Dr. Francine Camitta Butler: Endocrinologist and Diabetes/Obesity Specialist

Dr. Fran Butler

Early one Friday afternoon, two weeks after my stroke, a cerebral bleed of unidentified cause, my husband and I drove from York to a retirement community on the outskirts of Philadelphia to interview Dr. Francine Camitta Butler.  

As a promising student, Francine went to Girls High in Philadelphia. After she graduated from there in January (instead of June) she started at Penn as a full-time student. She had planned to transfer to all-girls Bryn Mawr in the fall but decided to stay at the co-ed University of Pennsylvania instead. Her goal was to go into the medical field. As a young American woman in the 1950s, she could easily become a nurse or a medical technician, but becoming a doctor was a reach. 

As we talked, Francine Camitta recalled that her unenlightened high school physics teacher suggested that the women in his class would be better off studying English or a foreign language than science; physics was more suited for the men. This comment angered her, and she wanted to prove him wrong.

Girls High on Seventeenth and Spring Garden
 (before relocation in 1958) (Credit: px)

Her father was in the family shoe business and encouraged his daughter to do whatever she wanted to do. He wanted her to be happy. After college in the 1950s women were expected to marry and have kids. Francine’s unfailingly supportive dad carefully clipped articles from the newspaper about young women delaying marriage for a career and gave them to his daughter. (Francine’s mother was a milliner; she made and sold women’s hats.)

As young Francine felt drawn to work in medicine she volunteered at nearby Einstein Hospital  (formerly “The Jewish Hospital” and now part of Jefferson) one summer. She worked in the pathology lab cataloging slides. It seemed that the technicians (all women) were more interested in comparing diamond engagement rings than looking at the specimens. 

Postcard of The Jewish Hospital, Phila. (Credit: Stephanie Comfort)

Francine felt that this kind of job, without academic stimulation or inspiration, would not make her happy. Nursing was the other main option for women drawn to medicine, but this did not appeal to her either.  Becoming a doctor was a long shot and she knew no women physicians who could serve as role models.  So she had to look elsewhere. 

The general practitioner who delivered her (though he was not her family’s regular doctor), Dr. Morris Samitz, helped greatly. “He was the best mentor,” said Frannie as he gave her books to read and was “the father in medicine” she was “supposed to have.” 

She did well in college at Penn. When it was time to apply to medical school there was the obvious option of Women’s Medical College of Pennsylvania (the first American Medical School for women).  During her interview there, they proudly took her around and showed her where the nursery was, for when she would have a child of her own. Taken aback, she thought, “I didn’t even have a boyfriend yet!”

Women’s Medical College “didn’t seem right,” and Frannie decided that going to a co-ed medical school would be a healthier choice. 

When she interviewed at the University of Pennsylvania Dr. Mitchell, the head of admissions, told her she would make a wonderful doctor but that she could not join the incoming class since the five slots allocated to women (by a strict quota) were already filled. Undaunted, Francine walked out of his office feeling that everything would eventually be okay, though not at Penn. 

Hahnemann

When she was accepted to Hahnemann Medical College in Philadelphia she was, as noted above, one of five women in the starting class of 100 students. Fortunately, her male classmates were uniformly supportive and accepted her as an equal. When one of their teachers made a risqué remark, her colleagues let her know they were not happy about it. This kind of thing didn’t happen again.

She met York native Ivan Butler (the future neurosurgeon) in her sophomore year of medical school. He was a year ahead of her at Hahnemann and offered Frannie much support and encouragement in her studies. 

They were engaged the following year and were married in June of 1963, three days after she graduated. During their five-day honeymoon in Puerto Rico Ivan (finishing his rotating internship back home at the York Hospital) excitedly “presented” surgical cases to his new wife as they strolled along the beach. 

Dr. Woodward

While Ivan then did neurosurgical training at the University of Maryland in Baltimore, Frannie was able to do an internal medicine medicine residency there under Dr. Theodore Woodward. It was good for the two to be training at the same place. As residents, they worked in the hospital every other night and every other weekend, and they enjoyed close friendships with the other (tired) residents.

The neurosurgical trainees at the University of Maryland had the opportunity to spend three months at Queen Square Hospital in London learning the basics of classical British clinical neurology.  Ivan chose to go, and Frannie, of course, wanted to go along. By that time in her residency, her future career was beginning to take shape as she had become interested in endocrinology under Dr. Thomas Connor.  

Using his connections, Dr. Connor arranged for her to study in England with endocrine pioneers Dr. Russell Fraser at Hammersmith Hospital and Dr. Clara Lowy (who was especially interested in gestational diabetes) at King’s College. But only, said Dr. Woodward, if Frannie agreed to serve as Co-Chief Resident upon her return. (She couldn’t turn that honor down, could she?) 

Dr. Clara Lowy

Frannie told me that her experiences in England were quite inspiring and noted that there were many more women doctors in Great Britain than in the States, and she saw that they could more readily balance their medical careers with motherhood and family life. 

After the neurology training in London, Ivan spent a few weeks in Sweden learning aneurysm surgery techniques. However, it was way too expensive to stay there on a resident’s salary, said Frannie, compared to central London, and they returned home. 

(By the way, Frannie is still in touch with the 90-year-old Dr. Lowy, from whom she recently received a letter.)

After her residency, Dr. Francine Camitta-Butler had briefly toyed with the idea of doing obstetrics and gynecology but realized that “time management” would be a problem. She decided to do a fellowship in endocrinology with Dr. Connor.

As Ivan was completing his training with Dr. James Arnold he was slated to do the neurology and neurosurgery at the Fort Howard VA Hospital through the University but that opportunity suddenly fell through.

Fortunately, Dr. Frank W. Weaver (1909-2004), Chief of Surgery in York, “took care” of Ivan and brought him to the York Hospital to start a neurosurgical service. He would begin in July of 1968. By then, Frannie was pregnant and due to deliver in August. 

Sadly, the baby was stillborn. Frannie soon conceived again and while pregnant, she commuted from York to Baltimore (about 40 miles each way) to finish the second year of her fellowship.

When she opened her endocrinology practice in York in 1969 (mostly taking care of patients with diabetes and thyroid problems, but sometimes seeing rarer pituitary or adrenal disorders) there was only one other woman physician on the medical staff of the 500-bed hospital, Dr. Lois Kushner. (Dr. Kushner was the first woman physician Frannie met in the States!)  

This time ushered in the “second wave” of the feminist movement that developed in the context of other active social movements involving, for example, workers’ rights and damaging racial discrimination.  This brought progress in terms of women’s equity in medicine. In 1970 only 5% of American physicians were women; in 2025 that figure is currently 38%. 

Percentage of first-year medical students by gender
from 1965 to 2016
(Credit: Assoc. of American Medical Colleges)

Anyway, Franie’s second pregnancy went well and she delivered a healthy son. Since she and Ivan both had active medical practices (with meager coverage) they needed to find a live-in nanny to help out. A wise woman from Jamaica (who arrived here when their son Hank was six weeks old) turned out to be “a blessing from heaven,” said Frannie: this woman would be the “daytime mommy” while Dr. Camitta was the “nighttime mommy.” 

The kind Jamaican supplied abundant “lovin’” and was “wonderful” with Hank (and, eventually, with his two younger brothers, Scott and Matt). 

But when Hank was ten, the beloved nanny became ill. Frannie noted that “her color was pale” and that “her belly was sticking out.” In fact, her abdomen was (ominously) “rock hard.” It turned out that she had a very rare aggressive malignant endocrine tumor, a pheochromocytoma. She died soon after the diagnosis was made, and before any treatment could be offered. It was a terrible loss, but this was softened a bit when the nanny’s 16-year-old daughter left Jamaica to live with the Butlers for a while. 

Gloria Steinem

An interesting historical connection: The noted activist feminist Gloria Steinem came to York in the early 1970s as part of a speaking tour.  Frannie and Ivan were given the job of driving her to the airport after the session.  Ms. Steinem sat in the front passenger’s seat as Ivan drove.  In conversation, one of the things he mentioned was that in 1961, breaking into a male-dominated world, Ruth Kerr Jacoby became the first woman to be board-certified in neurosurgery. (Even now, only 8% of neurosurgeons are women.) 

Turning the gender tables, Gloria inquired as to when Ivan took time off to babysit his boys.  Frannie, seated in the back with a woman whose name she’s currently unable to recall, quickly spoke up for her weary husband: “He would if he had coverage!” (Fellow neurosurgeon Dr. Ronald Paul didn’t join Ivan until 1973.)                                   

Though she always maintained her own medical practice, Frannie enjoyed working with her colleagues, including reproductive endocrinologist Dr. Robert Filer and the multiple-boarded Dr. David Shearer. She said she and Dr. Shearer traveled south to Baltimore for weekly endocrine conferences at the University of Maryland and often went north to Hershey Medical Center to present interesting cases from York Hospital. This was way before cell phones, and Frannie had to know where the pay phones were along the way so if her beeper went off, she could respond.   

 Dr. Francine Camitta Butler said that her three sons were proud of what their busy mother did and that as she juggled the demands of family and work, she just tried to “keep things normal.”

Her practice, of course, evolved over the years. As the typical American diet changed and we gained weight, much of her work focused on the epidemics of obesity and type 2 diabetes. In the early 1960s, the rate of obesity in the US was 13%, with only 1% of adults being termed “morbidly obese.” The current rate of people living with obesity (as judged by BMI) is around 43%, with as many as 19% of those considered to be in the dangerous morbid obesity category.

US obesity rate by state 2022 (Credit: Joyce Ma)

And diabetes? In 1958, less than 1% of Americans were diabetic; that figure is now at least 10%, many of whom are undiagnosed. This shocking ten-fold increase in a formerly relatively uncommon disease happened in a generation. What happened? Our genetics didn't change; the food environment, the food landscape, did.

Dr. Camitta Butler said that a substantial part of the increase in obesity occurred after the food industry replaced the fat content of processed foods with lots of sugar. This was in response to the developing (and still incomplete) narrative connecting types of blood lipids (circulating fats) and diet with coronary heart disease. 

Unfortunately, more added sugar in food leads to more calories consumed overall (sugar is tasty but not satiating). The storage of excessive calories results in swollen and leaky fat cells with more fat in the “wrong” places, such as in the liver and muscle and around other internal organs, where it does damage. This contributes to an impaired response to insulin, insulin resistance, a forerunner of diabetes.

[Some science (with help from my husband): Adipose tissue (fat) is a highly active endocrine “organ” that regulates many metabolic pathways through the release of hormones and cytokines.  The most well-known of these circulating factors is leptin. This informs the brain (by way of the hypothalamus and hippocampus) about the body’s total energy stores; it regulates hunger, satiety, and energy expenditure. But it also affects, among other things, the immune system and inflammatory response, the heart and vascular system, the reproductive system, and bone growth. Lack of a response to the signaling actions of leptin is common in obesity.] 

Back to Frannie. At one point, she tried to address the problem of overweight by offering her patients a dietary plan with pharmaceutical (Sandoz) backing. The novel OPTIFAST very low-calorie total meal replacement (TMR) program promised quick results. Like all diets that severely restrict daily calorie intake (it now starts at 800-1200 calories but was even more limited initially), patients lose weight quickly. 

But it turned out that the weight loss is maintained only if patients continue to use some TMRs and have ongoing behavioral intervention, including engaging in 150-180 minutes of moderate or vigorous physical activity weekly. 

Dr. Camitta-Butler told me that (as there was virtually no formal instruction about nutrition in medical school) she learned a lot from the registered nutritionists at the York Hospital, especially Marta Smith, who worked closely with her on the OPTIFAST program.

I asked Frannie about Ozempic and other GLP-1 receptor agonists for weight loss (rather than for diabetes, as they were initially designed to be used and for which they are quite helpful).  She thought these weren’t good solutions for obesity alone, and said that we don’t yet know the extent of the long-term effects (both positive and negative) of these drugs since many tissues have GLP-1 receptors.  She was wary of people getting information about these highly active medicines from TV advertising or the internet rather than their doctor.   

Effects of GLP-1 or GLP1R agonists
(Credit: cardiab.biomedcentral.com)

After retirement, Frannie volunteered for a while with the international health and human rights organization "Doctors of the World.” Their stated mission is to “provide emergency and long-term medical care to vulnerable people, wherever they are.” Along with Dr. Wolfe Blotzer, she helped evaluate the torture claims of asylum seekers detained in the York County prison while awaiting deportation. 

In 2019, Frannie and Ivan planned to move from York to a retirement community outside of Philadelphia. Ivan died suddenly at 83, just before the move, and Frannie had to make the transition by herself. Nearly five years later, she has enjoyed the community and has remained active.  She has been able to continue to exercise and she learned to play the ukulele and duplicate bridge. The retirement community offers a variety of classes and lectures as well as field trips.

Her time is filled with new friendships and new challenges. She feels blessed that her sons and their families (she has seven grandchildren) live within a two-hour drive, allowing for frequent visits. She is proud of her sons' accomplishments in non-medical fields. One is in real estate law, one is an executive at Warner/Disney, and the third is the executive director of the PA Jewish Coalition and is a lobbyist for a few other entities. 

The extended Butler family (Credit: York Dispatch)

She remains connected to her Jewish faith and has enjoyed a leadership role in the Shannondell community. She noted that it has been enlightening to bring together people with different approaches to the observances of the Sabbath.

And as we ended the pleasant visit, Frannie walked us out of the building and carefully showed us some of the amenities of the beautiful facility. The wintry low sun was beginning to set, and she would soon get to celebrate Shabbat, the sacred day of rest, with others.

Suggested Readings: 

1. Coelho, Marisa. "Biochemistry of adipose tissue: an endocrine organ." Archives of Medical Science 2013; 9(2): 191-200. (Fat is a complex active tissue.)

2. DeAngelis, Catherine, MD, MPH. Pursuing Equity in Medicine: One Woman's Journey. CreateSpace Independent Publishing Platform, North Charleston South Carolina, 2016. (The story of a remarkable career and a plea for equity and impartiality; freedom from bias or favoritism. Dr. DeAngelis was the founder of the Hopkins General Pediatrics and Adolescent Medicine Division and the first woman editor-in-chief of JAMA.)

3. Yeo, Giles, PhD.The Science of Obesity and the Truth About Dieting. Pegasus Books, Ltd. New York, 2019.  (An entertaining but rigorous read. As a research geneticist, Dr. Giles has said that "we have evolved to eat when we are hungry and when there is food, not to stop." And in the 21st-century food environment, "we are preparing ourselves for a famine... that is never ever going to arrive." p. 22.)

By Anita Cherry 03/16/25

(March is Women's History Month in the US, UK, and Australia.)