In Memoriam: Jim Toole, MD: Ahead of His Time

Abstract

r James Francis "Jim" Toole was a great physician, researcher, teacher, and exceptional neurologist focused on cerebrovascular disease (Figure 1). Born on March 22 in 1925, he died peacefully on September 12, 2021, at the age of 96, in his home at Arbor Acres in Winston-Salem, North Carolina. He was surrounded by his wife of 69 years, Patricia, and their four children.In Andrew Lloyd Webber's Joseph and the Amazing Technicolor Dreamcoat, the Narrator sings to Joseph, "Go, Go, Go, Joseph" and repeats this over and over and over again along with the proclamation and encouragement that Joseph was ahead of his time. That was Jim Toole. He and his approach were ahead of the times.His approach was about mentoring, collaborations, and building teams-he believed in team science before it became the catchphrase it is today. Let us make few personal reflections on this world-renowned stroke neurologist.Dr Howard was privileged to have worked alongside Jim during the planning, development, conduct, dissemination, and archiving of the National Institute of Neurological Disorders and Stroke-funded ACAS (Asymptomatic Carotid Atherosclerosis Study), the seminal, multicenter, North American clinical trial of best medical management with and without carotid endarterectomy in individuals who had asymptomatic carotid stenosis. 1 In this trial, Jim built a team of neurologists, neurosurgeons, vascular surgeons, biostatisticians, ultrasonographers, and especially research coordinators to come together to screen, recruit, follow, and care for the patients and the integrity of their data towards producing the highest quality evidence to solve this timely clinical question. Site selection did not just include the traditional academic centers, but he sought out to engage with clinical centers new to stroke research such as the Marshfield Clinic in Marshfield, Wisconsin and Lehigh Valley Hospital in Allentown, Pennsylvania that became superstars of enrollment and retention