Bihuniak continued, “He also instilled in me that you never stop learning as faculty. Just because you are out of school, when you take on a career like this, you have a responsibility to continue learning. And he taught me what it means to mentor students, and I mentor a lot of the students. But it's because I had such a positive experience with him, I feel like it's my responsibility now to pay it forward.”
Erin Gaffney-Stomberg, PhD, RD, division chief, Combat Feeding division for the DEVCOM Soldier Center in Natick, Mass. also met Insogna as an undergraduate dietetic student at UConn. While working more than five years in Insogna’s lab, she first coordinated research studies, then began participating in the research, specifically looking at the effects of dietary protein on calcium absorption in the gut and mechanisms by which protein would impact calcium handling in the gut.
She was working on her master’s degree at the time, and “it was during that time I became interested in potentially pursuing a doctorate. That was not something that was ever in my plan, but Karl was really instrumental for two things. Certainly teaching me how to be a researcher and really instilling a love of research and science, but also very much encouraging me to go further with my education,” said Gaffney-Stomberg.
She credits him with encouraging her to earn her doctorate, and supporting her through that process.
“I can say very sincerely that if it was not for him, I would've never pursued a doctorate. He opened so many doors and possibilities and options for what is now a very exciting and fulfilling career that's taken many turns. Karl’s energy is amazing. He is so committed, his intellectual curiosity and the energy that he pours into anyone that he mentors. He also has an amazing ability to read people to see what they're capable of and pull that out of them,” explained Gaffney-Stomberg.
Throughout his career, Insogna served as editor for three journals, Aging, Bone, and Endocrinology. He served on Yale University and Yale School of Medicine committees such as the Women's Health Research at Yale, the Yale Brown Coxe BSRG Funds and Fellowship Committee, and Raymond P. Wong Fellowship Committee, and published 190 peer-reviewed journal articles. Insogna was appointed as professor of medicine in 2000.
Over the years, Insogna has been elected to many professional societies including the American Society for Clinical Investigation, the Interurban Club, the Connecticut Academy of Science and Engineering, the Board of Trustees of the National Osteoporosis Foundation, and as a fellow in both the American Association for the Advancement of Science and the American College of Physicians. In 2020, he was humbled to receive one of the inaugural Distinguished Clinical Career Awards from Yale Medicine for his contributions to the care of patients at Yale. In 2021, Insogna was honored with “one of the greatest academic accolades I've had the great good fortune to receive,” the American Society for Bone and Mineral Research’s Frederic C. Bartter Award, an award his mentor Arthur Broadus had received 32 years earlier. In addition to his work at the Yale Bone Center and working as an attending physician at Yale New Haven Hospital, for nearly 10 years, he served as the associate director for the Yale Center for X-Linked Hypophosphatemia with Carpenter.
Though it might sound cliché, he decided to stay at Yale for over 40 years for the people and the intellectual environment. “The people in my section are good scientists, they're good clinicians, and they're good people. And the intellectual environment here, the fervor for new ideas has kept me engaged. For most of my career, Yale School of Medicine was small—It was a small cadre of people working in a confined environment. You could bump into all kinds of people who were always willing to help you and that was really a distinguishing feature. You could stroll into a Nobel Prize Laureate's lab and ask them to help you with something, and they would say, ‘Sure, no problem.’”
Wysolmerski knows that the section has incredibly large shoes to fill. “We can’t let him fully retire, we can't find a replacement. We are thinking about splitting his position into two. Unfortunately, it's increasingly rare to find people with breadth of both clinical and scientific knowledge that Karl has as well as his laboratory medicine knowledge,” he explained.
On July 1, 2023, Insogna became Ensign Professor Emeritus of Medicine (Endocrinology), and officially hung up his stethoscope. Now that Insogna is partly retired, he has more time to spend with his wife of 44 years, Mary Beth, his son Tim, his daughter Iris, and his grandchildren, who he admits have him wrapped around his finger. He has gone to Cape May and Arizona with family members on birding excursions and is planning additional travel in the fall. He is pleased that his family’s team did not finish last in the World Series of Birding competition in Cape May several years ago.
He was recently notified that his R01 was renewed for five years, “so I will have money to run the lab,” he joked, and will move his research facility into 101 College Street when the building opens.
Foer is proud of him for recognizing when change needs to happen. “While so many other smart and accomplished leaders stay in place too long, Karl has the confidence and foresight to make space for future leaders. Even though he is no longer seeing patients in clinic, he just got another major grant which I think will help ease this transition, since everything he does in the lab ultimately is completely about patients,” she said.
“I'll still run the Yale Mineral Metabolism lab until John finds somebody to take my place,” said Insogna, which is fantastic news for Yale and all the future scientists that will be mentored by him.
Carpenter continues to be struck by Insogna’s character, that he wasn’t just writing a CV. “He was really living his life in that CV. And it impresses you over and over again. Incredibly giving, incredibly touching, extremely bright, and extremely able to apply knowledge to practice. They don't make them like that anymore, I have to say. I think one of the great legacies he will leave behind is the way he has set an example for how to be a complete academic physician.”
“I think being a physician made me a better person, and I'm hoping I helped people. And in the same way that my father was an incredible teacher, I tried to be a good mentor for the people who came through my lab and my clinic,” said Insogna.
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