Dr. John A. Clements, a giant in the field of respiratory research who solved one of the greatest mysteries of the human lung in the 1950s and then saved thousands of lives by designing a drug to treat lung failure in premature infants, died on September 3 at his home in Tiburon, California, north of San Francisco. He was 101 years old.
His death was confirmed by his daughter, Carol Clements.
In 1949, Dr. Clements had just graduated from Cornell Medical College (now Weill Cornell Medical College) and was working as a physiologist in the Army when he became intrigued by the amazing mechanics of human breathing.
Why do the millions of tiny air sacs in our lungs contract when we breathe out, but don’t collapse like a balloon? Dr. Clements theorized that there must be some chemical that relaxes the surface tension of the air sacs. He went on to identify this substance as a surfactant, a type of lubricant that acts like household cleaners.
Dr. Clements proved the presence of surfactant in the lungs in 1956 based on research using crude equipment he built himself.
His work led to a groundbreaking discovery three years later by two Harvard researchers advised by Dr. Clements: They found that premature babies who died from respiratory distress syndrome (RDS) had underdeveloped lungs and no pulmonary surfactant.
The disease was once the leading cause of newborn deaths in the United States, killing about 10,000 people a year in the 1960s.
One notable RDS death is Patrick Bouvier Kennedy, the second son of President John F. Kennedy and Jacqueline Kennedy. Patrick was born five and a half weeks prematurely in August 1963 and died a few days later.
“In the 1950s and early ’60s, if you had severe respiratory distress syndrome, you would die more than 90 percent of the time,” Dr. Clements said in a 2017 interview with the YouTube channel iBiology Science Stories.
The discovery that premature babies lack pulmonary surfactant triggered a worldwide rush to find a treatment. Some researchers tried surfactant substitutes extracted from sheep or cow lungs, but Dr. Clements believed that animal surfactants were dangerous to small babies.
So in response to a request from the Premature Baby Nursery at the University of California, San Francisco, where he was a professor of pulmonary biology and pediatrics, Dr. Clements began developing a synthetic surfactant.
“That might sound incredibly naive, or on the other hand, really arrogant,” he said in a 2017 interview published on the university’s website. “But I said, ‘Well, let me build it for you.’ If you believe in evolution, we’re trying to accomplish in a matter of weeks or months what it took divine providence millions of years to accomplish.”
His research led to the development of the first synthetic pulmonary surfactant, which the University of California licensed to the pharmaceutical company Burroughs Wellcome & Co. The company’s drug, Exosurf, was the first alternative surfactant approved for clinical use by the Food and Drug Administration in 1990.
Eventually, further research found that animal-derived surfactants were more effective, and today animal-derived surfactants are the most commonly used. Infant deaths from RDS in the United States have fallen to fewer than 500 per year.
In 1994, Dr. Clements received the Albert Lasker Clinical Medical Research Award for “what is widely recognized as the most important discovery in pulmonary physiology of the past 50 years,” according to the award citation.
Dr. Jordan U. Gutterman, who was director of the prize at the time, noted how exciting it was for scientists to be responsible for both breakthroughs in basic research and the development of marketable therapeutics.
“This is the incredible story of a man who looked at a problem, studied the physiology and solved the problem,” he told The New York Times.
Dr Clements donated his prize money of $25,000 to UNICEF.
John Allen Clements was born on March 16, 1923, in the Finger Lakes region of Auburn, New York, the youngest of four children to Harry Clements, an attorney, and Mae Victoria (Porter) Clements.
Both his parents encouraged his interest in science experiments from a young age: he attached a flashing light with the word “Scientist” to a shoebox and hung it in the window of their house, and he built a Tesla coil from parts he collected, but the police told him to turn it off after 6pm because it was interfering with the neighbors’ radio stations.
Dr. Clements took advantage of an Army-funded accelerated program to complete his undergraduate studies and his M.D. from Cornell University in five and a half years. After graduating in 1947, he took a position at the Army Chemical Center in Maryland.
In 1949, he married Margot S. Power, a classical singer who went on to perform with the Baltimore Symphony Orchestra, the Marin Symphony Orchestra, and the Carmel Bach Festival. She passed away in 2022. Dr. Clements is survived by his daughter, Carol, as well as a daughter, Christine Clements.
Dr. Clements was recruited by the University of California, San Francisco in 1959 and trained a generation of physicians and researchers in the school’s pulmonology laboratory.
After retiring in 2004, well into his 90s, he drove to his university office two or three days a week to continue his research and advise others.
He parked his car in the same place for 50 years, and Carol Clements said it spoke to his level of concentration: He was always thinking about his lab work, and if he’d parked his car somewhere else, he’d never remember where he’d parked it.
