This book is a personal story of an individual engaged in clinical research at a time when investigator-initiated research on humans was at its zenith.

Oliver E. Owen, M.D. was born in Roswell, New Mexico, located in the high plains of the southeastern part of the state. Inhabitants of this small town were straightforward, honest and industrious. In 1941, Roswell became the home of Walker Army Air Force Base. During the Second World War, there was an influx of people who generated excitement and enthusiasm in the Roswell village. Many of the schoolteachers were wives of army air force personnel stationed at the Base. The local and immigrant teachers were talented and devoted individuals who encouraged students to pursue higher education. The Roswell villagers created a nurturing community.

After World War II, rationing of food was discontinued and an epidemic of obesity was begun in North America. Clinical professors at medical schools were the primary individuals who dominated advances made in healthcare. This book tells the story of Dr. Owens personal quest from 1962-2005 as he strived to gain medical insight as a clinical investigator. Work was initiated at Johns Hopkins University Hospital and carried on at the Harvard University Peter Bent Brigham Hospital and Temple University Medical School and Hospital. The book describes his development and experiences as a dedicated medical scientist who had eye-to-eye contact with both normal and patient volunteers while uncovering the mysteries of human body metabolism. He and his colleagues defined the mechanisms that promoted survival during starvation and discovered disturbances that led to death when overall metabolism went awry. The book also includes background information regarding the organizational aspects of how clinical research is conducted.

As obesity was on the rise in North America, the threat from diseases that accompanied the excessive accumulation of body fat were becoming widely recognized. While starvation was a sure way to lose weight, a few clinical investigators thought that if prolonged starvation was going to be employed to reduce body fat, individuals subjected to fasting should be studied to detect impending dangers as well as the benefits of starvation. The metabolic mechanisms that came into play that allowed survival needed to be discovered. The source of fuel consumed by the brain during starvation was a peculiar enigma. Dr. Owen and his colleagues defined brain metabolism during starvation, discovering that ketone bodies (formerly thought to be toxic byproducts of fat metabolism) were in reality vital fuels for brain metabolism, and their consumption by this master organ of the body was essential for survival during starvation. This insightful finding triggered a reversal in the perception of ketone bodies by physician-scientists. Ketone body utilization as fuel by the brain spared the need of the body to mobilize proteins (amino acids) from muscle and other lean body tissues to synthesize glucose for brain energy needs.

Subsequent studies on obese volunteers undergoing lengthy starvation revealed that intricate orchestrated interplay exists among individual organs (brain, liver, kidney, muscle and adipose tissue), essential to support life during prolonged periods of starvation.

In addition to describing mechanisms employed during starvation, two other prominent disease conditions in the United States, alcoholic cirrhosis and diabetic ketoacidosis, were studied in detail. How excessive consumption of alcoholic beverages destroys the ability of the liver to provide glucose and ketone bodies for fuel to meet the body's energy requirements, and how the rest of the body comes to the aid of the dysfunctional liver of alcoholic patients, were detected and described.

Dr. Owen's research group's studies revealed how the catastrophic and simultaneous dumping of glucose, ketone bodies and free fatty acids into the bloodstream results in flooding the body with an overabundance of fuels during diabetic ketoacidosis. His team of clinical investigators gradually accumulated data regarding body composition (fat mass and fat-free mass) of lean to morbidly obese individuals with a five-fold difference in body weight. Body compositional variables were contrasted with energy requirements. From their data the principles of energy requirements for adult humans were developed. These studies showed that as the body size increases the resting metabolic requirements increase. However, there is a wide range of energy requirements of people of identical age, sex and body weight. In addition, Owen and colleagues published data showing that humans can consume food at a rate of 150 times their resting metabolic requirements. Further, walking uphill at a rate of about 5 miles per hour increases energy requirements only five-fold. If you want to lose weight, cut caloric intake!

During his time as a clinical investigator, it became evident that the drug industries were sponsoring more and more clinical studies. This activity was designed for profit. Investigator-initiated clinical research sponsored mostly by federal grants was disappearing from the American medical scene. Furthermore, litigation induced a fear among clinical investigators which restricted the enthusiasm to search for causes and cures of medical diseases.

In spite of all the miraculous tools that are now available, today's population is still dealing with the heartbreak and misery associated with medical problems, such as Alzheimer's disease, because sufficient numbers of well-trained clinical investigators are no longer available or able to discover cures for this dementia and other human maladies. This shortage of clinical investigators is preventing timely medical breakthroughs to improve healthcare in America and worldwide. This situation will undoubtedly result in a critical healthcare delivery deficit.

Dr. Owen hopes this book will help shed light on the critical shortage of clinical researchers and funding, and stimulate a resurgence of interest in and awareness of the importance of medical research in which medical doctors have eye-to-eye contact with normal and patient volunteers.