Beyond the Dome: Craig Smith

Co-founder and retired manager of Algenol Biofuels LLC; co-founder and CEO of Guilford Pharmaceuticals; and co-founding director of Johns Hopkins Medicine’s Division of General Internal Medicine

Published in Aequanimitas - Summer 2016

Growing up in a small town near Buffalo, New York, Craig Smith was inspired by his parents, his family’s physician and his love of science. Smith earned his M.D. at the University of Buffalo in 1972 and trained in internal medicine at The Johns Hopkins Hospital from 1972 to 1975. He served on the Department of Medicine faculty from 1975 to 1988. Smith’s efforts would herald a new era in medical training at the school of medicine.

In the spring of 1977, while finishing his second year as an assistant chief of service in the Department of Medicine, Smith met with then-Osler director Victor McKusick to advocate for the creation of a division of internal medicine at Johns Hopkins. McKusick embraced the idea and appointed Philip Tumulty the inaugural division director and Smith its associate director.

Together, Tumulty and Smith sought to build a division of exceptional general internists on the full-time faculty who would teach, care for patients, conduct clinical research and serve as role models. Smith was instrumental in securing funding for a fellowship training program. He served as division director from 1977 to 1985.

After growing the division to the third largest in the department of medicine in research and clinical practice income, Smith stepped down in 1985, when he was appointed a Burroughs Welcome Scholar in pharmacoepidemiology. Three years later, he left for the private sector. Following a series of executive positions at Centocor, he co-founded Guilford Pharmaceuticals in 1993. During his time at Centocor and Guilford, he led or participated in the development of several drugs, including Centoxin, ReoPro, Remicade, GLIADEL and Lusedra.

Smith retired in 2004, but two years later, he co-founded Algenol Biofuels LLC, an industrial biotech firm that creates ethanol from algae using carbon dioxide. He and his wife, Susan, live in Naples, Florida. They have two daughters and twin grandsons.

What did it take to build support for the creation of the Division of Internal Medicine, and why was it so important to you?

At that time, the pendulum had swung heavily in favor of subspecialty medicine and laboratory research as a route to academic success. A number of highly regarded clinicians had left the faculty to go to other institutions or into private practice. Though I didn’t think it was justified, there was a sense that Hopkins didn’t value clinical work or investigation. I was passionate about filling in the gaps and spoke to Phil Tumulty, whom I greatly admired. A white paper from Cornell, by a former Hopkins colleague (Jeremiah Barondess), made a compelling case to create a division of internal medicine that could help us grow general internal medicine and clinical investigation at Hopkins.

What were you able to accomplish during your time as division director?

We spent a lot of time building a strong faculty, growing our clinical practice, establishing the fellowship and conducting clinical research. We also came up with the idea to send fellows to the Johns Hopkins Bloomberg School of Public Health to study epidemiology and statistics. We started requiring our fellows to get master’s degrees in public health. That turned out to be a very important bridge across Wolfe Street.

What made you decide to switch to a career in the biotech world?

I was always interested in business and clinical research, and I wanted to take on new challenges and advance treatments, especially in biotechnology.

What lessons do you bring to the biotech world from your years at Johns Hopkins?

First, my time at Hopkins helped me become a person who enjoyed building and organizing groups with a purpose. Starting a division in academic medicine is different from starting a company, but both require the ability to recruit first-rate talent and build successful programs. I came to love clinical research and the opportunities created by the explosion at the applied level in medicine and physiology through biotechnology. I have used those skills to figure out how to apply them in a practical and potentially sound business way. I’ve taken on sepsis, neurodegenerative disease and brain tumors, to name a few of the windmills I’ve charged, and I have enjoyed real success in doing so. But I’ve also learned that failure in the world of drug development is the rule, not the exception.

What advice would you give Osler residents as they map out their futures?

Doing what I’ve done is not for everyone. I loved every minute of my time at Hopkins and feel academic medicine is a highly rewarding and fulfilling career. What I did was risky and scary at times, yet extraordinarily rewarding in many ways. If you have the wherewithal to do things that have never been done before, be prepared to pick yourself off the ground from time to time and keep going. Total commitment and persistence are key.