Little, James Alexander

James Alexander “Alick” Little was born in Detroit, Michigan on December 8, 1922, the son of John Burton and Beatrice Olive (Walker) Little. In 1934 his family moved to Parry Sound, Ontario where he received his early education. While in the Royal Canadian Army Medical Corp he studied medicine at the University of Toronto and received a M.D. in 1946. This was followed by four years of residency training in the University of Toronto hospital system and two years as a Medical Research Council Fellow in Biochemistry at the University of Toronto with a M.A. (Biochemistry) degree.

In 1952, he joined the staff of Sunnybrook Department of Veterans Affairs Hospital as Research Associate and Director of the Atherosclerosis Project. This ten year study was one of the first to establish the link between certain elevated serum lipid and lipoprotein fractions and coronary heart disease [1]. Concurrently, Dr. Little practiced medicine and joined the staff of St. Michael’s Hospital as Clinical Teacher (1954-1963) and was appointed Associate Professor at the University of Toronto in 1963. Four years later he was promoted to Assistant Professor. During these years he held various positions including Director of the Diabetic Clinic, Director of the Clinical Investigation Unit, Director of the Lipid Clinic, Director of the Division of Endocrinology, Metabolism, and Nephrology and Hospital Research Coordinator. He initiated their Artificial Kidney Program. In 1974 he was promoted to Professor of Medicine in the Faculty of Medicine.

During this time vital statistics continued to show that coronary heart disease and other complications of atherosclerosis were increasingly the major cause of death in our society. This convinced Dr. Little that his major research efforts should be redirected to the prevention of this disease. Therefore he initiated a series of studies of the effects of diet and medications on lipid and carbohydrate metabolism of patients with premature atherosclerosis due to elevated serum lipids and/or diabetes mellitus. This was done in collaboration with the Hospital Departments of Dietetics, Clinical Biochemistry and Pathology, and the Connaught Laboratories. This work brought him into contact with the U.S. National Heart Institute (NHI) (later called the National Heart and Lung Institute (NHLI) and still later the National Heart, Lung and Blood Institute (NHLBI). There had already been attempts to prevent coronary heart disease by lowering serum lipids by various means including diets and certain medications but the results were unconvincing because of relatively small numbers of subjects over relatively short periods of time. The majority of medical practitioners and cardiologists were openly antagonistic to suggestions that they should try to prevent atherosclerotic disease. The directorate of NHLBI wisely convened a Task Force of experts to develop and long-range plan to combat atherosclerosis by both research into the causes and by education of physicians and the public. For these purposes they funded a system of coordinated groups of scientists to carry out basic and applied research to study the prevalence of blood lipid abnormalities in the population and to best the hypothesis that lowering blood lipids will prevent atherosclerotic disease in man [2].

In December 1970, the NHLI issued a Request for Proposal (RFP) for development of Lipid Research Clinics at various universities “as part of a collaborative research program to study the structure, metabolism and functions of lipids and lipoproteins as they relate to premature atherosclerosis.” Dr. Little was a member of the review committee for awarding these proposals to U.S. universities. Later in 1971, a second RFP for Lipid Research Clinics was sent out and this time Toronto and McMaster Universities were invited to respond. A committee with representatives from both universities prepared a proposal submitted in December 1971. The proposal was accepted and the Toronto-McMaster LR Clinic was established. Up to this time this was the largest external medical research contract awarded by the USA, eventually totaling over $8 million.

Toronto-McMaster Lipid Research Clinic was the only Canadian clinic out of 12 clinics established in North America. Dr. Little was appointed its Director in 1972. During its 20 year duration, it participated in the Population Studies (Prevalence Study, 1972-1978; the Family Study, 1975-1978; and the Follow-up study) as well as the Coronary Primary Prevention Trial (CPPT). The final report of the CPPT was released in 1984 after 10 years of study. The Toronto –McMaster study alone screened 68,000 men in the area in order to find the 300 men suitable for the CPPT [3]. Dr. Little continued as director of the Lipid Research Clinic until the study was completed in 1992 [4].

Throughout his forty-year career and into retirement, Dr. Little has written extensively on metabolic diseases, lipid metabolism, atherosclerosis, diabetes and nutrition. Many of his publications have been the result of the two major research studies on atherosclerosis and lipids. In addition, Dr. Little has lectured to medical students and professionals on his areas of expertise, as well as presented papers at conferences, meetings of various societies and associations, and to members of the general public. His most recent curriculum vitae cites 121 articles and publications produced in collaboration with colleagues between 1951 and 2000 (not including the numerous publications resulting directly from the Lipid Research Clinic), 88 abstracts, and 118 invited lectures, talks and presentations.

Following his retirement from the University of Toronto in 1991, he has continued his ‘odyssey in metabolic research’ by continuing to write and publish in his fields of interest.
For his work as director of the Lipid Research Project in Toronto he received in 1981 a citation from the US National Institutes of Health Lipid Research Clinics Program. In 1984 he was named recipient of the Pfizer Travelling Fellow of the Clinical Research Institute in Montreal. In 1988 St. Michael’s Hospital renamed the Lipid Laboratory the “Alick Little Lipid Research Laboratory”. In that same year, he was the Organizing Committee Chairman of the first Canadian Consensus Conference on Cholesterol [5]. He became a Fellow of the American Heart Association (F.A.H.A.) in 2000.

NOTES

[1] “Studies of Male Survivors of myocardial infarction due to ‘essential’ atherosclerosis. II Lipids and lipoproteins. Little, J.A. and Shanoff, H.M. Can Med. Assoc. J. 89:961, 1963.
[2] Little, J.A. “The National Heart and Lung Institute Lipid Research Clinic Program a Toronto-McMaster University” Canadian Journal of Public Health, Sept-Oct. 1974, p. 379
[3] The records of this LR Clinic are in accession number A2002-0009
[4] There was a LRC funded by the U.S.A. in Russia and in Israel. Dr. Little feels that, it is to the credit of the U.S.A. for their generosity and foresight in development and funding the LRC Program and including Canada and other countries in all the stages.
[5] Canadian Medical Association Journal. Supplement. 1988. Vol. 139 (11)