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Focus on Brad A. Racette, MD

Brad A. Racette, MD is a professor of neurology. His areas of clinical interest include movement disorders, Parkinson disease, dystonia, Huntington disease and spasticity.

Dr. Racette sees patients at the Neurology Clinic, McMillan Building 517 S. Euclid Ave. and at the Center for Advanced Medicine, 4921 Parkview Place, Suite C, 6th floor.

FOR AN APPOINTMENT, PLEASE PHONE 314 362-6908.

Why did you choose neurology as your specialty?

I went into medical school debating between orthopedic surgery and neurology -- two very different specialties. I liked the diseases of the brain and the process of assessing a patient with a neurological problem. I thought neurology would hold my interest and challenge me better than anything else that I had experienced in medical school.

What brought you to Washington University?

When I interviewed for my residency, I had a sense that of all places that I visited, I would probably be the happiest at Washington University. There was just something about it that felt comfortable, probably, in part, because I am originally from the Midwest.

I did my residency here with no real expectations that I was going stay long term. Because of a strong faculty mentor, Dr. Joel Perlmutter, I ended up becoming very interested in my specialty --movement disorders. I stayed after my residency and did a fellowship with Joel. I came to St. Louis in 1993 and have been here ever since.
The Racettes in Tuscany


Which aspect of your practice do you find most interesting?

Almost all my research involves studying environmental and genetic risk factors for Parkinson’s disease. As far as my clinical practice – one half is spent medically managing people with Parkinson’s disease; the other half is performing Botox™ injections for neurologic conditions such as dystonia and spasticity in both adults and children. The patients I see have very treatable neurologic disorders. There are a lot of rewards that come with the successful treatment of my patients. I also specialize in treating children with cerebral palsy with Botox injections. My practice is very busy and rewarding -- I like all aspects of it.

Are there any new developments in your field?

There are lots of new developments and I like to think that we have contributed to some of them. We are doing some very interesting Parkinson’s disease research that looks at exposure to metals in the workplace and in the general environment. We also have some provocative data on pesticides and herbicides and how they may contribute to the risk of Parkinson’s disease. We’re interested in clarifying those potential risk factors to reduce exposure and in turn, the number of cases of Parkinson’s disease.

The first landmark treatment for Parkinson’s disease was the advent of the drug, levodopa, which was back in the 1970s.The next big advance was deep brain stimulation. Deep brain stimulation involves implanting pacemakers in the brain to help control the symptoms in Parkinson’s patients. About 10% of Parkinson’s patients are appropriate candidates for deep brain stimulation. It’s a very important and powerful treatment for the appropriately selected patient. I’d say that in my career, it has been the most important advance that has occurred.

I believe that the next major advances are going to build upon the understanding of rare genetic causes of Parkinson’s disease that have occurred in the last 15 years. These rare cases have led to the discovery of over 10 genes that are responsible for Parkinson’s disease in specific families. Those genes have taught us a lot about what seems to be happening in the brain of the person with Parkinson’s disease who doesn’t necessarily have a family history. It doesn’t tell us what causes it, but it tells us what happens after it starts. Based on those genetic findings, I think we’re going to see specific medicines targeted to the process that occurs in the brain, once the disease has started.

These new medicines will be aimed at trying to slow the progression of the disease based upon an understanding of what happens that keeps the disease progressing. Parkinson’s disease is a progressive disorder, unlike a condition like stroke where the brain damage does not change over time. Parkinson’s is an ongoing destructive process that doesn’t have a clear cause in most people. I think we’re going to see some targeted therapies – hopefully in the next decade, because we are getting to the point where we now understand this process better.

Where are you from originally?

I was born and raised in Mattoon, Illinois. I went to college on the east coast and my wife is from the east – so I didn’t necessarily intend to settle in the Midwest. We moved to St. Louis from Chicago. There’s a quality of life here that you don’t see anywhere else and that’s been very important to us. When we visit my in-laws back East, we end up spending 10 times more time in traffic than we ever would here. The shutdown of highway 40 pales in comparison to an accident on the Garden State Parkway at rush hour. In St. Louis, we don’t drive to work – we bike or take the train. We live close enough that I can run home from work at least once a week –it takes me 26 minutes if the weather cooperates (and if I’m running well).

Do you have a particular award or achievement that is gratifying?

The most important achievement that has influenced the rest of my career was attending Princeton. I came from a small town and going to Princeton wasn’t even on my radar screen. I thought it was too expensive and not even an option. I was actually registered to go to the University of Illinois, but I was recruited to play football at Princeton. I took on a significant amount of debt and it was obviously a bit of a struggle for my parents.

While at Princeton, I was actually discouraged from considering more advanced courses. They thought that since I was from a public school in the Midwest, I wasn’t going to do well if I was pushed too hard – especially in that first year. I was pretty tenacious in taking the classes that I wanted and ended up majoring in molecular biology – I worked incredibly hard and graduated with honors. I would say that that’s probably the most important accomplishment in my life because it paved the way for the rest of my career.

What do you do when you’re not working?

My children's sports occupy a huge part of my free time. Both my kids play select soccer. I help coach my younger daughter’s soccer team (even though I have never played soccer in my life). Soccer is a big deal in our house. Both kids are also very skilled runners.

I used to be exclusively a runner, now I cycle. If I’m not doing family things and if I can be out riding – that’s where you’ll find me. The highlight of our year is when my wife and I to go to Europe with a group of friends for a week and just cycle. I’ve climbed Mt. Etna four times and Mt. Ventoux (in France) on my bike. In our minds, it’s the best vacation we could have. Now it’s not most people’s idea of a vacation, because we’ll go out and ride 300-400 miles in a week. You may be ready to cry at some point during the day because you’re exhausted and your legs are screaming -- but it is immense fun. Aside from my family, cycling is my passion.

What is the best advice you’ve ever received?

I would say that the best advice I’ve received was from my mentor, Dr. Joel Perlmutter, who encouraged me to try reserve at least half my time for research. When I started here on faculty, I wasn’t sure what I was going to do in the way of research. But when I began genetics research, I had enough time set aside so that I could have some success and get NIH (National Institutes of Health) funding. It’s really the key to academic success – if you want to do research, you have to have the time.

What lifestyle change do you think could most benefit our health (besides cycling through Europe)?

I think what we are most lacking is exercise. Also, people’s dietary choices are abysmal. My wife is a researcher here as well –her interest is obesity and diabetes research. Our family lives a lifestyle that includes lots of physical activity and a very healthy diet. There’s no question that diet is important – but I think that most people are too inactive. Exercise is the cornerstone for good health -- but it’s also the hardest thing to get people to do. My wife and I have a lifestyle approach to exercise. We have a time of day -- every day, where we exercise. It only works well when it is integrated into your lifestyle. It’s not the exception, but it’s the expectation.

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