Biological Chemistry: Study Finds Regulated Transcription of Novel RNAs Neuroscience: Old-line Antibiotic Saves Neurons After Spinal Cord Trauma Cell Biology: Structure Turns Iron Entry into Cells on Its Head Political Action Students Get Face to Face with Mass. Voters Letter to the Editor   Monkey Protein Blocks Infection by HIV Iron Maidens May Be at Higher Risk for Diabetes Protein Interferes with RNAi   The HMS Faculty Council Academy Honors 75 New Members MD-PhD Program Celebrates 30 Years Finalists Named for Teaching Award, Votes Invited Honors and Advances   Patient-Doctor Gets Dinged on Wards   House Fire Exposes Gaps in Care   Front Page

BULLETIN The HMS Faculty Council At the Jan. 21 meeting of the Faculty Council, Debra Weinstein, HMS assistant professor of medicine at Massachusetts General Hospital and director of graduate medical education at Partners, told the council that although the hospitals are in compliance, the issue of a restricted 80-hour workweek for house staff remains hotly debated. Proponents contend that by limiting the workweek, physicians will be more rested and this will lead to improved patient safety, quality of care, and education for residents. Opponents argue that reduced hours will lead to medical errors due to a lack of continuity, unfavorable coverage ratios, and deterioration of the quality of education. Compliance with New Hours To comply with the new regulations, residency training programs have introduced changes in graduate medical education to improve efficiency and maintain a balance between education and service. These approaches include restructuring house staff schedules, recruitment of personnel to assume some of the workload, and discontinuing selected rotations. A Web-based system was established that allows residents to log in their work hours. The biggest problem appears to be the requirement of a 10-hour break following a completed shift. Weinstein and collaborators concluded that the impact of the 80-hour workweek remains to be determined. Richard Schwartzstein, HMS associate professor of medicine and director of graduate medical education at Beth Israel Deaconess Medical Center, concurred. While acknowledging data that demonstrate diminished cognitive ability as a consequence of sleep deprivation, Schwartzstein cited practical problems that have resulted from the restrictions. These include decreased attendance at didactic sessions because substantial numbers of house staff have to leave in order to observe the 10-hours-off rule or the rule limiting time in the hospital to 30 hours. He also cited decreased continuity of care and decreased resident identification with the patients. The regulations are also burdensome to administration who must monitor compliance, yet there is no additional time or funding to support this activity. Vincent Chiang, HMS assistant professor of pediatrics and pediatric core clerkship director at Children's Hospital, reported that since schedules for residents and fellows in pediatrics were already close to an 80-hour workweek, it was thought that the regulations would have little impact. Instead, the additional guidelines for the 10-hour postshift break have had a disruptive effect on the pediatric training program. However, Chiang concluded that despite the paucity of data in medicine to suggest that there is a benefit from reduced hours, data from airline and automotive industries support the claim that reduced work hours do help to avert sleep deprivation and fatigue. Stanley Ashley, HMS professor of surgery and surgical training director at Brigham and Women's Hospital, reminded the council that work hour limitation requirements cannot be ignored because accreditation is at risk. The program applied for a work hour extension to 88 hours, for educational purposes, which was granted. Ashley agreed that the most difficult part of the regulations is the mandatory 10-hour postshift off-duty time. Ashley said that with the extension to 88 hours, and by scheduling conferences early and late in the day, the program has been able to maintain compliance and has functioned well. Frances Baxley, a third-year HMS student, felt strongly that intangibles such as quality of life are important to today's medical students and that the restricted hours do give hope that one can achieve some degree of balance in life. Financial Outlook for HMS Cynthia Walker, dean for finance, reported that this is a time of great opportunity for the School, but that there are many financial challenges. She said that new initiatives involving science on the Quad are already in progress. These include the new Systems Biology Department, headed by Marc Kirschner; systems neuroscience, an outgrowth of the Neurobiology Department with links to the University; chemical biology, which will collaborate with the Department of Microbiology and Molecular Genetics and Faculty of Arts and Sciences; biosecurity and emerging infectious diseases, under the umbrella of a grant developed by Dennis Kasper and John Mekalanos to fund the New England Regional Center of Excellence on Biodefense and Emerging Infectious Diseases; and the Center for Molecular and Cellular Dynamics, an extension of structural biology. To develop these initiatives, the School plans to expand the Quad faculty in all departments over the next five years. During this period, there will be 17 new faculty recruited to the new departments and divisions and 25 added to existing departments. This is an ambitious and costly venture. The School has attempted to create a separate financing program to cover the costs associated with the expansions brought about by the new research building. Additional financing comes from gifts in hand, from President Summers's funds, and from fundraising (a key initiative with the new dean for resource development, Jeffrey Newton, and collaborations with the University's Development Office). The target amount to fully fund the new positions is approximately $225 million, which will be sought over a 10-year period. Major cost increases over the next five years are largely related to personnel issues (salary, fringe benefit costs, faculty recruitment packages), support and maintenance of new and increased space, as well as the tax to the University. Actions launched to meet the projected shortfall include renting out vacant lab space, prioritizing capital investment, seeking new revenues, reducing staffing (an enhanced severance plan has been rolled out), somewhat reduced pay programs, and increasing research density. Dean Joseph Martin said that the report was sobering, but that this was the only way to go; the School could not afford to stand still. Saying that fiscal difficulties are anticipated in the short term, but that the shortfall will be resolved, he cited the new fund-raising opportunities that will be available in cooperation with the University through centralized efforts and sharing of donors. He hoped that the new "centers" concept would yield donations and that some donors to the University with interest in research going on at the Medical School would now have the opportunity to contribute to HMS.   Academy Honors 75 New Members The Academy at Harvard Medical School welcomed 75 new members in a ceremony on February 23, increasing its ranks to 212. Its membership now represents 25 departments and 17 institutions in the Harvard Medical community. In his keynote address, Academy director George Thibault (right) drew a quote from Harvard president Charles Eliot's dedication of the original Quad: "'I dedicate these buildings and their successors to the teaching of the medical and surgical arts.'" Thibault explained that Eliot's commitment to teaching is one of the historical precedents upon which the Academy was founded just two years ago. The need for the organization grew out of a deficit of investment in medical education at a time when research and health care technology have been growing, he said. The consequence has been a larger faculty dealing with more complex issues, but having less and less time to teach. According to Thibault, who is also a professor of medicine at Brigham and Women's Hospital, the Academy has addressed the need to rejuvenate education by establishing a community of educational scholars, providing services to all faculty who teach such as advocating for promotion, and creating a crucible for educational innovation. The Academy is now playing a major role in the medical education reform initiative at HMS. For a list of new Academy members, see http://academy.med.harvard.edu. (Photo by Steve Gilbert)   MD-PhD Program Celebrates 30 Years Last month, the MD-PhD program at HMS held a reception honoring the 30th anniversary of the grant that created the program as well as the appointment of its new director, Christopher A. Walsh. Program funding has come from the National Institute of General Medical Sciences, which established the Medical Scientist Training Program (MSTP) in 1964. The purpose was to prepare investigators to bridge the gap between biomedical sciences and clinical practice. The Medical School received its first MSTP award in 1974 and today is one of 40 institutions to have such funding. The grant must be competitively renewed every five years, with the next renewal submission due in January 2006. Of the 145 MD-PhD students at HMS, 45 are appointed to training grant positions. The MSTP budget in AY '04 is about $2 million, which goes for stipends and tuition support. Pictured above at the reception are, from left, HMS dean Joseph Martin; Christopher A. Walsh, the director and Bullard professor of neurology at Beth Israel Deaconess Medical Center; and his wife, Ming Hui Chen, HMS assistant professor of medicine at Brigham and Women's Hospital. (Photo by Richard Wood)   Finalists Named for Teaching Award, Votes Invited The Klaus Peter International Teaching Award, given each year to an HMS faculty member distinguished in international medical education and mentoring of international students, residents, and fellows at HMS, has named four finalists for the 2004 award. The honor is named for Klaus Peter, dean of Ludwig Maximilians University in Munich, which has a six-year alliance with HMS that includes a student exchange program. The nominees are: Andrew Colin, HMS associate professor of pediatrics at Children's Hospital, who clinically trains fellows overseas through a formal fellowship in the Pulmonary Division at Children's. He works with the Department of Pediatrics at Ramathibodi Hospital, Mahidol University Medical School in Bangkok, and Kwong Wah Hospital in Hong Kong. Paul Cusick, HMS instructor in medicine at Massachusetts General Hospital and the medical director of the Promesa project. The project offers medical services to remote areas in the mountains of Honduras, where along with Medical School faculty and students, Cusick performs fieldwork for three months every year. He is also a mentor in the Hispanic Medical Students program. Lena Dohlman, assistant professor of anesthesia at Mass. General, who has volunteered for 20 years in Indonesia, Vietnam, and St. Lucia, teaching anesthesia and trauma management. For the past seven years, she also has organized anesthesia residents from Beth Israel Deaconess Medical Center and MGH to travel to Tanzania for teaching fellowships. Joyce Sackey, HMS assistant professor of medicine at BID, who created an international program in care of patients with HIV and inaugurated a fellowship training program for visiting physicians from Ghana at HMS and BID. She also cofounded Foundation for African Relief, a nonprofit organization that funds the work of scholars returning to Ghana. Harvard Medical International invites HMS faculty, students, residents, and fellows to submit a vote for one of the candidates above, as well as nominations for the 2005 award to teresa_cushing@hms.harvard.edu by April 3. The recipient will be announced at the HMS graduation on June 10.   Honors and Advances The Pezcoller Foundation-American Association for Cancer Research (AACR) International Award for Cancer Research 2004 has been given to Stanley Korsmeyer, Howard Hughes investigator, HMS professor of medicine at Brigham and Women's Hospital, and the Sidney Farber professor of pathology at Dana-Farber Cancer Institute. The award recognizes Korsmeyer's studies in programmed cell death. He will give an award lecture, "Gateways to Apoptosis," at the AACR annual meeting later this month in Orlando, Fla. Ulrich von Andrian, HMS professor of pathology, is the recipient of the 2004 Amgen Outstanding Investigator Award from the American Society for Investigative Pathology (ASIP). He is recognized for his contributions as a microcirculatory investigator advancing the understanding of molecules and mechanisms that control leukocyte adhesion and recruitment. Von Andrian will present a lecture titled "Cellular Dynamics of Immune Cell Migration in Lymph Nodes" during the ASIP's annual meeting on April 18 in Washington, D.C.