In the face of sweeping changes in the health care industry, Harvard Medical School and Beth Israel Hospital have joined together to establish a foundation that will develop new ways to nurture the academic mission of teaching and research. The two institutions announced the formation of the Harvard Medical School-Beth Israel HealthCare Foundation for Research and Education shortly after the new year.
"Here's an organization that is created by both institutions-that lives because of its parents-that has at the top of its radar screen the academic mission," said Michael Rosenblatt, Robert H. Ebert Professor of Molecular Medicine.
Rosenblatt has been named the foundation's executive director. He will report jointly to Daniel Tosteson, dean of Harvard Medical School, and Mitchell Rabkin, president and CEO of Beth Israel.
The newly formed foundation will seek to develop new financial resources for medical education, provide greater institutional and financial support for academic physicians as they pursue teaching and research activities, and move clinical education of students into outpatient settings. In addition, the foundation will seek to foster collaborations between basic researchers at HMS and Beth Israel faculty involved in clinical care and research.
As one of its first steps, the foundation will establish a high-tech clinical education center for HMS students at Beth Israel's new ambulatory care center, the Carl J. Shapiro Center for Ambulatory Medicine. The foundation will also pursue setting up collaborative research programs at the Harvard Institutes of Medicine. The formation of the foundation, Rosenblatt and others said, is a response to changes in medicine that have been building for the past half century. As advances in postwar science began to translate into new treatments-new drugs, antibiotics, artificial joints, organ transplants-the costs of medicine began to soar. Employers, who had assumed the cost of health insurance for working Americans, became disgruntled about the escalation in medical costs. And then a new breed of insurance companies arose.
Many health insurance companies had traditionally been nonprofit institutions. The new breed were "for-profit" companies that collectively struck a deal with the private sector, Rosenblatt explained.
"They said, 'We'll sell you a policy to cover all your employees for 20 percent less.' They then turned around and said to hospitals and practices, 'You want the 10,000 employees? You can have them at a discount [to us] or you're not going to have them at all.'"
To compensate for the discount on reimbursements from the insurance companies, hospitals began cutting back on costs. In this new fiscal environment, teaching hospitals have struggled to continue subsidizing the cost of training new doctors and conducting innovative research.
At the same time, institutions like Beth Israel have become responsible not just for inpatient care but for the care of patients in far-flung offices and clinics. This fanning out of services into the community has imposed additional pressures on the teaching of medicine.
"Previously faculty were at the BI," Rabkin said. "Now they're out in Leominster. What's the curriculum you're going to develop? Where is the quality control?"
With the teaching mission of its affiliates threatened, HMS began looking for creative ways to help protect the academic mission of its teaching hospitals. "We wanted to find new ways of making evident to our clinical faculty and the institutions where they work that Harvard is a full partner in the academic mission of its affiliates," Tosteson said.
In the beginning, the small group met every week, then every other week. The focus was to figure out "how the two institutions could take their areas of total identity-research and teaching-and bring them together, meld them, shelter them, so we can get them growing again," Rosenblatt said.
The two institutions decided that pooling resources to form a joint venture would be the best approach. "Once the idea of a joint venture captured everybody's imagination, I would say both sides were really rushing toward it," Rosenblatt said.
Background documents on issues such as research, teaching, communications, and development were prepared and discussed. A letter of intent was drafted and approved by Beth Israel's Board of Trustees and the Harvard Corporation in early December. "At that point, it was a matter of getting ready to translate the concept into the reality," Rosenblatt explained.
As director of the foundation, Rosenblatt will sit in on the key meetings of both institutions. His charge will be to represent the academic mission as decisions are made. "It's a tremendous step forward to have an organization nested in the two institutions that can be the voice of the academic mission. That to me is one of the really brilliant things to come out of this," Rosenblatt said.
Over the next few months, Rosenblatt will be working
to further the three main aims of the foundation-teaching,
research, and development. He will work toward setting up a
clinical education center in Beth Israel's new ambulatory
care center. In addition to providing a venue for the
teaching of outpatient care, the center will provide the
latest in computer technology-electronic textbooks and
virtual patients. "We hope it will be something like the
Medical Education Center for clinical education-a place to
come back to during the day," Rosenblatt said."Each of these big, proud
institutions had to shed a
little control to go into
the joint venture."
--Michael Rosenblatt
On the research front, Rosenblatt will be reviewing the portfolios of researchers at Beth Israel and HMS with the aim of identifying-and providing seed money to support-new collaborations. "I'll try to be a matchmaker and provide a little honey so the bears will come out of the cave and start working together."
He will be especially interested in projects designed to turn basic research findings into clinical breakthroughs; such projects are more likely than pure research projects to attract outside funding.
In addition to providing funds for the venture, the two institutions will also be creating a "time bank." They will establish minimum amounts of time that faculty members will provide the foundation for teaching purposes; the foundation may then draw on these time deposits to staff its teaching efforts.
"Say you want to teach cancer from a whole patient point of view. You'd want an oncologist who gives chemotherapy, a surgeon who takes the tumor out, a radiation therapist, a psychiatrist for dealing with terminal illness," Rosenblatt said. "To cut across those departmental boundaries is very difficult now. But the foundation can take its teaching IOUs [from the time bank] and do something new with that."
"Ultimately, it is our hope that all research and education that is carried out by members of the Harvard faculty at the BI will be carried out under the aegis of the foundation," Tosteson said.
While the new foundation hopes to protect the sense of academic mission among faculty, it is also intended to bolster the morale of students. "Medical students are very vulnerable and insecure. Then they go across the street [to the Beth Israel]" says Daniel Federman, dean of education at Harvard Medical School. "The formation of the foundation sends a message. Harvard Medical students are not [merely] tolerated. They're welcomed, invited. They're sponsored. They're blessed."
One of the bigger challenges in clinical education today is developing effective methods for teaching students how to examine patients under enormous time constraints. A doctor today is lucky to have 20 to 30 minutes with each patient.
"A veteran like me can see a patient, and I know what I'm looking for and I'm pretty efficient. To ask a medical student to see a patient in that time frame is the harder part," Rosenblatt said.
Another challenge will be to prepare the student for the moral vicissitudes of medical practice. "A terrific deprofessionalization has happened as medical care has become an item of commerce and far less a professional contribution," Federman said. "Students face a moral battering. They arrive dedicated to the patient and they are mantled with an institutional responsibility to serve the institution, serve it efficiently, with no similar stress on quality of care."
Federman and Tosteson both stressed that the newly strengthened relationship between HMS and Beth Israel "doesn't mean no one else is doing anything good, that the MGH, the Brigham, the Deaconess, Children's and other affiliates aren't doing plenty. They are doing plenty," Federman said. "We get fabulous educational support from all kinds of places."
However, the foundation could serve as a prototype for strengthening the academic mission of all of HMS's affiliated hospitals. "What this does is construct a joint planning instrument," Federman said.
"We have to be proactive," Rosenblatt added. "And that's what we hope this foundation will do. It will help us get out ahead of the wave to where we're controlling a little bit more of our destiny. Even though we see what's coming at us, we can get oriented, come to handle that and serve our mission."
The foundation also hopes to draw national attention to the crisis in medical education. "In the last analysis, the public has got to come to grips with the question of who will take care of [their] grandchildren, and how well trained will that doctor be," Rabkin said. "What will be the body of knowledge that he or she will have?"
--Misia Landau
One of the most exciting recent discoveries in biology is that the daily, or circadian, rhythms of fruit flies-and presumably of humans as well-are driven by the switching on and off of genes in a handful of cells. One gene known to be an integral part of the "molecular clock" of flies is a gene called per.
For the past few years, researchers have suspected that per, along with the protein it produces, does not act alone but that it depends on one or more partners to perform its molecular timekeeping. Recently, a team of Harvard Medical School researchers headed by Charles Weitz, assistant professor of neurobiology, working in collaboration with researchers at other universities, has netted one of per's partners.
Weitz and his colleagues have cloned a gene called timeless that produces a key protein component of the clock in flies. They have shown that the Timeless protein binds the Per protein. Further studies of the on-and-off patterns of timeless suggest that it behaves the same way as per.
"They're cycling together. So there's a suspicion that their regulation is part of the same process," says Weitz.
How the Per and Timeless proteins interact to drive the molecular clock is still not known. Nor is it clear whether the Timeless protein is interacting alone with the Per protein in a kind of molecular pas-de-deux, or whether it is part of a larger ensemble of Per-interacting proteins.
Normally, the brain cells that function as the molecular clock for the fly undergo a rhythmic cycle. As part of this cycle, the per gene switches on around the same time each day, thus initiating the synthesis of per messenger RNA. The mRNA is then dispatched outside of the nucleus, to the cytoplasm, where the Per protein is made. The Per protein gradually accumulates in the cell for several hours and then, at some point, swiftly moves into the nucleus. Once inside the nucleus, the Per protein is thought to interact with other proteins to shut its own gene off, thereby ending the circadian cycle.
This cycling of Per protein is at the core of the fruit fly clock mechanism. Yet it appears to be completely thwarted in flies with the timeless mutant. The Per protein never seems to accumulate sufficiently, which prevents it from making the critical entry into the nucleus. "This was a strong hint that the two genes [timeless and per] were interacting," says Weitz.
Still, the timeless gene-though mapped to a region of chromosome two-had not been cloned. To hunt down the gene, Weitz teamed up with the discoverers of timeless, Michael Young, of Rockefeller University, and Amita Seghal, of the University of Pennsylvania, in a unique three-way collaboration.
"It looked like there were
a bunch of places where the
behavior of the per gene and
protein were regulated to
make the loop work and be
a [molecular] clock."
--Charles Weitz
Young continued to sort through DNA from chromosome two in hopes of homing in on the gene that causes the timeless mutations in flies. Weitz and postdoc Nicholas Gekakis, utilizing a method known as the yeast two-hybrid screen, used the Per protein as a kind of bait to fish for genes producing Per-interacting proteins. After screening 20 million clones of DNA copied from fruit fly mRNAs, Gekakis netted 48 interacting clones. When the HMS researchers compared their genetic booty with a timeless gene cloned by a member of Young's lab, they found that one third of their DNA fragments matched various regions of Young's clone.
"The two methods converged on the same thing. The chances that that could happen randomly are extremely low," says Weitz.
Seghal, meanwhile, had observed that the mRNA produced by the timeless gene from Young's lab cycled up and down once every 24 hours, in sync with the cycling of per mRNA. "That was the third independent criterion for [timeless being] involved in clock function," says Weitz.
But precisely how do the Per and Timeless proteins interact to drive the molecular clock? Although this is not yet known, it appears that the Timeless protein may be serving as an escort, ushering the Per protein from the cytoplasm into the nucleus. "Maybe the Timeless protein is involved in setting that nuclear entry event, allowing it to occur," Weitz says.
Precisely how the pair of proteins interact with other proteins inside the nucleus to switch off per-and possibly other genes-is unclear. "How it does that is a big mystery. That's one of the big questions still open," Weitz says.
"Not much is known about all the steps in this loop yet," he adds. "Does Per-or Per and Timeless-bind [directly to the] DNA? There's no reason to think they do. They don't look like DNA-binding proteins by sequence. If they don't, they must direct or control something that does."
Weitz is currently using the two-hybrid system to detect other components in the mo-lecular clock of flies. Piece by piece, he and other researchers are discovering the genes and proteins that nature uses to mark a day's time.
--Misia Landau
HMS/HSDM class of 1998 announce
The Second Year Show
Doxx Presents:
Faustian Bargains
(and other diverticula)
January 25, 26 and 27
7:30 pm
Tower Auditorium
Mass. College of Art
621 Huntington Ave, Boston
Tickets: $6 (students $5). For advance tickets, call 522-8271.
"The hospital didn't have basic resources such as sutures, syringes and latex gloves-the things we take for granted," says Bhandari, a 1995 graduate of Harvard Medical School.
As with many who have traveled abroad, Bhandari's eyes were newly opened to the wealth of resources we enjoy in the United States. In Katmandu, a young diabetic boy had died because the hospital lacked a simple blood glucose monitor to measure blood sugar levels and gauge appropriate insulin intake; in one of Bhandari's HMS courses, a blood glucose monitor was used for demonstration purposes and then forgotten.
"I remembered that after the demonstration, the blood glucose monitor remained in the corner, untouched for three or four months. That made me realize how often we don't pay attention to the surplus of equipment available to us," says Bhandari.
That dichotomy between rich and poor stirred Bhandari to develop a plan of action. In the spring of 1995, he established a nonprofit organization, Resources International, to undertake the "systematic collection of spare medical supplies, equipment and literature from major Boston area hospitals and health care facilities." Bhandari, who is 27 years old, is postponing a residency in orthopedic surgery while he builds this organization.
To start Resources International, Bhandari obtained a
$25,000 grant from the Echoing Green Foundation in New York
City, which provides support for nonprofit community
organizations. He also enlisted his wife, Shalini Gupta, and
a close friend and HMS classmate, Wei Lin, as Resources
International volunteers.
Resources International has focused on collecting and distributing such basic supplies as crutches, blood glucose monitors and wheelchairs. Massachusetts General Hospital, Harvard Medical School and Harvard Community Health Plan have all chipped in with donated items.
"There is such an availability and turnover in these supplies (here), and such a universal need for them in so many parts of the world," Bhandari says.
To distribute the supplies, Bhandari's group has relied on the aid of U.S.-based international relief agencies that have well-established ties to hospitals and clinics in developing nations. So far, Resources International has worked with Helen Keller International, The Grant Foundation, and AmeriCares.
Already Bhandari's group has received letters of thanks-and encouragement-from those who have received the badly needed medical items.
Resources International has also begun collecting computers and health-related computer software for donation to hospitals in countries such as India, Nepal, Cambodia, Peru and Haiti. In total, Resources International has now provided needy hospitals and clinics with $40,000 in supplies and computers.
"There is a big need for computers in these hospitals," Bhandari says. "Often clinical studies can not be conducted because large amounts of data can not be organized efficiently. Hundreds of charts are too difficult to keep track of. A computer with a database is all these hospitals really need."
In addition to sending computers overseas, Resources International has sent several Macintoshes to The New England Home for Little Wanderers in Jamaica Plain. The foster home and special-education school has used the donated Macintoshes to set up a long-awaited computer center.
"There is a huge turnover of computers in America, even among the average household. It's really not worth it, financially speaking, to trade in an old computer," says Bhandari. "You get a better deal by donating it, which enables you to write it off as a charitable tax deduction."
Inspired by his father's participation in community service, Bhandari began his own legacy of volunteer work by spearheading a tutoring program during his undergraduate years at the University of California at Berkeley. More than 300 high school students from the Berkeley community benefitted from his tutoring program.
Bhandari also has volunteered in a Calcutta orphanage founded by Mother Theresa. While an undergraduate at Berkeley, he spent a summer at the orphanage teaching English and serving as a "big brother." "Just spending time with the kids was important," he says.
In Nepal, Manish Bhandari visited children in villages outside Katmandu.
All of these volunteer experiences have served as a
source of inspiration for Bhandari as he has worked to build
Resources International. He now has ambitious plans for
expanding the scope of the organization's work and
influence. He would like to acquire a warehouse where
systematic cataloging of donated equipment and supplies
could be done quickly and efficiently. He also would like
to build a nationwide network of facilities that would
regularly donate surplus supplies to Resources
International. Finally, he hopes to establish a Resources
International Fellowship at HMS that would provide a student
with the opportunity to work at a hospital in a developing
country.
"Creating a sense of awareness among faculty and students at HMS is important to the future of Resources International," he says.
Bhandari sees Resources International's overall mission as that of "helping in any way possible." The same mission drives Bhandari as he contemplates pursuing a medical career as an orthopedic surgeon.
"There is a worldwide need for orthopedic supplies. By specializing in this, I can pursue my career plans, as well as Resources International's central mission."
--Ann Kennon
For more information about Resources International, call 617-524-1368, or e-mail to: manish.b@ix.netcom.com.
We watched as the psychiatrist on the videotape explained that their conversation would be replayed for Harvard medical students. We saw her agree to be taped. Then we watched as she complained of FBI agents who were plotting to kill her, told how her son's penis and testicles had been removed and replaced with a plastic prosthesis, and described how "old men physicians" had performed a hysterectomy on her "with joy and happiness and glee." At the end of the interview, she said, "Well, at least I'm not paranoid!" We burst out laughing.
Yet, as I put down paranoid schizophrenia under "Axis I Diagnosis," I felt uncomfortable. I, too, had laughed at some of the delusions of this highly disorganized patient. The distance provided by the videotape gave us leave to laugh and break the tension of our exam situation. I observed her actions not only with clinical interest, but with a sense of voyeurism. As I wrote my mental status evaluation, I wondered how this woman, so out of touch with reality, could understand the function of her interview. How could she understand how she would be perceived by us? How could I accept her willingness to be interviewed as informed consent? In the effort to preserve her autonomy, I wondered if we had actually violated her rights as a patient and her values as a human being. I wondered if we had failed the patient-doctor relationship by satisfying our needs at the expense of her dignity.
In my past year and a half of medical school, I have tried to understand how best to preserve the patients' values and protect their autonomy. My discomfort with our response to the woman was partly that our laughter seemed to be a failure to live up to that obligation. She had agreed to be interviewed; perhaps our responsibility as part of that patient-doctor pact was to respond to her in a more empathetic way.
Yet, there is a flip side to this struggle as well. Today the patient-doctor relationship is becoming increasingly patient directed. Patients will tell their physicians what they want. But how far and how easily will I be willing to compromise my values to preserve those of my patients?
My college years were a time of self-exploration and personal growth. I tested my boundaries, determined my limits. I created my own set of values. Now in medical school, it is no longer enough to have my own set of values. I must learn how I will mesh my values with my patients' beliefs, how I will validate their ideals without compromising my own as we attempt to develop care protocols that are mutually acceptable. While in college I tried to discover who I am; now I am trying to understand how I will act in the context of who other people are.
Last year, I observed as a local hospital ethics committee wrestled with the issues raised by a patient who demanded that no Catholics touch him in the course of his medical care. In an effort to preserve this patient's autonomy, the hospital staffed the operating room with medical staff with Jewish-sounding last names. The physicians were outraged, feeling that they had been discriminated against. After the procedure, it was discovered that the patient was a paranoid schizophrenic.
While the case of the schizophrenic seems easy to dismiss as clearly violating the physicians' values, there are situations when a patient could legitimately ask to select medical staff by gender or race. What if the person had been raped or beaten? But alternatively, the patient could be sexist or racist. Who should decide whether the request is valid, and what criteria should be used? The patient-doctor relationship is very sensitive and invasive, prying into the most private and even frightening parts of patients' lives as they face physical or mental failure. Should we therefore err on the side of preserving a patient's ideals over those of the medical staff to whom these relationships are more routine?
Complicating the struggle is the fact that many of the patients we see are themselves in crisis. In the face of illness, they reevaluate and reaffirm their principles to accommodate their new situations. Last year, I saw a Jehovah's Witness man who had just received a heart transplant after his heart was destroyed by viral myocarditis. While his wife respected his decision to accept the heart, she-if she had been the patient-would have refused the organ transplantation because of her religious beliefs that it would have afterlife repercussions. "I couldn't help it," the husband said. "I just wanted to live."
In dealing with this patient, not only was I challenged by a set of religious values that I was uncomfortable with, but I listened as the patient grappled with his own beliefs. And, I witnessed his struggle to explain his decision to his wife.
This need to achieve a compromise between conflicting ideals is a new challenge, one that I have only just begun to recognize. Yet I can already perceive how this struggle will challenge my definition of self and commitment to my values. I do not yet have any idea how I will achieve resolution, or indeed if it is even possible.
Here is what second grader Anthony Lowe wrote: "I don't want anybody to go outside because they are getting shot. I see grown people and kids around my house. Sometimes it is bad and sometimes it is not bad around my house. They shoot people and they die."
On January 11, the Harvard School of Public Health held a forum titled "Death of Innocents," a program that highlighted the problem of adolescents carrying guns. K. Kaufer Christoffel, a professor of pediatrics at Northwestern University, pointed to the essays by Lowe and his Chicago peers as an example of how gun carrying can rob children of their innocence.
"Instead of getting [essays] about the mailman, the fire hydrant and the dog around the corner, [Hyde Park Bank] got disturbing essays like this from Anthony Lowe," she said.
The HSPH forum was organized by the Harvard Injury Control Center, which is one of eight "injury control" centers in the country supported by the federal government. Established in 1987, the center has conducted research on gun-related deaths and injuries, and sought to develop interventional strategies for fighting this health problem.
The scope of the problem is captured in recent research conducted by David Hemenway, deputy director of the injury control center. In a survey of adolescents in two northern cities, he found that 17 percent of teenagers (14-18 years old) carried a concealed weapon. Forty-two percent of the teens said they had easy access to a handgun. And most disturbing of all, 19 percent said that at least one family member had been shot.
"These kids want fewer guns and they want to feel safer," Hemenway said.
Philip Cook told the audience that our lawmakers need to enact sensible gun-control legislation.
Philip Cook, a professor of public policy at Duke University, told the audience that these statistics demand that our lawmakers enact better gun-control legislation. In addition, he said, "We need to support community policing, create stronger alliances [within the community], and improve education in an effort to reduce the number of gun- carrying individuals."
Christoffel has created an organization called the Handgun Epidemic Lowering Plan (HELP). "The HELP network promotes a public health approach to the handgun epidemic and so promotes a reduction in the availability of handguns. As part of its work, HELP collects and disseminates information about the handgun epidemic and about strategies to control it to policy makers, the media and interested members of the public," she said.
HELP, she added, is designed to reach out to children like Anthony Lowe. "Anthony tells us what it feels like to grow up in his violent world. His essay represents a distortion of childhood. We owe it to the kids to give them back their childhoods."
--Ann Kennon
Countway Library Workshops
Wed., Jan. 24, 2 pm, Countway Plus/Medline
Tues., Jan. 30, 10 am, Art of Searching the Web
Wed., Jan. 31, 5 pm, Countway Plus/Medline
Mon., Feb. 5, 10 am, Countway Plus/Medline
Tues., Feb. 5, 1 pm, Internet Intro
For location and to register, call 617/432-2134.
BBRI-Boston Biomedical Rsrch. Inst.
BIH-Beth Israel Hosp.
BWH-Brigham & Women's Hosp.
B/WRVA-Brockton/W. Roxbury
Veterans Administration
CBR-Center for Blood Research
CH-Cambridge Hosp.
CHMC-Children's Hosp.
DFCI-Dana Farber Cancer Inst.
DH-Deaconess Hosp.
FDC-Forsyth Dental Ctr.
HMS-Harvard Medical School
HSPH-Harvard School of
Public Health
JBCC-Judge Baker Children's Ctr.
JDC-Joslin Diabetes Ctr.
MAH-Mt. Auburn Hosp.
MEEI-Mass. Eye & Ear Infirmary
MGH-Mass. General Hosp.
MH-McLean Hosp.
MMHC-Mass. Mental Health Ctr.
SERI-Schepens Eye Research Inst.
SRH-Spaulding Rehab. Hosp.
WEDNESDAY, JANUARY 24
Gary Tzeng, BWH
Anesthesia Grand Rounds:
Non-Cardiac Considerations of Chest Trauma
7 am, CWN L1 Anesthesia Lecture Hall, BWH
Louis Braverman
U Mass Med. Ctr.
Anesthesia Grand Rounds:
Anesthesia and the Thyroid
7 am, Sherman Aud., BIH
Dana Zalkind, DH
Plastic Surgery Grand Rounds:
Regional Anesthesia Local Anesthetics Toxicities
7-8 am, CRI Bldg., 2nd Fl., DH
Nancy Rigotti, MGH
OB/GYN Grand Rounds:
Smoking Cessation and Women's Health-What Can We Do?
7:30-8:30 am, Duncan Reid Conf. Rm., BWH
Michael Mennuti
U Penn Med. Ctr.
OB/GYN Grand Rounds:
A 35-Year-Old Pregnant Woman Considering Serum Screening
8 am, Riesman Conf. Rm.,
BIH
John Paris, BC
Surgical Grand Rounds:
Physician Refusal of Requested Treatment-Ethical Analysis
8 am, Joslin Aud., DH
Deborah Barron & Raphael Bueno, BWH
Anesthesia Grand Rounds:
Tracheal Resection/Reconstruction Surgery and Anesthesia
8 am, CWN L1 Anesthesia Lecture Hall, BWH
Andrew Margolin, The Massasoit School
Academic Teaching Conference:
Understanding Adolescent Male Aggression Through Narration
9-10 am, 4th Fl. Aud.,
JBCC
Samuel Thier, MGH
Psychiatry Grand Rounds:
State of the MGH and Partners Health Care
11 am-Noon, Blake 1 Aud., MGH
Bruce Vladeck, United Hosp. Fund, NY
Health Policy & Management Presentation:
The Future of Medicare
11:30 am-12:30 pm, Kresge G-2, HSPH
Robert Husson, CHMC
Grand Rounds:
Tuberculosis
Noon-1 pm, Enders Aud., CHMC
Mitchell Sogin, Woods Hole Marine Biology Lab
Molecular Biology Seminar:
The Search for our Ancestral Roots-Ribosomal RNAs as
"Molecular Chronometers"
12:30 pm, Wellman 11 Conf. Rm., MGH
Stefanie Rassnick
Univ. of Pittsburgh
Behavioral Immunology Study Group & Psychiatry Seminar:
The Neurobiology of Stress-Induced Changes in Immune System
Function
3:30-5 pm, Palmer-Baker Span 4 Conf. Rm., DH
Steven Hebert, BWH
Endocrine Grand Rounds:
Molecular Dissection of Distal Mechanisms for Renal Sodium,
Potassium, and Divalent Mineral Ion Handling
4:15-5:30 pm, Enders Aud., CHMC
Stuart Schlossman, DFCI
Immunology Seminar:
Human T-Cell Activation, CD26 and CD27 Mediate Novel
Costimulatory Signals
5-6 pm, Bldg. D Amp., HMS
THURSDAY, JANUARY 25
Michael Palmer, Mass. Medical Society
Anesthesia Lecture:
From Discovery to Recovery-One Doctor's Story
8 am, Clinics 3 Amp., MGH
Lisa Iezzoni, BIH
Medical Grand Rounds:
Report Cards on Doctors and Hospitals-How Will They Affect
Patient Care?
8-9 am, Sherman Aud., BIH
Robert Neer, MGH
Medical Grand Rounds:
Postmenopausal Osteoporosis-New vs. Old Treatment
8-9 am, Blake Aud., MGH
Sidney Rudenstein, MAH
Medical Grand Rounds:
Bladder Cancer-Update 1996
8:15 am, Hurwitz Aud., MAH
Gilbert Daniels, MGH
OB/GYN Grand Rounds:
Thyroid Disease in Pregnancy
8:30 am, Meigs Conf. Rm., Vincent 2, MGH
The Art & Science of Rehabilitation
A World of Innovation
A special presentation of the New Beginnings in
Rehabilitation Series
8:30 am - 1 pm, SRH
Presenters from SRH:
David Burke
Paul Corcoran
Judith Evanko
Sheila Golden-Baker
Maureen Holden(Spaulding Gait Lab)
Wayne Klein
Paul Petrone
Noreen Poirier
Jan Sullivan
Alan Witkower
Howard Weiner, BWH
Neurology Grand Rounds:
Oral Tolerance and the Treatment of Multiple Sclerosis
9-10 am, Ether Dome, Bulfinch 4, MGH
Joseph Pinzone, MGH
Calcium Rounds:
Case Presentations
9:15-10:15 am, Fuller-Albright Library, MGH
Robert McCarley, BVA
Mental Health & Behavioral Science Clinical Case Conference:
Schizotypal Personality Disorder
10:30 am-Noon, Bldg. 22,
Rm. 1, BVA
Brian McGovern, MGH
Case Records of the MGH (CPC):
A 50-Year-Old Woman With a Diagnosis of Cardiomyopathy, an
Electronic Pacemaker, and Cardiac Arrest in Ventricular
Fibrillation
11 am-Noon, Ether Dome, Bulfinch 4, MGH
Jae Jung, NERPC
Committee on Virology Seminar:
Molecular Basis of Herpesvirus Saimiri Oncogenecity
Noon, MEC, Rm. 250,
HMS
Nadeem Karimbux, HSDM
Dental Medicine Joint Seminar:
The Role of Type XII Collagen in Periodontal Wound Healing
Noon, Haigh Aud., FDC
Robert Korngold
Thomas Jefferson Univ.
Blood Research Seminar:
Effect of CD4 and IgE Receptor Peptide Analogs in
Autoimmunity and Transplantation Models
Noon, Latham Library,
CBR
Albert Galaburda, BIH
Behavioral Neuroscience Seminar:
Topics of Visual Agnosia
Noon-1 pm, L1 Anesthesia Conf. Rm., BWH
Electra Coucouvanis, UCSF
Cutaneous Biology Research Center Seminar:
Signals for Cell Death and Survival Control Morphogenesis in
the Mouse Embryo
Noon-1 pm, CNY Bldg. 149, Rm. 7231, MGH-East
Michael Grossbard, MGH
Bone Marrow Transplant Conference:
Adjuvant Immunotoxin Therapy Following ABMT
Noon-1 pm, Dana 1820, DFCI
Martin Kafka, MH
Psychopharmacology Grand Rounds:
An Operational Definition for High Sex Drive in Men and its
Clinical Implications
Noon-1 pm, DeMarneffe Bldg., Rm. 132, MH
Ken Mandl, CHMC
Newborn Epidemiology and Health Policy Conference:
Impact of Reduced Obstetrical and Newborn Length of Stay
1:30 pm, JPN Conf. Rm., Enders Bldg., CHMC
Michael O'Rourke, Univ. So. Wales, Australia
Cardiovascular Grand Rounds:
Arterial Wave Reflection as the Cause of Systolic
Hypertension and Cardiac Failure-Mechanisms and Strategies
for Monitoring and Therapy
3-4 pm, Duncan Reid Conf. Rm., BWH
Paul Pilch, BU School of Med.
Metabolism Research Seminar:
Insulin Regulated Vesicular Trafficking in Fat and Muscle
4 pm, Level III Lecture Hall, JDC
Lawrence Katz
Duke Univ. Med. Ctr.
Neurobiology Lecture:
Neurotrophins in Cortical Development and Competition
4 pm, Goldenson Bldg., Rm. 122, HMS
Julie Silver, SRH
New Beginnings in Rehabilitation:
Prevention and Treatment of Diabetic Foot Complications
4-5 pm, Spaulding Neighborhood Rehab. Ctr., Framingham
Wolfgang Driever, MGH
Seminars in Molecular Medicine:
Genetic Analysis of Pattern Formation in the Zebrafish CNS
4-5 pm, Carrie Hall Conf. Rm., BWH
Elazer Edelman, BWH
Seminar in Vascular Biology:
Restenosis-Lessons Learned From Endogenous Forms of Vascular
Repair
4:30-5:30 pm, Enders Aud., CHMC
Moses Judah Folkman, CHMC
Eleventh Apffel Memorial Lecture:
Endogenous Inhibitors of Angiogenesis
5:30 pm, Kennedy G-2A, DH
Michael Joseph, MEEI & Norbert Liebsch, MGH
Skull Base Center Tumor Conference:
Case Presentations
6-7 pm, Orr Conf. Rm., Cox 2, MGH
FRIDAY, JANUARY 26
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular Conference:
Case Presentations
7-9 am, Gray 2 Reading Rm., MGH
Mark Goldberg, BWH
Hematology/Oncology Grand Rounds:
Erythropoietin Biology in Clinical Applications
8-9 am, Carrie Hall Conf. Rm., BWH
Kenneth Norris & Alan Schatzberg, Stanford Univ. School of
Med.
Psychopharmacology Lecture:
New Antidepressants
11 am, Chapel, MMHC
Marcus Fuhrer, NIH
Distinguished Lecture Series:
The Research Informed Practice of Medical
Rehabilitation-Shortfalls, Correctives, and Prospects
11 am-Noon, Conf. Rms. 8A&B, SRH
Elliot Israel, BWH
Medical Grand Rounds:
Leukotrienes in Asthma
Noon-1 pm, Bornstein Amp., BWH
MONDAY, JANUARY 29
Joan Butterton, MGH
Infectious Disease Unit Conference:
Schistomiasis
8-9 am, Bigelow 8 Conf. Rm., MGH
John Hartwig, BWH
Hematology/Oncology Research Seminar
GTPases, Polyphosphoinositides and Platelet-Actin Assemblies
8:30-9:30 am, Thorn B&C Conf. Rm., BWH
Bessel van der Kolk, HRI Trauma Ctr.
Psychiatry Grand Rounds:
Trauma and Memory II-The Research Data
10:30 am-Noon, Chapel, MMHC
Jeremy Ruskin, MGH
Medical Grand Rounds:
Advances in Cardiac Arrhythmia Management
Noon, Lecture Hall, Main Bldg., CH
Mariano Barbacid, Bristol-Myers Squibb
Human Neurobiology Seminar:
Life and Death Without Neurotrophin Receptors
Noon, Goldenson Bldg. Rm. 122, HMS
Robert Simms, BU
Arthritis Grand Rounds:
Steroid-Induced Osteoporosis
Noon-1 pm, Ether Dome, Bulfinch 4, MGH
Randall Margolis, BWH
Pathology Grand Rounds:
Pigmented Spindle and Epithelioid Cell Nevomelanocytes and
Nevi
12:30-1:30 pm, 3rd Fl. Pathology Conf. Rm., BWH
Erika Kates, Tufts Univ.
Family Violence Seminar:
Avenues Out of Poverty for Women and Children
12:30-2 pm, Seminar Rm. 1, DFCI, 57 Binney St.
Ruth Lehmann, Whitehead Institute
Cutaneous Biology Research Center Seminar:
RNA Localization and the Establishment of Polarity in
Drosophila
4-5 pm, CNY, Bldg. 149, Rm. 7231, MGH-East
TUESDAY, JANUARY 30
Kathy Dwyer & Sally Trombly, Risk Management, Harvard
OB/GYN Grand Rounds:
Informed Consent and Patient Refusal for Treatment in
Obstetrics
8-9 am, OB/GYN Conf. Rm., Parsons 1st Fl., MAH
Seward Rutkove, BIH
Primary Care Seminar:
Uses and Abuses of EMG and Nerve Conduction Studies
8-9 am, Riesman Aud.,
BIH
Michael Rauchman, BWH
Renal Grand Rounds:
General Nephrology
8:40-9:30 am, Thorn Bldg., Ground Fl. Conf. Rm., BWH
Christina Spengler, HSPH
Work-in-Progress Seminar:
Respiratory Sensations During Exercise in Subjects Lacking
Ventilatory Chemosensitivity
9:30-10:30 am, Bldg. I, Rm. 1301, HSPH
Rogelio Bayog, BVA
Conference on Addictions:
Case Conference on Major Mental Illness and Substance Abuse
9:30-11 am, Bldg. 2, Ward 2-1-C Day Rm., BVA
Raj Goyal, B/WRVA
GI Grand Rounds:
Dysphagia
11 am-Noon, Jackson 7 Library, MGH
Dejan Budimirovic, BVA
Psychopharmacology Conference:
Case Presentation
11 am-12:30 pm, Bldg. 2 LRC, BVA
David Sachs, MGH
Blood Research Seminar:
Transplantation Tolerance
Noon, CBR, 800 Huntington Ave.
Robert Brown, MGH
Neurobiology Seminar:
Motor Neuron Disease and Superoxide Dismutase-Lessons From
Genetics and Transgenic Mice
12:15 pm, Goldenson Bldg., Rm. 122, HMS
John Hedley-Whyte, HMS & HSPH
Quality of Care Research Seminar:
Ambulatory Surgery-Expansion, Limitations and Informatics
12:30-1:30 pm, Kresge G-2, HSPH
Robert Greene, BVA
Neuroscience Basics of Psychopharmacology: LTP
1-2 pm, Bldg. 2 LRC, BVA
Richard Masland, MGH
Broadhurst Foundation Visiting Lecture: Coarse Coding in the
Retina?
4 pm, Taft Conf. Rm., SERI
Michael Klagsbrun, CHMC
GI Research Seminar:
Growth Factor and Receptor Activities of Transmembrane H§-
EGF
4-5 pm, Jackson 7 Library, MGH
Pradeep Bhide, MGH
Neuroscience Seminar:
Regulation of Cell Cycle in the Corpus Striatum
4-5 pm, deMarneffe Bldg.,
Rm. 132, MH
Helen Edelberg, HMS
Division on Aging Seminar:
Update on Alzheimer's Disease
4:30-5:30 pm, Trustman Board Rm., BIH
Richard Scott, St. Barnabas Med. Ctr.
Fertility and Endocrinology Conference:
Ovarian Reserve
5-6 pm, Amb. Services Bldg. I, Swift Library, BWH
WEDNESDAY, JANUARY 31
Patrick Seigne, BWH
Anesthesia Grand Rounds:
Adult Respiratory Distress Syndrome (ARDS)
7 am, CWN L1, Anesthesia Lecture Hall, BWH
David Glass, Dartmouth-Hitchcock Med. Ctr.
Anesthesia Grand Rounds:
Perioperative Care of the Patient With Hemodynamic Disease
7 am, Sherman Aud., BIH
Faculty & Residents, DH & HMS
Plastic Surgery Grand Rounds:
Morbidity and Mortality Conference
7-8 am, CRI Bldg., 2nd Fl., DH
Andrew Jeon, BWH
Anesthesia Grand Rounds:
The Role of BWH and the Anesthesia Dept. in Boston's Health
Care System
8 am, CWN L1, Anesthesia Lecture Hall, BWH
Thomas O'Donnell, NEMC
Surgical Grand Rounds:
Surgery for Chronic Venous Insufficiency
8 am, Joslin Aud., NEDH
Jan Schnitzer, BIH
Pathology Research Conference:
Endothelial Caveolae Integrate Cell Surface Signaling With
Vesicular Transport
8:30 am, Rahilly Conf. Rm., 3rd Fl. Amory Bldg., BWH
Ross Baldessarini, MH
Psychiatry Grand Rounds:
Risks and Implications of Interrupting Long-term Maintenance
Treatment With Psychotropic Agents
11 am-Noon, Blake 1 Aud., MGH
Dennis Lund, CHMC
Medical Grand Rounds:
Pediatric Trauma
Noon-1 pm, Enders Aud., CHMC
Susan Ettner, HMS
Mental Health Policy Working Group/Malcolm Wiener Ctr. for
Social Policy Seminar:
Psychiatric Treatment and Outcomes of Medicare Patients
4 pm, Taubman Bldg., Rm. 401, JFK School of Gov't.,
Cambridge
Rachel Smolker, Bunting Institute Science Scholar
Bunting Institute Colloquium:
Communication and Behavior of Bottlenose Dolphins
4 pm, 34 Concord Ave., Cambridge
John Parrish, MGH (Panel Chair)
MGH Women in Academic Medicine Panel:
The Road Between Academia and Industry
4-6 pm, Wellman Conf. Rm., MGH
Jeffrey Bluestone, Univ. Chicago
Immunology Seminar:
The Complexities of CD28/B7
T Cell Costimulation
5-6 pm, Bldg. D Amp., HMS
Marco Wen, SRH
New Beginnings in Rehabilitation:
Evaluation and Treatment of Common Pain Syndromes
7:30-8:30 pm, Neighborhood Center, Brookline, SRH
THURSDAY, FEBRUARY 1
H. Franklin Bunn, BWH
Medical Grand Rounds:
Sickle Cell Disease-New Developments in Therapy
8 am, Sherman Aud., BIH
Kevin Donohoe, BIH
Joint Program of Nuclear Medicine Lecture:
Risk Communication
8 am, Bleibtrieu Room, DFCI
Charles Hatem, MAH
Medical Grand Rounds:
Morbidity and Mortality & Dept. of Medicine Meeting
8:15 am, Hurwitz Aud., MAH
Robert Alexander, BVA
Mental Health & Behavioral Sciences Council Clinical Care
Conference:
Case Presentation and Discussion of Treatment-Resistant
Schizophrenia
10:30 am-Noon, Bldg. 22,
Rm. 1, BVA
Saul Zackson, Univ. of Calgary
Dental Medicine Joint Seminar:
Induction of Adhesive Junctions in Fibroblasts and Myocytes
Noon, Haigh Aud., FDC
Judy Adams, MGH
Reproductive Endocrinology Clinical Conference:
Ultrasonography in Reproductive Endocrinology
Noon-1 pm, 5th Fl. Conf. Rm., Bartlett Hall Ext., MGH
Charlie Welsch, MGH
Psychopharmacology Grand Rounds:
ECT in the High Risk Patient
Noon-1 pm, deMarneffe Bldg., Rm. 132, MH
Carl Apstein, BU School of Med.
Cardiovascular Grand Rounds:
Experimental Cardiogenic Shock-New Concepts in Physiology
and Management
3-4 pm, Duncan Reid Conf. Rm., BWH
Joseph Goldstein, Univ. Texas SW Med. Ctr.
Metabolism Research Seminar:
Regulation of Cellular Cholesterol by SREBP, a Membrane-
Bound Sterol Sensor and Transcriptional Activator
4 pm, Level III Lecture Hall, JDC
FRIDAY, FEBRUARY 2
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular Conference:
Case Presentations
7-9 am, Gray 2 Reading Rm., MGH
Gordon Weir, JDC
Endocrinology Grand Rounds:
Islet Transplantation-Why Is It Taking So Long?
9-10 am, Riesman Lecture Hall, BIH
Lee Cohen, MGH
Psychopharmacology Lecture:
Affective Disturbance in Pregnancy
11 am, Chapel, MMHC
William Crowley, MGH
Academic Conference:
Use of GnRH Analogs and Clinical Medicine
11 am-Noon, Pierce Hall, MH
Joseph Goldstein, Univ. Texas SW Med. Ctr.
Medical Grand Rounds/Priscilla White Lectureship on
Metabolism:
The Biotechnology Industry in 1996-Moving From the Surreal
(Gene Product) to the Real (Therapeutic Product)
Noon, Bornstein Amp., BWH
SATURDAY, FEBRUARY 3
Arlan Fuller, MGH
Surgical Grand Rounds:
Management of Ovarian Carcinoma
9-10 am, Riesman Lecture Hall, BIH
MONDAY, FEBRUARY 5
Alan D'Andrea, DFCI
Hematology/Oncology Research Seminar:
DUB-1, a Cytokine-Inducible Protease That Regulates Cell
Growth
8:30-9:30 am, Thorn B&C Conf. Rm., BWH
Joseph Coyle, HMS
Psychiatry Grand Rounds:
Is Schizophrenia a Neurodegenerative Disorder?
10:30 am-Noon, Chapel, MMHC
Karl Proppe, Salem Hosp.
Combined Pathology Grand Rounds:
Managed Care, Pathology and the Free Market
12:30-1:30 pm, Riesman Lecture Hall, BIH
Errol Friedberg, Univ. Texas SW Med. Ctr.
Cell Biology Seminar:
Excision Repair and Transcription in Eukaryotes-Connections
and Intersections
4 pm, Cannon Rm., Bldg C,
HMS
TUESDAY, FEBRUARY 6
Michael Rosenblatt
BIH
Primary Care Seminar:
Modern Treatment of Osteoporosis
8-9 am, Riesman Aud.,
BIH
Ramon Molina, HSPH
Work-in-Progress Seminar:
Possible Role of IL-13 on Pneumocystis Pneumonia Clearance
9:30 am, Bldg. I, Rm. 1301,
HSPH
David Mather, BVA
Conference on Addictions:
Self-Medicating and Substance Abuse Relapse
9:30-11 am, Bldg. 2, Ward 2-1-C Day Rm., BVA
Peter Macklem, Montreal Chest Institute
Work-in-Progress Seminar:
The Way We Breathe in Health and Disease
10:30-11:30 am, Bldg. I, Rm. 1301, HSPH
Bernard Aserkoff & Daniel Quirk, MGH
GI Grand Rounds:
Operations Improvement-Upper GI Bleeding
11 am, Jackson 7, MGH
Dejan Budimirovic, BVA
Psychopharmacology Conference:
Literature Presentation
11 am-12:30 pm, Bldg. 2 LRC, BVA
Manuel Serrano, Cold Spring Harbor Lab
Blood Research Seminar:
Cell Cycle and Cancer-Recent Studies on p16
Noon, Latham Library, CBR, 200 Longwood Ave.
Psychiatry Case Conference
Major Depressive Disorder: A Fifty Year Perspective
Grace Chang, Andrew Stoll and
George Vaillant, BWH
Noon-1:15 pm, Carrie Hall Conf. Rm., BWH
David Hatler, BWH
Neurology Lecture:
Memory:-An Immunology Perspective
12:15 pm, Goldenson Bldg., Rm. 122, HMS
Arthur Waltman, MGH
Radiology Grand Rounds:
Pulmonary Embolism, What You Always Wanted To Know But Were
Afraid To Ask
12:30 pm, Bornstein Amp., BWH
Arlene Ash, BU School of Med.
Quality of Care Research Seminar:
The Role of Risk-Adjusted Payment Models in Health Care
Reform
12:30-1:30 pm, Kresge G-2, HSPH
Richard D'Aquila, MGH
Harvard AIDS Institute Research Seminar:
HIV-1RT Inhibitor Resistance Mutations and Replication
Capacity
12:30-1:30 pm, Kresge 502, HSPH
Roy Lobb, Biogen
Research Seminar:
Small Molecule Antagonists of a-4 Integrins-Potential
Therapeutics for IBD
4 pm, Jackson 7, MGH
Sandra Schmid, Scripps Research Inst.
Cell Biology Lecture:
Endocytosis of Receptor Tyrosine Kinases-A Private Escort
Service?
5 pm, Goldenson Bldg., Rm. 122, HMS
Robert Brooks, MH
Obsessive Compulsive and Related Disorders Speakers Program:
Strategies for Fostering Self-esteem-The Search for Islands
of Competency
6:30 pm, deMarneffe Bldg., MH
