Contents:
Commencement
First Lady Hillary Rodham Clinton, shown on stage with Medical
Dean Joseph Martin, said that Medicare, the federal government, and all
health plans should support academic health centers.
In her Commencement address at the June 4 Class Day ceremony on the Quad, First Lady Hillary Rodham Clinton acknowledged many of the challenges the medical and dental graduates will face, saying that the greatest is keeping the pledge in their class oath that "the health of my patients will be my first concern."
From the focus of this patient-doctor bond, her talk expanded to a perspective on ethics, research funding, medical record privacy, Medicare, patient rights, and health insurance. The First Lady mentioned some of the President's initiatives, of course, and worked within his political agenda. Yet she was convincing. She issued a defense of academic health centers, which, incidentally, an Association of American Medical Colleges survey has found to be underappreciated even by most Congressional health committee staffers.
The First Lady said that all Americans have a stake in the President's proposal for a 21st century research fund to boost the budget of the National Institutes of Health "at least by 50 percent over the next five years." To ensure that technology does not run wild, however, ethics should always keep pace with science, she noted.
The Human Genome Project offers a mixed blessing with ramifications for the patient-doctor relationship. "You should be able to look your patients in the eye and say information about your genes will be used to heal you, not deny you a job or affordable health insurance," Mrs. Clinton said.
Three missions of academic health centers have helped make American health care the best in the world, she said. The first two she listed were research and training, traditional legs of academic medicine's three-legged stool. The last was a more finely wrought form of the third leg, patient care: "the care for the most vulnerable." The First Lady said, "It is time for us to recognize that paying for those academic health centers and their vital missions is in the best interest of us all." She specifically called on all insurers to chip in on the academic mission.
Perhaps her most impassioned moments came when addressing health care access and insurance. "Let's be clear," she said, "as a nation, we have to continue to work toward universal, affordable, quality health care for every single American."
The full text of Mrs. Clinton's speech is available on the Web at http://www.med.harvard.edu/grad98.
--Robert Neal
Barry R. Bloom will become the next dean of the Faculty of Public Health at Harvard, President Neil Rudenstine announced on June 11.
A leading expert in immunology, tropical diseases, and international health, Bloom is the Weinstock professor and former chairman of microbiology and immunology at the Albert Einstein College of Medicine and an investigator of the Howard Hughes Medical Institute. He is noted for his involvement with the World Health Organization, the Institute of Medicine, the National Institutes of Health, and other organizations.
"Barry Bloom is an internationally distinguished health scientist with a broadly inclusive vision of public health," Rudenstine said. "He is widely known for his passionate commitment to understanding and combating infectious diseases worldwide. He is also a leading thinker and compelling speaker about the future of public health education and research."
In accepting the appointment, Bloom said, "There are enormous needs and disparities in health within this country and globally, and there are pressing resource constraints on assuring the highest quality of health for all. In a time of change and uncertainty, it is a great privilege to have the opportunity to serve one of the world's leading institutions in addressing creatively the challenges in public health."
Bloom will begin his transition to Harvard this summer, and expects to begin his full-time work as dean before the end of the fall term. James Ware, who has served as acting dean of the School for this past academic year, will carry forward in that role until Bloom assumes the deanship. Ware will then resume his service as the School's academic dean.
Bloom holds a bachelor's degree in biology from Amherst and a PhD in immunology from Rockefeller University. He joined the faculty of Albert Einstein College of Medicine in 1964. He became a full professor in 1973 and served as chairman of the Department of Microbiology and Immunology from 1978 to 1990, the year in which he also became a Howard Hughes investigator.
"I know Barry well," said HMS Dean Joseph Martin. "He is a superb scholar at the interface of medicine and public health. I look forward to many fruitful collaborative interactions individually and between our two schools."
Alumni Week may be a time for old friends to reunite, but graduates of the Division of Medical Sciences (DMS) were busy drawing a different set of connections at their annual Alumni Symposium, held on June 3. Participants spoke about how they are pinpointing the molecular and cellular interactions that give rise to a wide variety of diseases, from the relatively rare Marfan's syndrome to notoriously common diseases such as Alzheimer's and breast cancer.
Familiar medical conditions, such as infertility, are also being understood in terms of defects in the interplay between cells and proteins, said the first speaker, David Albertini, '75. A professor of anatomy and cell biology at Tufts, Albertini told the audience of 50 people that when he was a graduate student, infertility was viewed largely as a problem between sperm and egg. Now researchers are looking at a more basic communication problem--between an immature egg cell, or oocyte, and its surrounding layer of nutritive cells, the follicle.
| David Albertini, DMS '75, presents his research on the molecular basis of infertility. |
Albertini and his colleagues recently discovered that a protein, GDF-9, is critical to this interaction. When they knocked out the GDF-9 gene in mice, follicles failed to form normally, which in turn caused oocytes to deteriorate. HMS researchers David Paul and Dan Goodenough have recently discovered that knocking out the protein connexin 37 causes defects in oocyte development. Understanding the role of GDF-9, connexin 37, and other proteins in the development of oocytes and follicles could lead to new methods of restoring fertility, said Albertini.
Keeping the focus on women's health, Elizabeth Spar, '92, described how women experience a decrease in their estrogen levels during menopause. Spar, who was a research associate at the Dana-Farber Cancer Institute, discovered that the protein cyclin D1 regulates the activity of estrogen receptors. Because tumors with estrogen receptors are more likely to respond to chemotherapy, increasing levels of cyclin D1 in postmenopausal breast cancer patients could enhance treatment.
A Role Player in Alzheimer's
Researchers are also exploring how proteins interact to cause Alzheimer's disease. William Rebeck, '91, described how the protein ApoE binds amyloid-beta (A-beta), the protein that makes up the ruinous plaques found in the brains of Alzheimer's patients. Although it is not clear how ApoE interacts with A-beta, it appears to be involved in the growth of amyloid plaques rather than their initial formation. Intriguingly, some forms of ApoE may be more damaging than others. Rebeck, who is an assistant professor of neurology at MGH, also described how people carrying the gene for ApoE 4 are at higher risk for developing the disease at an early age. Once they have it, the proportion of cortex covered by plaques is significantly greater, said Rebeck. "We're beginning to put together a genetic picture of individuals to see the risk of developing Alzheimer's disease later in life," he said. Since there are no known cures or preventive measures, Rebeck said he did not advocate the widespread use of genetic tests for Alzheimer's at the moment.
Yet genetic tests could be extremely useful for those at risk of developing Marfan's syndrome, said Reed Peyritz, '72. Marfan's syndrome, which affects one in 4,000 people, is characterized by attenuated limbs, curved spines, ocular defects, and, most damaging, cardiovascular defects. Several years ago, Peyritz, who is chair of the Department of Human Genetics at MCP-Hahnemann School of Medicine, in collaboration with colleagues, discovered that the fibrillin gene is mutated in people with Marfan's syndrome. Fibrillin interacts with other proteins to form elastin fibers, which are the basis for skin, bone, and other tissues. A mutation in the fibrillin gene could easily produce widespread abnormalities, Peyritz said.
Fortunately, Marfan's syndrome can be effectively treated. In fact, several years ago, Peyritz helped develop and test surgical and chemical protocols that have saved the lives of hundreds of Marfan's patients. "Yet seven years after the discovery of the mutation in the fibrillin gene, there is not a single lab providing diagnosis of Marfan's using a genetic test," said Peyritz.
--Misia Landau
Alumni Week Symposia
Can infection of the gums cause heart disease?
In its broader form, this apparently far-fetched idea is not new. In 1923, scientists coined the phrase "focal infections," meaning infections that stir up trouble far from their site of origin. A belief that dental infections might be at the root of systemic inflammations led to large-scale extractions of healthy teeth.
No one advocates returning to that Draconian practice. But the notion that dental infections might cause serious disease, especially of the cardiovascular system, is regaining currency, says Raul Garcia, a 1981 HSDM graduate who spoke at the Dental School's Alumni Symposium on June 6. Garcia heads the Department of Health Policy and Health Services Research at Boston University School of Dental Medicine.
Unfortunately, C. Everett Koop's creed that "a person is not truly healthy without good oral health" is often ignored by physicians. To test whether the former surgeon general has a point, Garcia tried to document epidemiologic links between periodontal disease--which afflicts one in five American adults--and overall mortality, and between periodontal disease and cardiovascular disease, in particular.
Garcia and collaborators analyzed combined data from the Dental Longitudinal Study and the Normative Aging Study, both based at the Boston VA Outpatient Clinic. This study enrolled and followed over their lifetime 1,231 men who were healthy, white- and blue-collar workers in Boston.
At enrollment and after at least 25 years of follow-up, scientists assessed the periodontal health of the men by measuring bone loss around their teeth and by probing pocket depth at the gum line.
When calculating the relative risk posed by periodontal disease, Garcia was surprised to find that the men with the most bone loss were 85 percent more likely to die during follow-up than those with little or no bone loss. Importantly, the elevation of risk associated with bone loss approached that of established risk factors, such as smoking or family history of heart disease. The study controlled for a host of known cardiovascular risk factors, including blood pressure, cholesterol levels, body mass index, and physical exercise.
Related analyses turned up similar results. For example, analyzing just the nonsmokers in the cohort--done to ensure that smoking was not confounding the statistics--showed that the 20 percent of men with the worst bone loss had 2.5 times higher mortality than all others.
This link also appeared when Garcia's team studied coronary heart disease (CHD). People with the most bone loss faced a 70 percent increased risk of developing symptoms of heart disease. Similar results applied to stroke.
Tripling the Risk of Death
"Whichever way one analyzes the data, your risk of death increases up to three-fold if you have periodontal disease," he says.
Yet the case is far from closed. While corroborating evidence from other researchers is growing, negative reports exist, as well. In 1996, Harvard scientists studying 44,119 male health professionals reported a link between tooth loss and CHD, but they could not find an overall connection between periodontal disease and CHD (see Focus, Nov. 1, 1996). Garcia notes that this might be because the Harvard study uses self-reported periodontal information rather than more objective clinical assessments.
All his work can do is generate hypotheses, not test them, says Garcia. Assessing whether oral risk factors indeed cause or worsen CHD will require controlled clinical trials and biological studies of the underlying mechanisms. As a first step, other researchers showed last year that atherosclerotic plaques in patients' diseased coronary vessels contained DNA specific to Porphyromonas gingivalis, a bacterium causing periodontal disease.
Those skeptical about a cause-effect relationship between the health of the mouth and that of the heart may want to interpret the data more narrowly, says Garcia. Periodontal disease can serve as a red flag indicating a person's increased susceptibility to chronic inflammations throughout the body, including those that researchers nationwide are increasingly implicating in the development of atherosclerosis.
All this broadens the vista--and responsibilities--of dentists. "The potential for dentists to have a major impact on the public's general health and well-being is awesome," says Garcia.
--Gabrielle Strobel
Researchers at Harvard Medical School have identified a protein that works with the mammalian CLOCK protein to regulate circadian rhythms. Together, the two proteins appear to induce transcription of circadian rhythm genes. Their findings are published in the June 5 Science.
The daily, or circadian, rhythms of fruit flies--and presumably of mammals as well--are driven by the switching on and off of genes in selected cells. Per is one gene known to be an integral part of the molecular clock of flies. Researchers have also identified mammalian genes similar to per.
When the per gene is switched on, it initiates the synthesis of messenger RNA. The mRNA is then dispatched outside the nucleus, where the PER protein is made. The PER protein gradually accumulates in the cell for several hours and then moves swiftly into the nucleus, shutting off its own gene and ending the circadian cycle. Until now, it was unclear what turned on per.
Last year, researchers at Northwestern University identified the first mammalian circadian gene in mice, which they named Clock. Mice with mutated Clock genes have disrupted rest and activity patterns. But it was unclear how CLOCK, the protein encoded by this gene, controlled circadian rhythms.
Charles Weitz, HMS assistant professor of neurobiology, and his colleagues suspected that CLOCK might be involved in the transcriptional activation of the mammalian per gene and most likely needed a partner to do the job. They identified a protein that interacts with CLOCK, named BMAL1, and found that BMAL1 and CLOCK bind to transcription factor sites near one of the mammalian per genes, producing an increase in transcriptional activity. When the researchers used BMAL1 and a mutant version of CLOCK, the proteins bound to the same sites, but no transcriptional activity resulted.
Breast feeding, not passive inhalation, may be the primary route through which infants get exposed to the products of tobacco smoke. Researchers at Brigham and Women's Hospital and Massachusetts General Hospital report in the June American Journal of Public Health that urine levels of cotinine--a surrogate marker for nicotine--were 10 times higher in breast-fed babies than in bottle-fed babies of smoking mothers.
It is unknown whether the tobacco compounds present in breast milk cause the health problems seen in some children of smoking women, which include reduced lung function and a higher incidence of asthma. Nevertheless, the study emphasizes once again the importance for mothers not to smoke during pregnancy and nursing, says first author Maria Mascola, instructor in obstetrics, gynecology and reproductive biology at MGH.
This work was part of the Maternal/Infant Lung Study, a long-term project conducted by BWH's Channing Laboratories in collaboration with the East Boston Neighborhood Health Center. The scientists analyzed data on maternal smoking and the presence of other smokers in the home along with results of infant urine tests for 330 babies and their mothers who received care through the center.
Co-authors of this study include Frank Speizer, the Edward H. Kass professor of medicine at Channing Laboratories, John Hanrahan, assistant professor of medicine there, and researchers elsewhere.
Patients with late-stage cancer frequently overestimate their chances of survival, leading many of them into aggressive treatments that may increase suffering without markedly extending life.
Jane Weeks, assistant professor of medicine at the Dana-Farber Cancer Institute, Russell Phillips, associate professor of medicine at Beth Israel Deaconess Medical Center, and colleagues studied 917 adults with metastatic lung or colon cancer, assessing their preferences either for aggressive, potentially life-extending therapy or for palliative therapy focusing on relief of pain and discomfort. Their findings are published in the June 3 Journal of the American Medical Association.
Patients who believed they would live at least 6 months were nearly three times more likely to favor life-extending therapy over palliative care compared with patients who thought there was at least a 10 percent chance that they would not live 6 months.
While physicians were generally able to make accurate prognoses concerning patient survival, 82 percent of patients overestimated their chances of surviving 6 months. Those who preferred life-extending therapy were 60 percent more likely to have a hospital readmission, undergo attempted resuscitation, or die while on a ventilator. However, after controlling for potential prognostic factors, their survival was no better than that of patients who preferred palliative care.
One reason HIV, the AIDS virus, is so deadly is that it is extremely crafty in evading the immune system's attempts to destroy it; for example, altering surface proteins to escape detection by T cells and neutralization by antibodies. Using simian immunodeficiency virus (SIV) as a model of its human counterpart, researchers at the New England Regional Primate Research Center have uncovered a role for carbohydrates in HIV's immune evasion--a discovery they say has important implications both for the understanding of AIDS pathogenesis and for the development of AIDS vaccines. The study is published in the June Nature Medicine.
An earlier observation that gp120, an envelope glycoprotein found in both HIV and SIV, is heavily glycosylated (linked to carbohydrates called glycosyl groups) has led to speculation that these carbohydrates help shield the virus from immune recognition. The new study provides evidence supporting this hypothesis.
Julie Reitter, research fellow in microbiology and molecular genetics, and colleagues infected rhesus monkeys either with wild-type SIV or with one of several mutant forms of the virus that lacked different combinations of glycosylation sites in gp120. "The monkeys infected with the mutant viruses mounted considerably stronger neutralizing antibody responses" compared with those infected with wild-type virus, the authors write. Six months later, the mutant-infected monkeys had neutralizing antibody levels 50 times higher than the other group. They suggest that future vaccines, made with mutant gp120 lacking selected glycosylation sites, might meet with greater success than earlier vaccines using unaltered gp120.
Co-authors, also at the Primate Center, are Robert Means, a research assistant in microbiology and molecular genetics, and Ronald Desrosiers, a professor of microbiology and molecular genetics.
We all know that a high fiber diet is good for you, but few of us know why. Richard Hodin, associate professor of surgery at Beth Israel Deaconess; Sonia Archer, instructor in surgery; and their colleagues in the department are digging beneath the anecdotal and epidemiological evidence and revealing the molecular foundations that support this observation. They found that a fatty acid produced by bacterial fermentation of fiber in the colon activates a human gene critical for arresting growth of colon cancer cells.
"Butyrate is a breakdown product of fiber in the colon and one of the things it does is turn on a cell cycle inhibitor called p21," says Archer. Scientists already knew that the fatty acid butyrate is important in protecting against colon cancer, and that the human protein p21 stops cancerous cells from dividing. But until now, no one realized that butyrate's protective functions are completely crippled without p21.
| Sonia Archer and Richard Hodin recently found that a fatty acid called butyrate, a breakdown product of fiber, stifles cancer by activating a cell cycle inhibitor. |
According to Hodin, the researchers have discovered the key role of the p21 protein in the link between butyrate and colon cancer. The results of their investigation appear in the June 9 Proceedings of the National Academy of Sciences.
Butyrate is produced when bacteria that make up the normal flora found in the colon ferment ingested fiber. The researchers believe that the fatty acid induces its effects by causing a local chemical change in histones--the chromatin molecules that package DNA. Butyrate appears to interfere with the number of acetyl groups bound to histones, upsetting a delicate balance and thereby neutralizing the histones' usual positive charge. The ionic interaction between histones and DNA is disrupted as a result, exposing the p21 gene to transcription factors that can switch it on and begin production of the p21 protein.
Gumming Up the Cancer Works
P21 is not the only gene to be regulated in this way, and little is known about how specific genes are regulated by histone hyperacetylation. But the evidence from Hodin's group suggests that this is how butyrate influences p21. Once activated, p21 stops cancers from growing by interfering in the cycle of events that leads to cell division. Without butyrate, the gene remains tightly packaged and inaccessible. "The results of these studies are of potential clinical interest, since agents which increase p21 expression within colon cancer cells may be incorporated into strategies directed towards the prevention and treatment of colon cancer," the authors write.
In vitro experiments by Hodin's team found that the p21 gene is turned on and operates at maximal efficiency when butyrate is added at concentrations within the range of those found in the colon of normal healthy adults. Other researchers have already shown promising in vivo results in rodents. Colon cancers were prevented or reduced in rats ingesting high fiber diets with associated high concentrations of colonic butyrate.
The authors also agree that butyrate may be an effective weapon against other cancers if a method of delivering it to sites outside the colon can be found. "Butyrate is known to prevent growth of other carcinoma cells--the question is how to deliver it," says Archer.
There is still much to be learned about butyrate and its role in colon cancer. For instance, scientists do not know why butyrate does not turn on p21 and inhibit growth in normal noncancerous cells. But the "take home" message is becoming clearer: "People should eat a high fiber diet," says Hodin. "Although it's only a first step, the idea is that when you eat a high fiber diet, p21 is turned on in your colon cells and stops them forming into cancer cells."
--Kristin Weidenbach
At the end of this month, Gerald S. Foster, '51, is stepping down as HMS faculty associate dean for admissions, a position he has held since 1994. Before that, he was director of admissions from 1982, and for most of the time between then and 1967, he served on the admissions committee.
| Daniel Federman (left) pays tribute to Gerald Foster, who is stepping down from his admissions post. Foster (below) accepts a recognition plaque. |
"Jerry Foster has presided over the selection of more HMS students than anyone else in history," said Daniel Federman, dean for medical education, at a tribute to Foster during the June 5 Alumni Day program. "He is also responsible as much as anyone else for the high proportion of minority medical students being trained here." Federman presented Foster with a plaque from the Harvard Medical Alumni Association for his distinguished service. It bore the inscription "Qui eligit optime, nos eligit." ("Who chooses best, chooses us.")
Foster also received a tribute at the Alumni Council dinner on June 2. There, Federman quantified Foster's contribution to the Medical School: during his 15 years of leadership, there were 50,000 applications, 15,000 interviews, 4,000 acceptances, and 3,000 entering students.
At the dinner, Theresa Orr, assistant dean and director of admissions and financial aid, said, "Jerry Foster is one of those people that every professional should have a chance to work with--a terrific mentor, a great teacher, and an outstanding human being." She said he has unfailing integrity, a "willingness to do what is right even at the risk of criticism."
Succeeding Foster will be Jules Dienstag, associate professor of medicine, from the GI Unit at Massachusetts General Hospital.
The three student speakers who preceded Hillary Clinton at the Medical and Dental Schools' Class Day ceremony on June 4, all drew messages from the human side of their experience. In effect, the talks were the new doctors' first prescriptions, antidotes to the disordering technological changes in health care research, practice, and funding.
Kelly Cook, who received her DMD, spoke about the network of human relationships needed to support the pursuit of a doctoral degree, concluding that DMD stood for Done! Mom and Dad. The two medical student speakers, Tokunbo Babagbemi and Anthony Mitchell (who is also a minister), found lessons in interaction with patients. Babagbemi described the student's ordeal of being on call, a state of alert and inconvenience, which transformed during her talk into "an extension of our humanity" in caring for others. With a series of aphorisms, Mitchell expressed the things he learned in medical school, the critical insight being that "the difference between a technician and a physician is compassion."
The Class of 1998 made history, said Allison Bryant, one of the ceremony's student comoderators, since it was the first class ever to enter the Medical School with more than 50 percent women. The Dental School's Class of '98 had 43 percent women. The Class of '98 was extraordinarily diverse since ethnic minorities made up the majority of the medical class and just under half of the dental class.
The Medical School graduated 161 students while the Dental School graduated 53. The latter number is unusually high as a result of a change in the dental curriculum four years ago from a five- to a four-year course of study toward the DMD. The first four-year class and the last five-year class converged this year.
The top residency selection for MDs was internal medicine; for DMDs, it was orthodontics.
Comoderator Samuel Somers (far left) helped introduce student speakers Anthony Mitchell, Tokunbo Babagbemi (on stage above with Hillary Clinton), and dental speaker Kelly Cook (right). Three faces of the HMS Class of '98: Rachel Clark and Marissa Brett (below left) and MyrthaCesar (below right).
| Medical School grads: Ann Chen, left, Harvey Greisman and his son (below left), Ethan Basch (below center), and Oscar Benavidez (below right). |
| Dental School grads: John Seul (below left), and Rasheed Simjee (right) flanked by his brother Sohail, HSDM '95. |
Class of 1998
Christiana Bardon, Henry Asbury Christian Award
Sonya Shin, Community Service Award, Robert H. Ebert Prize, and Rose Seegal Prize
Kirsten Greineder, Society for Academic Emergency Medicine Excellence in Emergency Medicine Award
Stephen Ely and Michael Lazarski, Harvard Dental Alumni Association Gold Medal
Wells Messersmith, Kurt Isselbacher Prize
Jennifer Mack, Bemy Jelin '91 Prize
Guillermo Tearney, Harold Lamport Biomedical Research Prize
Christiana Bardon, Paula Brathwaite, Charlene Brown, Anthony Mitchell, and Victoria Smith, Multiculturalism Award
Nana Twum-Danso, NBI Healthcare Foundation Humanism in Medicine Award
Robert Congdon and Soojin Kim, Dr. Norman B. Nesbett Award
Kevin Strauss, New England Pediatric Society Prize
Melinda Fan, Leon Reznick Memorial Prize
Anne West, Dr. Sirgay Sanger Award
Jennifer Brown, James Tolbert Shipley Prize
Thomas Ruescher and Anupama Tate, Harvard Dental Alumni Association Silver Medal
Faculty
Orah Platt, Best Preclinical Teacher
Gillian Lieberman, Best Clinical Teacher
Charles Hatem, NBI Healthcare Foundation Humanism in Medicine Award
Gerald S. Foster, Faculty Member Who Has Had Greatest Impact on Class of 1998
School of Public Health Commencement speaker Ingar Brueggemann congratulated the students not only on their freshly minted degrees, but also on having extended her an invitation to speak. Brueggemann, secretary general of the International Planned Parenthood Federation, said her topic, sexual and reproductive rights, is not an easy subject to confront. "I have tough things to talk about, negative things," she said, introducing a speech laced with statistics and anecdotes about the grim circumstances of many women and children around the world. Brueggeman said sexual and reproductive rights are "part and parcel" of human rights, and she urged the public health graduates to work toward realizing standards such as those in the Universal Declaration of Human Rights (a copy of which is given to each HSPH graduate at commencement).
In another talk, class president William Faidi described health and other systems as being in a kind of turbulence that does not lend itself to quick-fix solutions, panaceas, or "wizardry." He said the problems in these systems--and the social, political, economic, and ethical challenges they can cloak--can only be solved through diligence.
The School conferred 356 degrees at the ceremony, a record number that involved an increase of more than 100 graduates from a decade ago. The majority of HSPH graduates earn master's degrees: this year, 175 earned their Master's of Public Health and 122 earned their Master's of Science. As has been the case for several years, the class included more women than men, 207 to 149, or 58 percent.
--Peter Wehrwein
| Class president William Faidi ( left) addresses his classmates at the degree ceremony. Ingar Brueggemann (bottom left), the keynote speaker, discusses sexual and reproductive rights. Pictured below are graduates Francisco Arredondo-Soberon (left), Proochista Ariana and Emily Chan (center) and Acting Dean James Ware. |
Class of 1998
Leslie Hsu, Albert Schweitzer Award & Dr. Fang-Ching Sun Memorial Award
Jonathan Sorci, Albert Schweitzer Award
Bryan Spencer, Uwe Brinkmann Memorial Travel Fellowship
Carolynne Shinn, François-Xavier Bagnoud Health and Human Rights Essay Award
Jonathan French and Aaron Foster, Robert B. Reed Prize in Biostatistical Science
R. Jeffrey Layne, Samdperil Health Law Essay Award
Proochista Ariana, Student Recognition Award
Tanya Kachen, Charles F. Wilinsky Award
Chung-Ming Hsieh, Edgar Haber Award in Biological Sciences
Faculty
Jane Gardner, Roger L. Nichols Excellence in Teaching Award
T. Hatch Whitfield, Teaching Assistant Award
Robert Blendon, David Hemenway, and Michael Reich, Faculty Teaching Citations
The June 5 Alumni Day program brought four panelists to the Quad to discuss the environment for undergraduate and graduate medical education. Following were a tribute to Faculty Associate Dean for Admissions Gerald Foster, who is retiring from this position after 15 years of heading admissions (see p. 3), and an update on the Medical School from Dean Joseph Martin.
The first two panelists, Eric Larson, '73, associate dean for clinical affairs at the University of Washington Medical Center, and David Blumenthal, '74, chief of the Health Policy, Research and Development Unit at Massachusetts General Hospital, discussed economic issues.
| Sharon Murphy, '69, (left) and Anna Berkenblit, '96, share the stage to discuss isssues in medical student and resident education. |
Looking down the road, Blumenthal said, "About the best we can hope for is to make sure that the economic interests of providers and the welfare of patients are aligned, so that when health care organizations do well, their patients do well also."
In the meantime, the environment for education is shifting. Sharon Murphy, '69, professor of pediatrics at Northwestern and chief of the Division of Hematology and Oncology at Children's Memorial, stressed the financial difficulties in training physicians that her hospital and others are facing. Anna Berkenblit, '96, a primary care resident at Brigham and Women's Hospital and Harvard Pilgrim Health Care, addressed the innovative approach of her residency. Since it is based in part at the Harvard Pilgrim HMO, it provides education in a real-world environment emphasizing the outpatient setting.
Dean Joseph Martin completed the program with a review of his priorities and strategies for research and medical education within the Harvard medical community, saying he plans "to use these annual occasions to report on our progress."
At a reception on June 3, Alvin Poussaint, faculty associate dean for minority affairs; Joseph Martin, medical dean; and a panel of two students and three faculty members (including an alumna) kicked off a year-long celebration of the 30th anniversary of affirmative action at Harvard Medical School. Panelists William Silen, faculty dean for faculty development and diversity, and Mark Ghaly, '01, emphasized the importance of looking not only at proportions of minority students, but at the continuum leading minorities from high school to academic medicine and professional practice. Ghaly said that affirmative action is not just a question of enrollment, "it's about pipeline issues." HMS has more than 10 percent African-American students, one of the highest proportions among top-ranked medical schools. This year's graduating class had more than 50 percent minorities.
Bertha Madras (left), associate professor of psychobiology at the
New England Regional Primate Research Center, will serve as its acting director
beginning July 1, when director Ronald Hunt (below right) steps down.
James Adelstein, former HMS executive dean for academic programs, said,
"As its second director, Ron Hunt brought the New England Regional
Primate Research Center to scientific maturity. Under his leadership the
programs in virology and neuroscience blossomed. We owe him a debt of gratitude
for his thoughtful stewardship over more than two decades."
Madras was selected based on her scientific achievements and leadership in neurobiology and her commitment to the Primate Center. Dennis Kasper, HMS executive dean for academic programs, called her "an outstanding choice for this position." A search committee has been formed by the Medical School to select a new permanent leader for the center.
These faculty members were appointed to a full professorship in May.
Jane Newburger
Professor of Pediatrics
Children's Hospital
Newburger, associate cardiologist in chief at Children's, has performed prospective clinical trials relevant to the field of pediatric cardiology. Her research has focused on the evaluation and treatment of children with Kawasaki disease. She also studies the effects of cardiopulmonary bypass techniques on the early postoperative course and later neurologic and developmental function in children with congenital heart disease.
Frank McKeon
Professor of Cell Biology
Harvard Medical School
McKeon's lab is focused on two major questions regarding regulation of the immune response and genetic alterations in tumorigenesis. The first concerns the molecular mechanisms that regulate the movement of the NF-AT transcription factors from the cytoplasm to the nucleus, an essential step in T cell activation. The second addresses the checkpoint mechanisms that ensure proper chromosome segregation and the role of the tumor suppressor p53 protein in this process. The recent discovery by the laboratory of p53-related genes, p73 and p63, suggests new functions and pathways for the p53 family in tumorigenesis and development.
Donald Kaufman
Clinical Professor of Medicine
Massachusetts General Hospital
Kaufman, a medical oncologist with broad clinical interests, is the director of the multidisciplinary Genitourinary Oncology Disease Center at MGH. His research focuses on the innovative management of urinary tract cancers and includes trials of newer hormones for treating prostate cancer and chemotherapeutic regimens for treating hormone resistant disease. He has worked with urologists and radiation oncologists at MGH to treat invasive bladder cancers with chemotherapy and radiation while conserving the bladder.
Robert Brown
Professor of Neurology
Massachusetts General Hospital
Brown investigates the genetic basis for selected neuromuscular diseases such as amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease, periodic paralysis, and some forms of muscular dystrophy. His laboratory identified gene defects that cause hyperkalemic periodic paralysis and one type of ALS.
Lisa Iezzoni
Professor of Medicine
Beth Israel Deaconess
Medical Center
Iezzoni's research involves risk adjustment, an essential methodology for many health services, health policy, and quality improvement studies. She has examined the clinical validity and statistical properties of the major risk adjustment methodologies used nationwide to assess the performance of doctors and hospitals and to predict resource consumption for payment purposes. Recently, she has begun to study policy issues raised by disability, specifically walking impairments.
These full professors have been appointed to an endowed chair.
Thomas Inui
Paul C. Cabot Professor of Ambulatory
Care and Prevention
Harvard Pilgrim Health Care
Head of the HMS/Harvard Pilgrim Health Care Department of Ambulatory Care and Prevention, Inui oversees programs in community-based primary care, nutrition and prevention, critical appraisal of medical literature, and basic clinical skills for all HMS students. He specializes in physician-patient communication, health promotion and disease prevention, and the social context of medicine and medical humanities. He is particularly recognized for his expertise in qualitative research methods applied to the evaluation of health services and for documenting the impact of innovations in primary care.
J. Thomas Lamont
Charlotte F. and Irving W.
Rabb Professor of Medicine
Beth Israel Deaconess
Medical Center
Lamont, chief of the Division of Gastroenterology at BID, is interested in the diagnosis and treatment of gastrointestinal infections. His laboratory studies the structure and function of bacterial toxins and the mechanisms of intestinal inflammation. He also studies the structure and regulation of intestinal glycoconjugates, including mucin.
The National Institutes of Health has appointed Gerald Fischbach director of the National Institute of Neurological Disorders and Stroke (NINDS) in Bethesda, Md., effective July 30. Fischbach is the Nathan Marsh Pusey professor of neurobiology and chairman of the department at HMS. As director of NINDS, he will oversee a staff of more than 700 scientists, physician-scientists, and administrators, and an annual budget close to $800 million.
The institute supports research by investigators in public and private institutions and 23 intramural laboratories and branches. It has been at the forefront of U.S. efforts in brain research since 1950, with studies ranging from the structure and function of single brain cells to tests of new diagnostic tools and treatments for people with neurological disorders. Fischbach is an internationally renowned neuroscientist who has studied the formation and maintenance of synapses. He is the founding director of the Harvard University Initiative on Mind, Brain, and Behavior.
* Guowei Fang, HMS research fellow in cell biology, received a Career Award in Biomedical Sciences from the Burroughs Wellcome Fund for his research on the mechanism of the spindle assembly checkpoint control. The award is part of a $12.5 million total grant designed to foster the career development of young biomedical researchers. Awards provide support ranging from $412,500 for four years to $532,400 for six years.
* John Ayanian, assistant professor of health care policy at BWH, received the 1998 Young Investigator Award from the Association for Health Services Research for his outstanding achievements and contributions to the field of health services research. His research includes the relation of sociodemographic factors--including gender, race, and socioeconomic status--to the process and outcomes of health care, and the effect of physician and organizational characteristics on the quality of health care.
The School of Dental Medicine just graduated the first dentists to have gone through its problem-based curriculum and, according to a new report, their educational experience was a success. The curriculum not only improved the training of the 27 pioneering students, but also had a profound effect on their professors and boosted the academic standing of the School's applicants.
The report, recently submitted to The Journal of Dental Education by the associate dean of dental education, T. Howard Howell, details the changes in the dental school curriculum, a project started in 1990 and put into action in 1994. The director of curriculum development, Karl Matlin; the associate dean of students, Ellen Libert; and the director of assessment in the office of educational development, Patricia McArdle, also contributed to the report.
Although the earlier version of the curriculum was producing some of the top dentists in the U.S., both students and faculty recognized that it was time to revise the five-year program. It needed updating to reduce redundant material, to streamline the sequence of courses, and to incorporate comprehensive patient care.
With the support of HSDM Dean R. Bruce Donoff, the School planned a new curriculum based on the Medical School's New Pathway. It focuses on problem-solving, teaching students critical thinking and clinical skills along with basic science. Students would spend more time learning skills and applying them to clinical settings.
In 1992, Donoff and all the departmental and administrative heads held a retreat to rework the School's goals and to chart the new curriculum.
During the first two years, students concentrate on basic medical science, with simultaneous courses emphasizing its dental aspects. A standard course in gross anatomy is complemented by another class focusing on the head, neck, and oral cavity.
In the third year, students form eight-person treatment teams supervised by a senior tutor and a group of clinical faculty. Those teams function as small group practices, teaching students both patient care and management skills. In the fourth year, the student teams spend much of their time in advanced rotations and clinics in affiliated institutions.
The architects of the new curriculum decided to discontinue the fifth year of study since it had been dedicated to research, something that students would be picking up much earlier.
Although the report mentions that the success of the new curriculum will be measured by the careers of its graduates, it notes that the benefits have already extended beyond the students' education.
The number of applicants to the Dental School has ballooned from 245 for the class of 1996 to 878 for the class of 2002. The enrolling students tend to be from more selective schools and have higher test scores than before. Their overall grade point average also rose from 3.35 for the class of 1996 to 3.64 for the class of 2002.
The curriculum has affected the faculty, as well.
According to the report, "As the curriculum has taken shape, it is evident that it does not only impact student life but dramatically alters every relationship within the School. It is impossible to preach individual initiative and responsibility and interdisciplinary thinking to students, as one must do in a problem-based curriculum, without the faculty also listening to the sermon and becoming believers."
--Cassie Ferguson
Calendar Deadlines: Focus normally appears every other Friday, with some variation for holidays and summer. The calendar in each standard issue includes events in the two-week period beginning the Wednesday after the Friday issue date. The deadline for calendar submissions is Wednesday of the week before the issue date. This means that the deadline for submission is two to four weeks before the event. Sorry, we cannot accept any submissions that come in after the deadline. If you would like to receive submission information, leave your request and fax number at 432-1592. The next Focus deadline is July 8.
Key to Institutions:
BBRI-Boston Biomed. Rsrch. Inst.
BIDE-Beth Israel Deaconess/East
Campus
BIDW-Beth Israel Deaconess/West Campus
BWH-Brigham
& Women's Hosp.
BVA-Brockton Veterans Administration
CBR-Center for Blood Research
CAM-Cambridge Hosp.
CH-Children's Hosp.
DFCI-Dana-Farber Cancer Inst.
FDC-Forsyth Dental Ctr.
HMS-Harvard Medical School
HIM-Harvard Insts. of Medicine
HSDM-Harvard School
of Dental Medicine
HSPH-Harvard School of Public Health
HU-Harvard University
JBCC-Judge Baker Children's
Ctr.
JDC-Joslin Diabetes Ctr.
MTA-Mt. Auburn
Hosp.
MEEI-Mass. Eye & Ear Infirmary
MGH-Mass.
General Hosp.
MGHE-Mass. General Hosp. East
MH-McLean
Hosp.
MMHC-Mass. Mental Health Ctr.
SBI-Shriners
Burns Inst.
SERI-Schepens Eye Research Inst.
SRH-Spaulding
Rehab. Hosp.
WRVA-West Roxbury VA
The Office of Admissions will give summer tours of the Medical School to the public in June, July, and August. Registration is required. For more information, visit www.hms.harvard.edu/ admissions/tours/ schedule/index.html. Tour dates include June 26 and July 17.
Wednesday, June 24
Medicine Grand Rounds Reisa Sperling, BWH Update on Treatment for Alzheimer's Disease 8:00-9:00 am, Macht Aud., CAM
Neurosurgery Grand Rounds Mark Proctor, CH Children's Hospital Service 8:00-9:00 am, Carnegie Classroom, DFCI
Oncology Conference Larry Marks, Duke Univ. Radiation Therapy for Breast Cancer: Post Mastectomy, Post Transplant, and CT Based Planning 8:00-9:00 am, Smith Building, Rm. 308 A&B, DFCI
Medicine Grand Rounds Dept. of Med. Residents & Faculty, CH Cases From the Wards/Graduation/Teaching Awards 12:00 pm, Enders Aud., CH
Psychiatry Grand Rounds Jagdish Ragade, BVA Literature Conference 1:00-2:30 pm, Learning Resource Ctr., BVA
Oncology Symposium
Harold Varmus, NIH; Charles Stiles,
DFCI;
Xandra Breakefield, MGH;
Paul Kliehues,
IARC;
& Frank McKeon, HMS
Giovanni Armenise-Harvard
Foundation T
he Genetics of Human Brain Cancer
1:15-5:45 pm, Walter Amp, MEC, HMS
Thursday, June 25
Anesthesiology Grand Rounds Patrick O'Gara, BWH Preoperative Evaluation of the Cardiac Patient 8:00 am, Clinics 3, Upper Amp., MGH
Medicine Grand Rounds John Godine & Steven Calderwood, MGH Cushing's Syndrome-Subacute Bacterial Endocarditis 8:00-9:00 am, Blake Bldg., O'Keeffe Aud., MGH
Virology Seminar Andrea Csejtey, HMS Towards the Structure of the Reovirus Outer Capsid Protein Sigma 3 12:00 pm, MEC, Rm. 250, HMS
Dentistry Seminar Leonard Kaban, MGH Jaw Lengthening by Distraction Osteogenesis: Biological and Clinical Considerations 12:00 pm, Haigh Aud., FDC
Ophthalmology Lecture Paul Overbeek, Baylor Coll. of Med. Broadhurst Distinguised Lecture: Growth Factors and Ocular Differentiation 4:00 pm, Taft Conf. Rm., SERI
Anesthesiology Lecture Series Deborah Reynolds, BID Laser Safety in the Operating Room 4:00-5:00 pm, Kirstein Living Rm., BIDE
Ophthalmology Lecture Series Paul Overbeek, SERI Growth Factors and Ocular Differentiation 4:00-5:00 pm, Taft Conf, Rm., SERI
Friday, June 26
Psychiatry Conference Pierre LeBars, New York Instit. of Med. Research Ginkgo Root for Treatment of Cognitive Deficits in Dementia 12:00 pm, Clinics 1, Lower Amp., MGH
Tuesday, June 30
Ophthalmology Seminar J. Wallace McMeel & Gilbert Feke, SERI Ocular Circulation Studies: New Technology and New Directions 1:00-2:00 pm, Taft Conf. Rm., SERI
Geriatrics Grand Rounds Aida Won & Lorraine Kyne, HMS Second Year Fellows Talks 4:30-5:30 pm, Trustman Boardrm., BIDE
Wednesday, July 1
Anesthesiology Grand Rounds Leonard Bushnell, BID Synergistic Epidural Analgesia 7:00-8:45 am, Sherman Aud., BIDE
Medicine Grand Rounds David Bor, CAM Chief's Case 8:00-9:00 am, Macht Aud., CAM
Neurosurgery Grand Rounds Francis Rockett, Newton-Wellesley Hosp. Neurosurgery in the Real World 8:00-9:00 am, Carnegie Classrm., DFCI
Medicine Grand Rounds Philip Pizzo, CH AIDS in Children: The Changing Faces of an Epidemic 12:00 pm, Enders Aud., CH
Wednesday, July 8
Anesthesiology Conference Scott Segal, BWH The Airway Management Algorithm 7:00 am, CWN L1 Lecture Hall, BWH
Anesthesiology Grand Rounds William Arnold, Univ. of Virg. Health System Chemical Dependence in Anesthesiologists 7:00-8:45 am, Sherman Aud., BIDE
Anesthesiology Conference John Fox, BWH Morbidity & Mortality 8:00 am, CWN L1 Lect. Hall, BWH
Medicine Grand Rounds Alan Krensky, Stanford Univ. Med. Ctr. The Cellular and Molecular Basis of Transplant Rejection 12:00 pm, Enders Aud., CH
Thursday, July 9
Anesthesiology Lecture Series Eran Metzgar, BID Electroconvulsive Therapy 4:00-5:00 pm, Kirstein Bldg., Grossman Conf. Ctr., BIDE
Wednesday, July 15
Anesthesiology Grand Rounds George Topulos, BWH Hypotension 7:00 am, CWN L1 Lect. Hall, BWH
Anesthesiology Conference Paul Lennon, BWH Intraoperative Tachycardia 8:00 am, CWN L1 Lect. Hall, BWH
Medicine Grand Rounds Carlo Buonomo, CH The Radiology of Child Abuse 12:00 pm, Enders Aud., CH
Thursday, July 16
Anesthesiology Lecture Series Lena Dohlman, BID Escape to Vietnam: Teaching and Learning in a Developing Country 4:00-5:00 pm, Kirstein Bldg., Grossman Conf. Ctr., BIDE
Focus
A Publication
of HMS Office of Public Affairs
Harvard Medical School, Office of Public Affairs
25 Shattuck Street, Room 001, Boston, MA 02115
Tel: 617/432-1589, Fax: 617/432-0089
E-mail: Focus@hms.harvard.edu
Editor
Robert Neal
Senior Science Writer
Misia Landau
Science Writer
Gabrielle Strobel
Production Manager
Suzanne Clifford
Assistant Editor
Tiffany Doyle
Copy Editor
Tom Reynolds
Photography:
Graham Ramsay (Archer and Madras photos)
Lionel Delevigne
(HMS Commencement Photos, except Dental speaker and Simjee brothers, which
were taken by Steve Gilbert)
Kent Dayton (HSPH Degree Ceremony
photos)
Steve Gilbert (Murphy and Albertini photos)