Contents:
Neuroscience
Brain Appears Unexpectedly Versatile in Interacting with Environment
Some of the ideas presented at this year's Society for Neuroscience meeting in Los Angeles--like the notion that patients might move prosthetic limbs just by thinking or that people with nerve damage may grow new brain cells--would have seemed more appropriate to a Hollywood movie only a few years ago.
But new research is changing the face of neuroscience, and even some of its central dogmas. The concept that we are born with all the neurons we will ever have is being challenged. At the same time, doctrines such as the importance of environment in shaping the brain are being reinforced in surprising new ways.
The Regenerating Brain
What makes the situation even more interesting is that some of the new discoveries are coming from scientists who once clung to the old beliefs. "I was one of those who were skeptical about the brain growing new nerve cells," said Pasko Rakic, a neuroscientist at Yale University School of Medicine, speaking at the meeting, which ran from Nov. 7 to 12. Using a new technique called double fluorescence mapping, which labels dividing neurons, he and his colleagues have spotted new neurons in the adult-monkey hippocampus, a brain area associated with memory and learning.
It is still unclear if these new neurons form functional connections with other hippocampal cells. But two teams, one led by the Salk Institute's Fred Gage and the other by Princeton's Elizabeth Gould, recently found that mice raised in cages equipped with running wheels, plastic tunnels, and other learning toys retained more neurons than those raised in cages lacking such attractions, though they did not appear to grow new neurons.
Gage and his colleagues recently repeated the same experiment with a different strain of mice, one known to be a poorer learner, and found that those housed in the deluxe cages did grow more new neurons--in fact, twice as many as the less privileged group. In another experiment, not officially reported at the meeting but published in the November Nature Medicine, Gage and colleagues in Sweden found new neurons in the brains of autopsied cancer patients.
Gage believes the new neurons in mice are the product of a residual population of primordial cells, called neural progenitors, rather than mature neurons splitting in two. Understanding how learning triggers new neuronal production in the mice, and which genes are responsible for the differences in the two strains, could someday be used to cultivate neurons in patients suffering from neurodegenerative diseases such as Alzheimer's. "We're getting control of this level of what you might call cell engineering," said Gage.
But this research is also significant, said Gage, because it "recapitulates in a new context" a classic doctrine: namely that organisms are the product of both genes and environment.
Music's Imprint on the Brain
This tenet was echoed in a number of presentations, including that of HMS researcher Gottfried Schlaug. Though great musicians are often thought to be born, not made, learning may have as much to do as genes with structuring the musical brain, he said. Schlaug and his colleagues compared the magnetic resonance images of the brains of 32 right-handed musicians and 24 right-handed men who did not play instruments. The musicians displayed a 5 percent increase in the volume of their cerebellum.
"So early and repeated practice can lead to microstructural changes in the brain, which in turn lead to macrostructural changes which we detect," said Schlaug, an instructor in neurology at Beth Israel Deaconess. "Musicians are not just born with these differences."
The power of music--listening as well as playing--may be so great that it can someday be used to activate regions of the brain that are damaged or impaired. Some doctors already use a technique called melodic intonation therapy to encourage singing in stroke patients who are unable to speak, which has sometimes led to recovery of their speech, said University of Texas researcher Lawrence Parsons. He and his colleagues, and an independent research team at McGill University, have discovered that music activates specific cognitive and emotional areas of the brain. They believe music may be used to retrain or activate areas deficient or lost due to neurological disease.
"There is no question that music can play a role and have a therapeutic effect," said Mark Jude Tramo, assistant professor of neurology at HMS. "Music is biologically part of human life, just as music is artistically a part of human life."
Thought into Action
Telekinesis, on the other hand, is not a routine part of life, but researchers at the California Institute of Technology hope someday to give near telekinetic powers to paralysis patients. They have found that a well-known region in the brain, the posterior parietal cortex, located between the visual and motor areas, appears to act as a kind of middleman, turning mental or visual plans into actions.
They have mapped areas relating to movements of the arm and the eye and have worked out their neural codes. "We've known where in the brain early plans for movement are made and how they are encoded," said research team leader Richard Andersen. He and his colleagues are planning to design prosthetic limbs that respond to these codes. As a first step, they are currently implanting electrodes in the posterior parietal lobes of healthy monkeys and will soon be training them to move an object on a computer screen.
"Our hope is to have the patient interact with the world just by thinking about it," said Andersen.
--Misia Landau
Uncovering the symptoms of an eating disorder may be as simple as asking, "Do you have an eating disorder?" Yet Anne Becker, assistant professor of medical anthropology at HMS, found that only one in four people with those symptoms or concerns had been questioned about the condition by their doctor.
"Most people think that eating disorders are a secretive thing," says Becker, who is the director of research and training at the Harvard Eating Disorders Center. "But we found that when they were asked, most individuals were willing to admit to their symptoms."
If physicians started to ask patients the question as part of routine exams, these disorders could be detected early on, before more serious problems developed. Other health care providers, coaches, and teachers should be asking as well, Becker suggests, particularly those who work in settings where people are likely to have eating problems, such as a college health clinic. Becker; along with Margo Stanley, a research assistant at MGH; and David Herzog, professor of psychiatry at HMS and MGH and the president and founder of the Harvard Eating Disorders Center, reported their findings in a poster session at the annual Eating Disorders Research Society meeting on November 6 in Cambridge.
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| Communication is the key to uncovering an eating disorder, says Anne Becker. |
The researchers found that of 224 respondents with eating disorder symptoms or concern, 97 percent had been willing to share this information with someone, yet only 25 percent had been asked about eating disorders by their doctor. An even smaller number, 11 and 9 percent, respectively, had been asked by their teachers or coaches.
The finding that doctors were unlikely to ask people who fit the profile of someone at risk for developing a disorder--college age females--surprised Becker. "It seems obvious," she says. "It might be so obvious that physicians overlook it."
Although people with eating disorders tend to visit their doctors more often than people without, primary care doctors often fail to recognize these disorders, says Becker.
While some physicians may simply be unaware of their patients' eating problems, others adopt a "Don't ask, don't tell" attitude toward these disorders. "Treating an eating disorder is a complicated, long process, and some physicians may be reluctant to address it," Becker says. She reports that some patients are actually relieved to be asked about eating disorder symptoms, since it provides an opportunity to bring up a subject that they would be too embarrassed or shy to bring up themselves.
"Sensitive, direct questioning may be useful for eliciting a discussion of symptoms," Becker says.
Alerting Educators
Spurred by the research results, the Harvard Eating Disorders Center held a symposium for clinicians from several fields on the "Detection and Management of Eating Disorders in the Primary Care Setting" last October at Massachusetts General Hospital.
The center will hold another conference next March--this one for educators--since physicians are not the only ones who should be asking questions, according to Becker. Teachers, psychologists, nurses, dietitians, youth group leaders, athletic directors, physical education teachers, and others will gather to learn about eating disorders and interventions, and to learn about the importance of communicating with their students.
--Cassie Ferguson
While well known as the main treatment centers for rare diseases, teaching hospitals have recently come under scrutiny for their value in treating more common disorders. Yet in comparing care at teaching and nonteaching hospitals for congestive heart failure and pneumonia, the most common causes of hospitalization in the U.S., Harvard researchers found that teaching hospitals still generally provide a higher quality of care.
"We found evidence that in teaching hospitals, physicians do better with the history, physical exam, and diagnostic tests," says John Ayanian, assistant professor of medicine and of health care policy at HMS and BWH. "However, there's also evidence that certain therapies are underutilized in teaching and nonteaching hospitals."
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| In a study of hospitals in four states, John Ayanian and his colleagues found that teaching hospitals deliver a higher quality of care for pneumonia and congestive heart failure than do nonteaching hospitals. |
Ayanian; Arnold Epstein, professor and chair of health policy and management at HSPH and professor of medicine at HMS and BWH; and their colleagues report in the November/December Health Affairs that if teaching hospitals can maintain their quality of care while containing their costs, those institutions should continue to play a prominent role in providing care for common illnesses.
"People have accepted that teaching hospitals provide high quality care for rare diseases, but are less certain about their value in treating common diseases," Epstein says. "With costs from 25 to 35 percent higher at teaching hospitals, the pressure's on to justify the expense."
Determining Quality
The researchers examined the quality of care in teaching and nonteaching hospitals in four states, measuring both the specifics of patient treatment and the overall quality of care. They asked a group of experts to rate teaching and nonteaching hospitals, checking to see whether physicians took specific steps to treat 883 people with congestive heart failure and 884 with pneumonia. Forty-five percent of patients with congestive heart failure and 46 percent of those with pneumonia had been treated in teaching hospitals. In a second part of the study, a group of practicing physicians rated the overall quality of care. The data came from the charts of Medicare patients in Massachusetts, New York, Pennsylvania, and Illinois from September 1991 through August 1992.
In the first part of the study, the researchers found that physicians in teaching hospitals met basic standards such as lung exams and measurements of potassium and creatinine levels more regularly than did those in nonteaching hospitals. However, the report notes that physicians at both kinds of hospitals failed to prescribe ACE inhibitors for half of the patients with congestive heart failure and were slow to administer antibiotics to pneumonia patients. "There's an important need for almost all hospitals to improve their use of effective therapies," says Ayanian.
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| Physicians rated the quality of care for common illnesses in teaching versus nonteaching hospitals. |
In the second part of the study, the practicing physicians read the charts of the patients and rated their perception of the overall quality of care. They found that for both diseases, around 65 percent of patients in teaching hospitals received care rated as "good to excellent" while only about 35 percent of patients in nonteaching hospitals scored that high. (See graphs.)
Part of the discrepancy in the quality of care may be due to teaching hospitals having both intern and resident physicians, which means that more physicians are available for each patient, says Ayanian.
Some of the value of teaching hospitals extends beyond the quality of patient care, says Epstein. "Important points are that teaching hospitals tend to care for underserved populations and to produce new knowledge."
Comparing the quality of treatment for the two common diseases adds another dimension to the current debate over the value of teaching hospitals, says Epstein, who hopes that this study will help guide policymakers.
--Cassie Ferguson
Resilience is a quality of active minds--and it now appears, of some active neurons. Harvard Medical School researchers have found that rapidly firing serotonin-releasing neurons, when interrupted, spring back into action much more quickly than those firing at a lower rate. The findings, made in lobsters, suggest that these neurons have a kind of built-in safety feature that prevents them from becoming distracted from the task at hand.
"It's like cells are either saying, 'I'm busy--don't bother me,' or 'I'm on vacation, I'm really not needed so, okay, I'll listen to what you're telling me,'" says Ed Kravitz, the George Packer Berry professor of neurobiology. He presented his findings this month at the 28th annual meeting of the Society for Neuroscience in Los Angeles.
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| Ed Kravitz has found an anti-distraction mechanism in lobster neurons. |
For this anti-distraction mechanism to work, neurons must have a capacity to remember what they were doing before the interruption. "What this says is that there's a sort of cellular memory of how the cell was being used," says Kravitz.
Serotoninergic cells fire slowly and continuously in lobsters--and also in mammals. Researchers knew that stimulation via an electrode could cause the neurons to pause from firing and that this period of "autoinhibition" was directly proportional to the duration and intensity of stimulation. Some slow-firing neurons were known to pause for minutes. Kravitz and his colleagues found that when they stimulated active neurons, they did not pause at all.
This anti-distraction mechanism does not involve the release of serotonin feeding back on the cell, Kravitz says, but rather is an intrinsic property of the neuron. Neurons that release other kinds of neurotransmitters, such as GABA and glutamate, do not display the anti-distraction mechanism.
An immune system protein that is being tested as a new treatment for rheumatoid arthritis also shows promise in suppressing the immune response to corneal transplants, reducing the likelihood of transplant rejection. M. Reza Dana, assistant professor of ophthalmology at HMS and Schepens Eye Research Institute, and Iva Dekaris of the Coratian Eye Bank, formerly a postdoctoral fellow in Dana's lab, used soluble tumor necrosis factoralpha receptor I (sTNFR-I) to block a key step in the immune system's attack on the transplanted cornea in mice. The treatment worked well whether injected under the eye's conjunctiva membrane or used topically in eye drops.
In rheumatoid arthritis, researchers use genetically modified tumor necrosis factor receptors that bind to TNF-alpha and block the immune cascade that leads to joint inflammation. A similar process seems to be at work in the corneal transplant study, through inhibition of the migration of Langerhans cells to the transplant site. These cells present foreign antigens that activate T cells.
"As an antivaccine, this suppresses immunization by suppressing the antigen-presenting cells," Dana says. "It promotes ignorance on the part of the immune system, so it has the potential to be useful for many ocular surface disorders," such as allergic conjunctivitis, herpetic keratitis, and other infections. In the transplant study, 60 percent of transplants in the sTNFR-treated mice survived at least eight weeks compared with 30 percent of control mice. He presented the findings November 7 at the Castroviejo Cornea Society meeting.
In a new study on patients hospitalized with severe chest pain or heart attack, treatment with aspirin and the blood thinning agent enoxaparin significantly reduced risk of death and adverse cardiac events. The study, which involved 3,910 patients from 200 hospitals in 10 countries, compared subcutaneous injections of enoxaparin, a low-molecular weight form of heparin, to standard heparin given intravenously. Both groups of patients got daily aspirin. Researchers at Brigham and Women's Hospital presented the findings Nov. 10 at the 71st Annual American Heart Association scientific sessions.
The combined incidence of death, heart attack, and recurrent chest pain requiring urgent bypass surgery or angioplasty at eight days was significantly reduced in patients treated with the enoxaparin and aspirin, and the treatment benefit was sustained through 43 days of follow-up. Unstable angina, a severe chest pain, is caused by a lack of blood flow that deprives the heart of oxygen. This occurs after the rupture of an atherosclerotic plaque and formation of clots within a coronary artery. Severe angina often prompts emergency hospitalization since they signal an increased risk of heart attack and death.
The results "demonstrate the superiority of enoxaparin therapy over standard heparin therapy," says lead investigator Elliott Antman, associate professor of medicine at HMS and BWH. "When combined with the results of another similar study ... we have seen a 20 percent reduction in death and cardiac events in patients treated with enoxaparin. With these findings, clinicians should now consider enoxaparin to be the blood thinner for the acute management of angina and non-Q wave heart attack."
Patients with noninsulin-dependent (type II) diabetes who were treated with a combination of diet and medication to decrease blood sugar levels showed improved quality of life and employment productivity, and less overall health care use than patients treated with diet alone, according to an article in the November 4 JAMA. Marcia Testa, lecturer on biostatistics at HSPH, and Donald Simonson, associate professor of medicine at HMS and Brigham and Women's Hospital, conducted a trial at 62 U.S. sites to assess the short-term outcomes of glycemic control in 569 diabetic patients. After a three-week placebo period, patients in the active therapy group were treated for 12 weeks with diet and the controlled-release sulfonylurea, glipizide gastrointestinal therapeutic system (GITS). The other patients were treated with diet and a placebo. Diaries were used to assess changes in glucose and hemoglobin A1c (HbA1c) levels and symptom distress, quality of life (QOL), and health economic indicators. HbA1c is a measure of long-term blood glucose control.
After 12 weeks, patients receiving the therapy had lower HbA1c and fasting
blood glucose levels and reported fewer symptoms, better overall health, and
improved cognitive functioning. Active therapy patients were also more likely
than the placebo group to retain their jobs and were more productive at work.
The authors write: "We conclude from our findings that the day-to-day QOL
in patients with type II
diabetes can be enhanced by better glucose control and should be considered
when implementing disease management programs, evaluating health outcomes and
patient satisfaction, and estimating the costs and benefits of therapeutic regimens
and prevention programs."
Health-conscious people usually avoid eating lots of nuts because of their high fat content. But two new studies from Brigham and Women's Hospital contradict this conventional wisdom, suggesting frequent nut consumption could reduce risk of heart disease. Using data from 86,016 females in the Nurses' Health Study, BWH's Frank Hu and colleagues found that women who consume more than five ounces of nuts a week had a 35 percent reduced risk of coronary heart disease compared with women who consumed less than one ounce per month. The study is published in the Nov. 14 issue of the British Medical Journal. And at the American Heart Association Conference, Christine Albert, instructor in medicine at HMS and BWH, presented comparable, though preliminary, results from the Physician's Health Study. Among the 22,071 male physicians in the study, those who ate more nuts had a lower risk of total and sudden cardiac death.
Researchers from both studies say the benefit of nuts may derive, in part, from their high level of alpha-linolenic acid, an n-3 fatty acid associated with reduced risk of cardiac death. Other constituents that may help explain the benefits include arginine (an amino acid that plays a role in blood clot formation), magnesium, copper, folic acid, protein, potassium, fiber, and Vitamin E. Hu also explains that "although nuts are notoriously high in fat, the fat is mostly unsaturated, the type that has been associated with lowering cholesterol."
The $206 billion agreement signed on Nov. 20 by tobacco companies and attorneys general from 46 states, including Massachusetts, follows on the heels of significantly more ambitious legislation rejected by the U.S. Senate last June.
That the attorneys general settled for a more limited deal, conforms with the theories of Robert Blendon, associate professor of health policy and management at HSPH, and his colleague John Young, research specialist at the School.
To determine why the Congressional bill had not garnered public support, Blendon and Young looked at opinion polls and reported their analyses in the Oct. 15 Journal of the American Medical Association. The two concluded that, on the surface, many Americans supported tighter regulation of tobacco, but disagreed with individual components of the Senate plan. The lesson to policymakers is the bigger the bill and the more items it has, the more likely people will disagree with one or more of its parts.
In addition, Americans do not trust the government and do not want higher taxes, says Young. Tobacco companies took advantage of this tax phobia last spring, advertising that the tobacco bill represented the highest tax increase in American history. Many Americans saw the cigarette price hike as punishing smokers, not tobacco companies, which created a conflict over individual rights. Though the majority of Americans do not smoke, most believe in an adult's right to smoke.
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| Robert Blendon (left) and John Young have gauged the U.S. mood toward tobacco. |
By the time the vote came before the Senate, about 60 percent of Americans said a no vote by a politician would not influence their vote in the Congressional elections. And without pressure from the American public, Congress rejected the bill. Blendon and Young say the same thing happened with the Clinton health plan. Although many considered particular issues important, the entire health care package did not galvanize the American public.
Teaching politics at HSPH, Blendon focuses on public opinion because he wants his colleagues to understand how they can use it to their advantage. He first gained an interest in educating health care policy professionals about politics when he saw his colleagues "running into brick walls. These were deeply dedicated professionals with no sense of how to frame their issues." He says public opinion research gauges the mood of the country, letting policymakers know whether they should work on large or small legislation.
For example, Blendon explains that although last spring's tobacco legislation was a high priority for many public health officials, it was too big for the times. Franklin Roosevelt could push the New Deal because the Great Depression made the public want extreme measures. But in more robust times, the public does not look to the government for big programs. "What's very frustrating is that in a public debate, the general mood of the country is often as important as the substance of the issue," Blendon says.
Consequently, the less ambitious tobacco deal drawn up by the attorneys general will go into effect rather than the bill put before the Senate. The Congressional bill proposed raising the cigarette tax $1.10 per pack, amounting to $516 billion over 25 years. It included provisions giving the Food and Drug Administration regulatory authority over nicotine. In contrast, if tobacco companies increase the price of cigarettes to fund payment for the current $206 billion agreement, a pack of cigarettes will go up by only 35 cents. The Congressional bill would have limited further compensation from court cases, but under the attorneys general agreement, states completely forfeit their rights to sue. The Congressional bill fined the tobacco companies if they failed to reduce underage smoking; in the current plan, tobacco companies have agreed to restrict advertising aimed at underage smokers, but no penalty applies if they do not.
The almost anticlimactic new tobacco deal may represent the piecemeal politics that takes place during better economic times. American politics moves in increments, Young explains. "People forget that time and time again." Adds Blendon, "The deal may not be the best for public health, but it may be the best that we can accomplish politically right now."
--Judy Silber
CareGroup, the parent company of Beth Israel Deaconess Medical Center, Mount Auburn Hospital, and other providers, has begun a significant redesign of its organization and services.
"This redesign will affect virtually every aspect of our large and complex organization. Each change is focused on our patients, and on our mission of care, teaching, and research," says James Reinertsen, the CareGroup CEO.
The organization reports that among the possibilities is relocating New England Baptist Hospital--a founding member of CareGroup--to the Longwood Medical Area. CareGroup states, however, that New England Baptist would not close or merge with another hospital. "The Baptist is an essential partner in the new CareGroup system," Reinertsen says.
Other options being considered are reduction of underutilized facilities over
three years and relocation of some clinical and nonclinical
services within CareGroup's seven-hospital system.
The National Institutes of Health, Office of Dietary Supplements (ODS) announced
on Oct. 1 that Kaumudi Joshipura, assistant professor of oral health
policy and epidemiology at HSDM, has received one of its four new Research Enhancement
Awards. Joshipura will study the relationship between oral health and coronary
heart
disease and stroke.
Judah Folkman, the Julia Dyckman Andrus professor of pediatric surgery at HMS and Children's Hospital, received the Stevens Honor Award for 1998 from the Stevens Institute of Technology in Hoboken, N.J., in October. This month he also was to receive the 1998 Steven C. Beering Award from Indiana University and the John Scott Award from the board of directors of City Trusts of Philadelphia. In December, he will receive the Keio Medical Science Prize from Keio Univeristy in Japan.
Richard Monson, professor of epidemiology at HSPH, was appointed associate dean for professional education, effective Aug. 1. In his new role, Monson oversees the Office for Professional Education and the Master of Public Health Program.
David W. Bates, associate professor of medicine at HMS and BWH, is the new chief of the Division of General Medicine at BWH. Bates was appointed Sept. 1. He also is the medical director of clinical and quality analysis for Partners HealthCare System.
The Samuel Rosenthal Foundation has chosen Nancy Andrews, Howard Hughes investigator and associate professor of pediatrics at HMS and Children's, as the recipient of its 1998 Award for Excellence in Academic Pediatrics. She was selected for her primary research on the study of pediatric hematology. The $25,000 award, established in 1995, recognizes senior academic pediatric investigators' exceptional midcareer contributions to the well-being of children.
Mount Auburn Hospital named Jeanette Clough its new president and CEO in October, while Andrew Brotman, interim Mount Auburn CEO, became CareGroup senior vice president and chief operating officer for Physician Practice Management. Clough began her career as a staff nurse at MGH. She holds a master's degree in science from Boston College and a master's in health administration from Suffolk University. She was the CEO of Deaconess Waltham Hospital for the past three years. Brotman is a New York Medical College graduate. He completed a residency at Lenox Hill Hospital and a psychiatric residency and fellowship at MGH. He previously served as vice president and medical director of Pathway Health Network and chief of psychiatry at BID.
On Oct. 26, John O'Brien, CEO of the Cambridge Health Alliance, received the 1998 Massachusetts Health Council Award. Since 1980, individuals have received the award for their outstanding contributions to the advancement of the general health of Commonwealth citizens. The Cambridge Health Alliance comprises Cambridge Hospital, Somerville Hospital, Neville Manor (a skilled nursing facility), the City of Cambridge Public Health Department, and more than 20 neighborhood health centers and primary care sites throughout Cambridge and Somerville. O'Brien also serves as commissioner of health for the City of Cambridge.
Students of the PhD Program in Biological and Biomedical Sciences at HMS have announced new, annual awards for BBS community members. This year's seven recipients are, for teaching, Stephen Buratowski, associate professor of biological chemistry and molecular pharmacology, and Christopher T. Walsh, the Hamilton Kuhn professor of biological chemistry and molecular pharmacology; for mentoring, Catherine Lee, associate professor of microbiology and molecular genetics, and C.-ting Wu, assistant professor of genetics; and for service, Heidi Rehm, BBS student in pathology, Vonda Shannon, current BBS administrator, and Becky Simonds, BBS administrator through June 1998.
Uterine fibroids, or tumors of the uterus, affect about 80 percent of women
and are the most common reason for hysterectomies in the U.S. The Center
for Uterine Fibroids at HMS and BWH aims to isolate the causes and provide
accurate information about this condition. Researchers are now enrolling women
to participate in one of
the center's two current clinical studies, "Finding Genes for Fibroids."
Anyone interested can call 617-278-0081 or visit the center on the Internet
at www.partners.org/fibroid.
The March of Dimes selected Harvard Pilgrim Health Care this October as one of two local recipients of the March of Dimes Perinatal Epidemiological Research Initiative (PERI). The three-year, $630,000 grant aims to find the causes of preterm birth. Janet Rich-Edwards of the Ambulatory Care and Prevention Department at HMS and HPHC received the award for her grant application titled, "Societal Factors, Stress Hormones, and Preterm Birth." The research will follow 6,000 women during pregnancy and continue until their children reach six months. March of Dimes funding will complement HPHC research already under way and financed by the National Institute of Child Health and Human Development.
An MGH research team led by Gary Sachs, HMS assistant professor of psychiatry, will be collaborating with the University of Pittsburgh, the University of Colorado, and nine other centers to study the treatment of bipolar disorder. The scientists want to improve diagnosis, test medication, and build informational and organizational structures for future research. The research is funded by a five-year, $20 million National Institute of Mental Health grant.
MGH and HMS are examining antiepileptic drugs (AEDs) and their effects on pregnant women. The AED Pregnancy Registry currently is enrolling pregnant women who take such drugs and already has registered more than 800. Those interested can either find out more information or enroll by calling the AED Pregnancy Registry at 1-888-233-2334.
The National Medical Fellowships (NMF) has selected Donnella S. Green, member of the 1999 HMS graduating class, as the 1998 William and Charlotte Cadbury Scholar. The annual, national award, established in 1977 by Irving Graef and the NMF board of directors, recognizes a single fourth-year medical student who is from an underrepresented minority group and has exhibited outstanding achievement, leadership, and community service. Green accepted the award--a certificate of merit and a $2,000 cash prize--on Nov. 2 in the Minority Affairs Program of the Association of American Medical Colleges' annual meeting in New Orleans.
The board of directors of the Nicholas J. Pisacano, MD, Memorial Foundation has chosen the 1998 recipients of the Pisacano Scholarship, awarded to notable students showing a strong interest in family practice medicine. Of 135 applicants, only six scholars received the award this year, two of whom are fourth-year HMS students Jennifer DeVoe and Nerissa Koehn.
In MemoriamWilliam C. Moloney, professor emeritus of medicine at HMS and BWH, died at age 90 on Nov. 3.
He graduated from Tufts College and Medical School, and in 1939, opened a private practice in Boston where he developed an expertise in blood disorders. During World War II, he served in the Army Medical Corps in Europe. He joined the faculty of Tufts Medical School after his return.
In 1966 he was appointed professor at HMS and chief of hematology at Peter Bent Brigham Hospital. He served as president of the Massachusetts chapter of the American Cancer Society from 1968 to 1970. Moloney continued to be active at BWH until last year.
Moloney is known for establishing blood banks in the Boston area and pioneering chemotherapy for treating leukemia and lymphoma, which ultimately caused his death.
He leaves two sons, Thomas and William; a daughter, Patricia; 24 grandchildren; and seven great-grandchildren.
These HMS and HSDM faculty members were appointed to new
professorships in October.
Lee Gehrke
Professor of Microbiology and Molecular Genetics and of Health Sciences
and Technology
Harvard Medical School
Gehrke's laboratory studies viral RNA structure
and RNA-protein interactions. His work focuses on mechanisms of selective viral
messenger RNA transplantation and on RNAcapsid protein interactions that
are required to initiate viral RNA replication. Gehrke's interests include viral
pathogenesis and the identification of targets for antiviral therapies.
T. Howard Howell
Professor of Periodontology
Harvard School of Dental Medicine
Howell, acting head of the Department of Periodontology, researches pharmacological
treatment of periodontal disease, including extensive investigation of periodontal
regeneration. He recently completed the first human clinical trials using various
growth factors for alveolar bone regeneration. As associate dean for dental
education, he oversees all pre- and postdoctoral programs at HSDM and was the
primary architect of the School's new problem-based learning predoctoral clinical
curriculum.
David Schoenfeld
Professor of Medicine|
Massachusetts General Hospital
Schoenfeld is a biostatistician involved
in the design, conduct, and analysis of clinical trials in endocrinology, pulmonary
intensive care, AIDS, and cancer. He directs the Clinical Coordinating Center
for the Acute Respiratory Distress Syndrome Network and conducts research in
statistical methods for analyzing survival data and studies of polygenetic etiology.
These faculty were appointed to a secondary or endowed professorship.
Steven Burakoff
The Margaret M. Dyson Professor of Pediatrics
Dana-Farber Cancer Institute
Burakoff, chair of pediatric oncology
at DFCI, investigates the signals that T cells use in fighting cancer, looking
for ways to bolster the immune system's defenses. His research has applications
in organ and bone marrow transplantation, since knowledge of T cell signaling
may help control a common side effect, graft-versus-host disease.
Roman DeSanctis
The Evelyn and James Jenks–Paul Dudley White Professor of Medicine
Massachusetts General Hospital
DeSanctis has been a clinician-teacher
at MGH since 1962. He served as acting chief of the MGH Cardiac Unit from 1989
to 1991. He is particularly interested in the clinical manifestations of coronary
artery disease, cardiac arrhythmias, and diseases of the aorta.
R. Bruce Donoff
The Walter C. Guralnick Distinguished Professor of Oral and Maxillofacial
Surgery
Harvard School of Dental Medicine
Donoff, dean of the School of Dental Medicine, is an oral and maxillofacial
surgeon who specializes in treatment of nerve injuries and is a visiting surgeon
at MGH. His other reseach interests are in wound healing, bone graft survival,
and oral cancer.
Leonard Kaban
The Walter C. Guralnick Professor of Oral and Maxillofacial Surgery
Harvard
School of Dental Medicine and Massachusetts General Hospital
Kaban is a pediatric oral and maxillofacial surgeon who studies the diagnosis,
management, and outcomes of craniofacial anomalies, specifically hemifacial
microsomia and other first and second branchial arch defects. In the laboratory,
he conducts research on the biology of distraction osteogenesis and fetal bone
wounds.
Stanley Korsmeyer
The Sidney Farber Professor of Pathology
Dana-Farber Cancer Institute
Korsmeyer's laboratory pursues a genetic
approach to the regulation of programmed cell death. The lab examines the effectors
and repressors of programmed cell death in mammalian cells and addresses the
developmental role and biochemical function of genes that regulate cell death.
Paul S. Russell
The John Homans Distinguished Professor of Surgery
Massachusetts General Hospital
Russell focuses on the surgical and
medical management of transplant patients and related problems, such as the
comparative antigenicity of different tissues, mechanisms of transplant rejection,
and control of rejection through the use of monoclonal antibodies to modulate
the immune response and induction of immunological unresponsiveness. He has
also helped develop agencies for the cooperative exchange of transplant organs.
Christine Seidman
Professor of Genetics
Harvard Medical School
Seidman, a Howard Hughes investigator and professor
of medicine at BWH, uses genetic techniques to study the molecular basis of
inherited human disorders, particularly those affecting the cardiovascular system.
Her laboratory has defined molecular defects responsible for several cardiomyopathies
and recently identified gene mutations that cause congenital heart disease.
Joseph Vacanti
The John Homans Professor of Surgery
Massachusetts General Hospital
Vacanti studies tissue engineering
for reconstructive surgery and organ fabrication to meet the need for organs
in transplantation. His clinical interests are in pediatric and transplantation
surgery.
Many people were surprised by a survey published in the September 2 JAMA, which found that 60 percent of U.S. medical schools reported including instruction about complementary or alternative medicine (CAM) in their curricula. The purpose of the study was to document the prevalence, scope, and diversity of medical school education in CAM. Replies were received from 117 of the 125 United States medical schools listed in the directory of the Association of American Medical Colleges. Of the schools that replied, 75 (64 percent) reported offering elective courses in CAM, or including these topics in required courses.
Of the 123 courses reported, 84 (68 percent) were stand-alone electives, 38 (31 percent) were part of required courses, and one (1 percent) was part of an elective. Thirty-eight courses (31 percent) were offered by departments of family practice and 14 (11 percent) by departments of medicine or internal medicine.
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| Miriam Wetzel |
A survey by the American Medical Association in 1996-97, less than two years ago, reported only 46 medical schools offering CAM as part of a required course. The recent survey indicates a substantial increase, especially considering that alternative medicine came fully into the consciousness of mainstream medicine only five years ago with the publication of the findings by David Eisenberg, assistant professor of medicine at HMS and BID, and colleagues that one in three Americans use some form of complementary or alternative therapy.
In the study, CAM was defined as treatment modalities not traditionally taught in Western medical schools, such as chiropractic, acupuncture, massage, and meditation/relaxation. Because of the rapid increase in CAM courses in U.S. medical schools, this definition may need to be updated. There also are other terms that are frequently used and often preferred, such as "integrative medicine" or "complementary or alternative health care practices."A distinction must be made between teaching about CAM and actually teaching the techniques to administer these therapies. Because of the widespread use and actual or perceived benefits, medical schools recognize the need to teach physicians about these therapies and how to work collaboratively with experienced CAM practitioners. It would be unacceptable to avoid this responsibility.
Finding the Best Medicine
The interest in CAM has prompted a new look at the science of clinical medicine. In spite of the advances of modern medicine, there is much we do not know or understand about health and illness and the body's natural ability to heal itself. There is strong emphasis today on evidence-based medicine. Much of the perceived beneficial effect of alternative therapies has been dismissed as placebo effect. An Oct. 13 New York Times article reports studies by neurobiologists that may help to explain the biological mechanisms responsible for the power of the placebo effect. Alternative medicine has frequently been criticized for its lack of scientific evidence. Recent criticism also contends that many advocates are not interested in scientific inquiry. On the contrary, the interest in CAM has intensified the search for effective treatments for many common illnesses that have baffled conventional medicine, for example, headache, back pain, and chronic fatigue. Some of these studies are now being conducted at the Center for Alternative Medicine Research and Education at Beth Israel Deaconess Medical Center and at Children's Hospital.
How can CAM be added to an already crowded medical curriculum? There is currently an active dialogue among medical educators. We want to teach future physicians to be critical thinkers and problem solvers, to be better at communicating with their patients, and to improve their teamworking skills. Because of the great diversity in content and format of existing CAM courses, the academic community is looking for information and models. The Association of American Medical Colleges has formed a special interest group under the leadership of Patricia Muehsam of Mt. Sinai Medical School. Muehsam favors the idea of integrating CAM into the medical curriculum by including these topics in existing courses. It is also important that CAM gains institutional support as an integral and legitimate part of the medical curriculum and is not treated as an interesting add-on.
An Alternative Course
At Harvard Medical School, we have offered a one-month elective course since 1993 titled "Alternative Medicine: Implications for Clinical Practice and Research," directed by David Eisenberg and Ted Kaptchuk. In addition, since 1997-98, a session on CAM is included in the Clinical Commons course required of all third-year students. The emphasis is on how to bring up the subject of CAM in a respectful and non-judgmental manner in the standard medical interview. Published guidelines are available to help students learn to end the "Don't ask, don't tell" approach to the use of alternative therapies. For doctors and other health care professionals, Eisenberg directs a popular continuing medical education course to be given February 28 to March 3, 1999.
Patients are increasingly seeking to identify physicians who are solidly grounded in conventional medicine and also knowledgeable about the value and limitations of alternative therapies. This emerging line of inquiry must be addressed with the same level of scientific rigor, clinical judgment, and shared decision-making as is expected in all other aspects of medical care.
--Miriam S. Wetzel
Miriam Wetzel, lecturer on Medical Education at HMS, is the first author on the September 2 JAMA article, "Courses Involving Complementary and Alternative Medicine at U.S. Medical Schools."
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