BROWN Volume 19 | Number 1 | Winter 2013 MEDICINE Troubled Waters In Philadelphia, Amy Nunn helps spread the gospel truth about HIV: Test. Treat. PLUS: CHILDREN OF MEN Prevent. MODEL PATIENTS

c1BrMed_Winter13.indd 1 1/28/13 4:01 PM Letter from the dean

Change Makers This edition of Brown Medicine highlights one of the exciting areas of research and clinical care at Brown, HIV/AIDS. Brown faculty are national experts in women and HIV, prisoner health, HIV and underserved populations, and HIV in developing countries including Kenya, Ghana, Haiti, South Africa, and India. Federal funding for research in this area at Brown tops $20 million annually. Further research by Amy Nunn has been focused on the prevention of HIV in high-risk areas like some neighborhoods of Philadelphia. In addition to research, the group headed by Tim Flanigan has provided outstanding clinical care coupled with dynamic education. I observe this each week when I see patients at the same time as Tim and other faculty in The Miriam Hospital Immunology Center. The center is filled with students, residents, fellows, and visiting physicians from other countries, as well as a variety of other people including high school students with an interest in medicine. Additional articles in this issue include a feature on fascinating translational research in urology headed by Kim Boekelheide in Pathology and Mark Sigman, chief of the Division of Urology. A photo essay on the clinical skills suite shows a very popular and busy part of the new Alpert Medical School building. (Not mentioned but soon to come online is a new fitness center for students on the fourth floor of the building.) Finally, there is a profile of our outgoing associate dean for medical education, Phil Gruppuso. Phil has been an extraordinary dean during the past seven years. He oversaw a complete revision of the medical curriculum. During his term he has earned respect from students, faculty, and the entire Brown community for his honesty and commitment to excellence. He has also been innovative in developing a proposal for a new Primary Care-Population Health Program and research fellowship opportunities for research-oriented students. Phil isn’t disappearing from education and will continue to teach and advise in the new Alpert Medical School building. ee goldberg Peter

Brown medicine | winter 2013 http://brownmedicinemagazine.org

c2-01BrMed_Winter13.indd 2 1/31/13 4:29 PM Letter from the editor INBOX

Winter 2013 | Volume 19 | Number 1

editor Full of Grace Kris Cambra art director Precious Medals Min O. Design I spend a lot of time with doctors, both in Staff writer Brown Medicine has made another strong showing in the Council for my professional and personal life. As I Phoebe Hall the Advancement and Support of Education (CASE) District 1 Excellence assistant Staff writer Awards. In the external magazine category (circulation under 25,000), write this, my son is in the operating room Kylah Goodfellow Klinge Brown Medicine captured the Silver for Best Overall, Bronze for for yet another procedure. Most of the editorial intern Best Writing, and Honorable Mention for Best Design. Dani Grodsky ’14 doctors who care for him are kind, gracious production Assistant people—people who choose to work on Frank Mullin printing the most complex cases, the tiniest and The Lane Press Inc. Medicine stint and he was a resident COMING most fragile bodies, and to deal with the editorial board charged with teaching my group. We ATTRACTIONS Sol Adelsky MD’13 didn’t necessarily make his task of M arch 15, 2013 attendant overwrought parents. But once George Bayliss MD’03 RES’06 both getting care done and doing no Match Day in awhile, I encounter a doctor who rests Robert Becher MD’06 harm easy. He stood out even then as a Norman Boucher very capable doctor and out-of-the-box M ay 24-26, 2013 on the knowledge that he or she knows Benjamin Brown ’08 MD’12 thinker as he tried to lead us. Over the Commencement-Reunion Weekend more than I do, who fails to listen or Christopher Dodson ’99 years it has been brutally apparent that brown.edu/go/medicalreunion MD’03 Heartiest the biggest medical challenges are not dismisses my concerns, and in so doing Dana Cook Grossman ’73 Congratulations high tech at all, and it is gratifying that O ctober 18-20, 2013 puts my son in danger. Those doctors I Krista Hachey ’07 MD’11 I t’s long overdue that David Egilman he is trying to address some of them and Medical Family Weekend WA want to send to Alpert Medical School to Galen Henderson MD’93 was made a professor of family medicine improve “family medicine.” Phyllis Hollenbeck ’73 MD’77 (Brown Medicine, Fall 2012). His blend of Chris Indech ’76 take the Doctoring course, which you’ll Natasha Hunter MD’12 idealism and practicality, accompanied MMSc’79 MD’79 read about in this issue. Susan Adler Kaplan ’58 MAT’65 by a wicked sense of humor, was memo- Norcross, GA Robert B. Klein, MD rable so many years ago, when I was a For one year I was a member of the Doctoring course’s non-physician faculty, Akanksha Mehta ’02 MD’06 medical student rotating through the MOVE so I know well its curriculum and its patient-centered approach. Students are Christine Montross MD’06 THAT BARGE taught to presume nothing and to remember that while the doctor may be an MMS’07 RES’10 T he brilliant blue span fo the new expert in the medicine, the patient (or the parent, I’d add) is the expert in his or Andrew E. Robin MD’13 Providence River Bridge (or Iway) was her experience of the illness. W rite Us. Brown Medicine may not be reproduced the perfect backdrop for a story on new While doctoring courses are gaining momentum in academic medicine, without prior consent and proper credit. Please send letters, which may be linkages between health care providers I can only hope that soon all doctors will receive and practice these lessons. For Address all requests to the editor. The edited for length and clarity, to: and faith communities. Photographer’s now, I am grateful to know that Brown-trained physicians go out into the world opinions of contributors do not necessarily reflect the views of The Warren Alpert • Brown Medicine assistant Brianna Babick helped Jesse each year, for the comfort and safety of patients and parents like me. Medical School of Brown University or its B o x G -ADV Burke make the most of the fading affiliated hospitals. Brown Medicine is Providence, RI 02912 December sun, while art director Mindy published three times a year by the Office of Biomedical Advancement. • [email protected] Oswald convinced the Providence Steam- © b rown medicine 2013 • Brownmedicinemagazine.org boat Company to move a river barge that was ruining the aesthetic. Anything for

Jared leeds; Mindy Oswald a great cover shot!

2 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 3

02-15BrMed_Winter13.indd 2-3 1/31/13 6:16 PM Wh at’s new in the classrooms, on the wards, and in the labs Groups of pharmacy, t heBeatnursing, medical, and social work Island’s nursing and pharmacy colleges, INTO XIcating students work and Rhode Island College’s nursing and through “paper social work schools. cases.” Indecent Exposure “Most fundamentally, they are learning how to work as a team with other health Study finds high blood levels of environmental care professionals at an early stage in pollutants in most women ages 16-49. their training,” says Paul George, MD, head of the Alpert Medical School’s A lmost one-quarter of American women of childbearing age meet or exceed second-year curriculum and the work- the median blood levels for lead, mercury, and PCBs, which can harm fetal and shop organizer. When George was in infant brain development. training as a physician a decade ago, he That’s the conclusion of a study by Brown researchers who analyzed blood says, he didn’t learn to work in these test results of more than 3,000 women between the ages of 16 and 49. The study, kinds of teams until he was a resident. which was published last November in the journal Environmental Research, also The students had a lot to learn from found that more than half of the women exceed the median for at least two of the each other’s developing expertise, but three pollutants. they mingled so naturally that one had Marcella Thompson, PhD, lead author of the study and a postdoctoral to carefully study the patches on the research associate for Brown’s Superfund Research Program, says her team shoulders of their white coats to deter- focused on lead, mercury, and PCBs because they are pervasive and per- mine who was a pharmacist, who was a sistent in the environment. The research “points out clearly the need to hea o nurse, and who was a doctor in training. look at health outcomes for multiple environmental chemical co-ex- i

m ke c —David Orenstein posures,” she says. The data analyzed in the study were collected from 1999 to 2004 for the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey. The survey also elicited information on health behaviors and socioeconomic and demo- graphic characteristics, allowing Thompson and coauthor Kim Boekelheide, MD, PhD, professor of medical science, to identify risk factors associated with increased levels of the pollutants, which pass to fetuses through the placenta and to babies through breast milk. NEW DIGS ing o her t stop taking her iron-laden The most significant link the researchers found was age: multivitamin because it could conflict compared to teens, women in their 30s and 40s have 12 times and with the antibiotic. Then time is up and 30 times greater risk, respectively, for above-median levels of two Team Effort the doctor, social worker, pharmacist, and or more pollutants. Fish and heavy alcohol consumption are also Students learn in interdisciplinary health care teams. nurse get feedback from an instructor. risk factors. In truth the team members won’t The study did discover one factor that greatly reduces blood pol- I nside the exam room, a woman has Can she afford the antibiotics she will have those professional titles until they lutant levels: breastfeeding. Unfortunately, Thompson says, that indicates pneumonia. Outside, three women and need? What other medicines is she tak- are done with school—and the patient, that nursing mothers are passing the pollutants that accumulated in their a man talk about a plan to make her well. ing? Does she encounter anything in her thankfully, isn’t really sick. She’s an bodies to their infants. The team—a doctor, a social worker, life that would make it harder to breathe? actor playing a patient for the sake of an Thompson says women should learn about their risks of co-exposure to ke c ke m

a pharmacist, and a nurse—discuss the They head back into the exam room unusual workshop hosted last November i lead, mercury, and PCBs well before they become pregnant—especially if they

notes from their interview with the ailing with their plan. They present it to the for more than 400 students from Alpert o plan to have a baby in their 30s or 40s. “We carry a history of our environmental hea middle-aged patient. Is she a smoker? patient and answer her questions, advis- Medical School, the University of Rhode exposures throughout our lives,” Thompson says. —D.O.

4 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 5

02-15BrMed_Winter13.indd 4-5 1/31/13 6:16 PM t heBeat How is Brown different from UPDATE other programs and schools of public health? Smoothing the Handoff Public health at Brown draws upon the University’s culture and philosophy An app ensures thorough transfer of patient info. of student-directed and individualized education and the discovery of new A former software consultant who knowledge through high-quality inter- developed a passion for health care, disciplinary research. Our Program is Scott Guelich MD’11 was already working “ Medicine is practiced by teams, and we need built upon our internationally recog- to bridge his experiences in Silicon better tools to support coordination.” nized public health centers that conduct Valley and medicine while a student at research that informs improvements in Alpert Medical School. On his clinical F ox Wetle leads promotion of health, delivery of health rotations, he recognized that physicians needed an easier way ation,e h co-founded Care Thread, a Providence-based com- the Public Health care, and quality of life. to find lower-cost drug equivalents for patients and created pany that is focused on improving one of the most problem- Program through its W hat are Brown’s areas of strength Generics, an iPhone app that was downloaded more than atic areas in clinical care: the patient handoff. Communications next transition. in public health? 10,000 times (Brown Medicine, Winter 2011). during handoff were identified by the 2010 Joint Commis- We have particular strengths ni But Guelich’s drive to provide physicians with more sion Center for Transforming Healthcare as a critical area e levator pitch understanding, preventing, and treat- effective tools for patient care didn’t end there. Upon gradu- in need of improvement. ing misuse of alcohol; in encouraging To keep every clinical team member Prepare for Launch healthy behaviors by addressing phys- up to date, Care Thread enables secure, ical activity, diet, and tobacco use; and HIPPA-compliant mobile messaging Public Health Program is well on its way to becoming in improving health care delivery by over between clinicians or entire care teams. It Heard Brown’s third professional school. studying service use, identifying the also streams a feed of important clinical most appropriate evidence-based inter- events for each patient, giving providers T errie (Fox) Wetle, PhD, associate dean of medicine for public health and public ventions, and examining the impact of “Up to 75 percent of women use a real-time rundown of the course of policy, is the administrative and academic leader of Brown’s public health enter- changes in health policy. care, and offers handoff summaries to prise. Since her arrival at Brown in 2000, Wetle has led the University’s strategic W hat will becoming a school of herbal and complementary medicines ensure safer care transitions. The tool is growth of the Public Health Program. Under her leadership the faculty has grown public health mean to your Program to treat their postmenopausal available for Apple and Android devices from just over 100 to more than 200, student enrollments have tripled, and research and to Brown University at large? and also works with a web browser. support has more than tripled, with annual external research funding at more than Becoming a school of public health will symptoms. Therefore, it is vitally “Care Thread was created to solve the $60 million. The Program has also grown to support five master’s programs— heighten our visibility, expand the pool important for health care providers fundamental communication challeng- including a robust, fully accredited MPH program—as well as three PhD programs, of applicants to our educational pro- es that health care providers face today,” four academic departments, and 11 nationally renowned research centers. grams, and improve our eligibility for to be aware of and informed about says Guelich. “Medicine is practiced by Brown University’s Public Health Program is now poised to be a school of public specific sources of funding. the non-pharmacological therapies teams, and we need better tools to sup- health. The faculty voted unanimously in support of the school last November, and How confident are you that port coordination. By connecting people, the Corporation will review the proposal in February (near press time). If the pro- Brown will be accredited as a school available for women who are we can improve patient outcomes.” posal is approved, the school will apply for official accreditation with the Council on of public health? How long will experiencing postmenopausal The company recently announced a Education for Public Health. the process take? $250,000 investment from the Slater Wetle talked to Brown Medicine about these next steps—and the importance of We have worked very hard ot address symptoms and who are looking for Technology Fund, a Rhode Island-focused public health broadly. all criteria for accreditation as we have an alternative to HRT.” economic development fund. Care Thread grown and evolved our programs. The has also partnered with Yankee Alliance, Why is public health so important? critically needed in our current health process of accreditation requires two —Ii r s Tong, MD, director of Women’s Primary Care at a group purchasing organization for Public health focuses no understand- care environment. There are many missed years of consultations, site visits, a de- (2) the Women’s Medicine Collaborative and assistant professor of hospitals—a collaboration that will ex-

ing, protecting, and improving the health opportunities for promoting health, and tailed self-study including external re- UELICH medicine, in a review of herbal and complementary medicine pand its sales reach throughout the G

ee g peter T

of our population. Success means lower our goal is to address that failure by devel- view of our programs, and a vote by the T used to treat symptoms of menopause published in the January Northeast—and was named “App of the O C S

rates of disease and improved quality of oping new knowledge and then translat- board of the accrediting agency—the o issue of The Obstetrician and Gynaecologist. Month” by Nuance Healthcare. l life, more appropriate use of health care, ing that understanding into meaningful Council on Education for Public Health. dberg Learn more at www.carethread.com. u o

and lower costs of care in general—all public health policy and practice. —Kylah Goodfellow Klinge c rtesy —K.G.K.

6 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 7

02-15BrMed_Winter13.indd 6-7 1/31/13 6:16 PM t heBeat A natomy of AN APPLE NEW FRONTIER a first-year medical A DAY student Last fall Nerve Center Lieberman Brown partners with the VA to seek therapies Second Course picked Rhode Island apples for patients with severe injuries. T o hear Dave Lieberman tell it, the BIG DOG, to make hard segue from cookbook author and TV SMALL CITY cider—“a good A new research center in Providence may help some injured veterans regain chef to medical student is a natural one. Lieberman walks start to the their independence. For his 2009 book, The 10 Things You his 3-year-old season.” The Center of Excellence for Neurorestoration and Neurotechnology, housed Need to Eat, about superfoods that are French Briard at the Providence Veterans Affairs Medical Center and led by Brown-affiliated easy to find and prepare, the 33-year-old in a park near his scientists, develops and tests technologies and therapies for former servicemembers Philadelphia native thought beyond the home, but “he’s with brain disorders, psychiatric conditions, and limb loss. recipe to consider obesity, cardiovascu- a big, lazy dog” FRENCH “The research aims to restore the ability of our veterans to pursue fulfilling and lar disease, and other diet-related afflic- who loves PRESS independent lives,” John Donoghue, professor of neuroscience and engineering and tions. “I had always wanted to take my to sleep. B elieve it or directorf o the center, said at its dedica- career in a more social-issue direction, not, Lieberman tion ceremony in October. and saw health and medicine as the per- needs only a The new center, which the VA is fund- fect way to do it,” says the former Food couple of cups ing with $4.5 million over five years, in- Network host of Good Deal and Eat This. of coffee each volves more than 30 researchers from In his first year at Alpert Medical School, day to stay regional hospitals as well as the Brown Lieberman has plans to blend his old ca- awake. Institute for Brain Science. Already they reer with his new one—but for now he’s are conducting clinical trials with real letting them marinate. —Phoebe Hall patients, Donoghue said. “Advancing science to restore health and quality of life for people with neuro- TOOLS OF GUITAR logical disorders and limb loss is a tre- THE TRADE Lieberman mendously inspiring research mission,” T he former picked up the Brown President Christina Paxson said. New York City instrument The center “has the potential to yield apartment during his many beneficial innovations for veter- dweller loves postbac studies ans and others,” she added. cooking in his at Columbia, The center focuses on four areas of re- C athy, one of the “big, bright” “to exercise search: advancing prosthetics for upper- patients who tested nter e

Providence COO KBooKS C the other side limb amputees; robotic- and computer- the BrainGate2 neural kitchen. Young and of my brain.” assisted rehabilitation for patients with interface, attended Hungry and Dave’s strokes, multiple sclerosis, and other the VA ceremony. irs Medical Dinners feature a disorders; neuromodulation technolo- ff simple, affordable A gies, such as electrical and magnetic brain stimulation, to treat chronic pain and meals that will psychiatric conditions; and the BrainGate brain-computer interface for people with terans e impress guests and V severe paralysis, which the National Institutes of Health highlighted as a top re- S TudY AID families alike. search breakthrough of 2012. idence v

T hanks to digital Lieberman co-wrote o Two BrainGate patients, Bob of Connecticut and Cathy of Massachusetts, traveled r P /

recordings of his 10 Things with his o to Providence for the VA ceremony. As research participants, the two tetraplegics st ada Ferr

professors’ lectures, Yale roommate - had, through a neural interface, manipulated robotic arms to grasp objects. o m

at m

Lieberman can Anahad O’Connor, a n Their feat foreshadowed what Providence VA Chaplain Daniel Cottrell invoked a D i

listen to them New York Times o for the center at the ceremony’s onset: “May the mysteries unlocked not only be the D

o m n i

again online. health columnist. K o success of science, but the triumph of the human spirit.” —D.O.

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02-15BrMed_Winter13.indd 8-9 1/31/13 6:16 PM t heBeat F indings meta-analyses and judging credibility many platforms, including the iPhone, based on factors like a journal’s prestige, Android, and Blackberry. “There is no size of study, and diversity of patient other application—no webpage, no book, Hover Moms and Dads population. no journal—that provides this service,” Careful parenting may offset genetic risk. “We continue to stay current with Jolis says. the literature and update the database, “We encourage people to check it out but we also added a feature so that you and give feedback. We are always open can request additional data if a test can- to suggestions and want to make it the not be found,” Jolis explains. Each test’s most useful product it can be,” Chung In statistical summary includes a direct adds. a new link to the source so that users can draw The pair recently released a third study, COO L TOOL their own conclusions from the data. app, Vitals & Fluids Medical Care Tracker, addiction re- The pair will release another app called which helps doctors and nurses keep ephaney ephaney Farrell

searcher Robert t Doctor Said What, which provides the track of patient vital signs, fluid status, Power in Your Pocket S Miranda Jr., asso- T imothy Jolis MD’13 is app happy. same function except translated into and much more. Chung and Jolis have New apps make diagnosis and management a snap.

ciate professor of ick and terms that patients can better under- individual ambitions to integrate their R psychiatry and hu- as Chung explains, “by doing this, we stand. medical knowledge and business acu- lis; lis; man behavior, found C ould your patient’s symptoms be o can effectively reduce medical costs by “When I told my family about the men to create companies whose soft- hy hy J t

that attentive parenting indicative of a life-threatening disease, o avoiding unnecessary testing.” original app, they downloaded it but ware can further facilitate the process m i can overcome a genetic a treatable infection, or an adverse reac- T The app includes almost 400 tests— then said they couldn’t use it because it of differential diagnosis and provide in- predisposition to alcohol tion to a drug? These questions are asked the product of Jolis’s and Chung’s work wasn’t in English,” Jolis jokes. novative assistance in the clinical setting. u o

use disorder among teens. in hospitals and doctors’ offices daily. c r rtesy eading and understanding thousands of The 99-cent application works on —D.G. Previously, Miranda and col- Now a smartphone app, Sensitivity and leagues had found that teens Specificity, can help determine which with a single difference in their tests will most effectively and accurately genes were more predisposed to provide the answers necessary to find the NOSTALGIA alcohol use disorder. In this follow- correct diagnosis. By searching through up study in Alcoholism: Clinical and Ex- a database filled with hundreds of peer- Welcome Back perimental Research, he found that the reviewed and hand-selected journal risk was largely overcome when parents F elise Milan MD’91, professor of were specifically mindful of their teen’s be- clinical medicine at Albert Einstein havior and peer group. “B  y doing this, we can effectively reduce College of Medicine, speaks Of the 104 adolescents ages 12-19 in the about innovations in teaching study, the team found 30 with the incrimi- medical costs by avoiding unnecessary at the General Internal Medicine nating allele. The data suggest that the asso- testing.” Residency Program reunion ciation between this genotype and risk for an in October. The event, which alcohol use disorder was moderated by greater drew more than 100 resident parental monitoring and reduced relations with alumni, current residents, faculty, negatively influencing friends. publications, a doctor or medical student while both were working at Memorial and their guests, included a ny sad c Oswald; ndy m As this work is still in early stages, continued can find various testing options and the Hospital of Rhode Island. i one-day conference at the Medical research on a larger population is needed to sub- average percentage of accurate positive Sensitivity and Specificity helps School on the past, present, and stantiate the interrelationship. However, Miranda and negative results for a specific ail- doctors practice evidence-based medi- future of primary care and the

says, “the take-home message from this research ment by simply typing in its name. cine while serving as a learning tool for o residency program. For alumni, u is that parents worried about their teen and The app was developed last year, students, as well as doctors, to build up rtesy who enjoyed a cocktail reception,

drinking should closely monitor their child’s spurred by the coincidental meeting of their knowledge of the most effective and T i dinner, and other opportunities m o

behavior and peer group.” —Adapted by Dani Timothy Jolis MD’13, the man with the reliable assessment options according t to reminisce and reconnect y J hy

Grodsky ’14 from an interview idea, and Waihong Chung MD’14, the to concrete experimental observation. o with each other, the past was l by David Orenstein man with the technological know-how, This has great potential benefit in that, is the best part. WA

10 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 11

02-15BrMed_Winter13.indd 10-11 1/31/13 6:16 PM ESS AY B y Piyush Gupta, MD RES’ F IELDNotes BY Jayson Marwaha ’14 md’18

were throwing trash into the hallways and Outside the Walls relieving themselves in the staircases. An intern volunteers for the Sandy relief effort. We turned on our headlamps, fought through the debris to our target apart- ment, and knocked. No answer. “Hello, A fter Hurricane Sandy hit, I packed met, watching the devastation out of the my name is Doctor Gupta, and I am here my duffel bag with medical supplies window flash by, it all seemed surreal. to help,” I said—words that I had never and scrubs, and—with the blessing of I was nervous. It was my first time spoken outside the hospital. After a my program director—hopped on a bus wearing my white coat outside of a med- moment, the door opened a crack, and headed for New York City. I grew up in ical setting; I had graduated from medi- an elderly lady peered around its bolted Connecticut; with my medical training, cal school only six months prior. I didn’t chain. Eyeing me, she opened the door I felt I could offer something tangible to know what to expect, or how much good farther, let us in. We assessed her medical my neighbors. I could actually do. And I confronted needs, made notes, told her news from When I arrived in New York, I linked more immediate fears too: I was in an “the outside,” gave her food and water. up with Occupy Sandy at St. Jacobi unfamiliar area, with multiple reports of For the next few days, I made similar Lutheran Church in Brooklyn. Within looting and crime; the streets were dark, house calls in Coney Island and the the hour, I was paired with two volun- the lights out. Rockaways. I came across myriad medi- teers to make house calls to apartments In the first apartment building, we cal problems and for the first time made that had been listed as “requiring med- faced pitch blackness and the shocking decisions without a senior resident or Simpler equipment didn’t work either. ical care.” We were briefed and dis- stench of garbage, urine, and feces. The attending to verify my assessments. I saw Like a Machine I saw doctors use kidney dishes to scoop patched almost immediately. Sitting in apartments had lacked running water and children with asthma exacerbations and blood out of patients because suction the back of a car with people I had just sanitation for more than a week. People no access to inhalers; elderly patients What does it take to keep a hospital running machines rarely functioned. I saw nurses who had run out of their blood pressure in Zanzibar? surround preemies with hot water bal- Shops on Pier 41 in Red Hook, medications and were experiencing dan- loons because the incubators wouldn’t Brooklyn, were devastated by a tidal gerously high blood pressures; disabled A long the coast fo the East African surgeon was accustomed was in sharp heat up. surge during Hurricane Sandy. people who, without running elevators, islands of Zanzibar sits a cluster of contrast to what we found in Zanzibar. were restricted to their apartments; indi- crumbling, concrete, whitewashed build- As of June 2012, about 80 percent of WE LL OILED viduals with severely infected wounds; ings that constitute Mnazi Mmoja, the Mnazi Mmoja’s equipment in the mater- Hospital machinery nrequires a aston- and people experiencing suicidal ide- islands’ biggest hospital. Lining its dim, nity theater—and about 75 percent in the ishing amount of maintenance. Some ations. All were grateful, trusting. rancid hallways are ancient machines Their confidence buoyed my own. with frayed cables, gathering dust. After my first few patients, I became It was here that I met an ENT sur- T hree of the four ultrasound machines more sure of my evaluations and recom- geon from Somerset, England, who had mendations, less insecure about my traveled to Zanzibar to volunteer. I was were broken, and women waited for hours relative inexperience, and more keenly working for MED International, a med- outside radiology each day. aware that medicine is just about a ical equipment nonprofit that I founded doctor and a patient, a person with a in 2011 and run with Han Sheng Chia ’14. need and a person who will try to help, in “How is it that every piece of equip- n c n ben or outside the hospital’s walls. WA er ment in my [own] hospital is always in neonatal unit—was broken. Though the top-of-the-line ultrasound machines sn j a o m R

i perfect condition?” the surgeon asked. “I hospital had four ultrasound machines, won’t last 90 days without regular checks ane ane o P iyush Gupta is an intern in Brown’s e don’t think I’ve ever stepped into an OR three had long been broken, and dozens and adjustments. And a quarter-million- l D ir ’02 lier Categorical Internal Medicine Residency where broken equipment was a problem.” of women waited for hours outside the dollar CT scanner? Probably even less essica essica

Program. j The seamless efficiency to which the radiology room each day. than that.

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02-15BrMed_Winter13.indd 12-13 1/31/13 6:16 PM F IELDNotes FromtheCOLLECTIONS by Sarah Baldwin-Beneich

In America and other developed types of items found in kindergarten One morning I walked into the tech- nations, equipment stays running be- classrooms and only a basic understand- nicians’ workroom and found one of Go Deep cause it is supported by professionals ing of electronics. If things are so easy them taking a screwdriver to an ironing wholly dedicated to its upkeep. In addi- to repair, why were they not being fixed? press. “Do you know if there are any new An early-17th-century tion to all the nurses and doctors darting On our trip and through our research, breakdowns in the main wards today?” book delves into around a hospital, there is also an army of we have discovered that the answer lies I asked. the human body. carefully coordinated clinical engineers largely in the prevailing dependency on “No, I don’t,” he replied. and on-call technicians focused on keep- foreign donors. It doesn’t make financial “Why are you working on the ironing I n 1543, Andreas Vesalius usheredn i ing everything functioning—all day, all sense for Mnazi Mmoja to set aside some press?” the era of modern anatomy with De night, all year, and in compliance with of its own budget for procurement or “Because the laundry room manager humani corporis fabrica librorum, the asked me to fix it.” first book of drawings and descriptions They have no way to prioritize repairs of the human body based on direct ob- It doesn’t make financial sense for Mnazi Mmoja or to organize workflow: There is no sys- servation (see Brown Medicine, Fall 2004). tem for reporting breakdowns, assigning Three-quarters of a century later—al- to set aside some of its budget for basic maintenance technicians to specific machines, or issu- most four centuries before 3D computer if it receives donated machines every month. ing deadlines. So when Mnazi Mmoja’s imaging became commonplace—Johan laundry man wants to be able to iron out Remmelin (1583-1632), a physician in wrinkles, his request becomes the top Augsburg, created what can be consid- item—the only item—on the to-do list. ered the first interactive anatomy book. industry and state regulations. They are even for basic maintenance if it receives These are the challenges that MED Titled Catoptrum microcosmicum aided by multimillion-dollar software crates of donated machines from dozens International is trying to address. We (microscopic mirror), Remmelin’s master- that issues alerts for machines that need of relief organizations every month. are working to make donations more piece comes close to rendering the human Lift the sun’s four flaps and maintenance or parts replacements. Donors rarely take time to study the relevant, management more efficient, body in three dimensions, and is still you’ll find a cupid, a man’s portrait, It’s a remarkable system, one that runs hospital’s needs, however, so those crates and expertise more available. If our widely regarded as the most ambitious and, finally, this: A deo est omnis on tight management, relevant exper- often carry equipment that misses the solutions work, they’ll wean Mnazi and impressive anatomical flapbook in medela (All healing is from God). tise, and strict regulation. mark. One day in June, I heard that sev- Mmoja off of equipment donations by history. It contains three full-page plates, Given the times, a sign of political It is a system that operates so smoothly eral dozen bed frames had been donated providing an incentive to invest in which feature a man, a woman, and a man prudence? that even some doctors barely notice it by an aid organization. I was surprised to maintenance and procurement of rele- and woman flanking a pregnant torso. until its absence is unmistakable—in a see the frames in a grassy patch behind vant technology—all while creating an The elaborately adorned engravings are flaps, prevented it from being a widely setting like Mnazi Mmoja. the hospital later that day; they stayed obvious change in availability of life- by the artist Lucas Kilian and based on used or enduring didactic tool. This there for a good part of the summer. The saving equipment. And if they’re really Remmelin’s own drawings. In each, extremely rare book is part of a 1987 gift Needs ASSESSMENT director of the hospital told me that pulse successful, in time they may even disap- flaps (also known as fugitive sheets) of 55,000 books and antique medical Last summer, oI went t Zanzibar with oximeters were one of Mnazi Mmoja’s pear behind the scenes, leaving Zanzi- peel back from different body parts to instruments from the Rhode Island Han Sheng to take a closer look at the greatest needs. The beds, on the other bar’s doctors wondering, “How is it that reveal the body’s anatomy layer by layer, are multilayered renderings of an eye, Medical Society to Brown. Housed at problem. What occurred was remark- hand, were irrelevant: Mnazi Mmoja every piece of equipment in my hospital some cross sections going 15 layers deep! the brain (both the male and female the John Hay Library, it was recently on able: In under an hour, an American simply had no immediate use for them. is always in perfect condition?” WA Lift the skin of the man’s front or the skulls, interestingly, have a snake crawl- display as part of an exhibit marking technician working with us put a suction But the problem isn’t as straightfor- woman’s back, for example, and you see ing through them), even the sun. The RIMS’s bicentennial. WA machine back into service with card- ward as overdependence on aid broadly Jayson Marwaha is the founder and veins and arteries. Lift a few more, and imagery embellishing the plates is highly board and electrical tape. He fixed a and on oft-unsuitable donated equipment co-executive director of MED International, you reveal muscles. Keep going, and even- allegorical. Sarah Baldwin-Beneich ’87 is the vacuum motor and an ultrasound moni- specifically. It is also rooted in issues of a nonprofit that designs, implements, and tually you see organs, and ultimately Remmelin’s flapbook, a technical former editor of Brown Medicine. tor with parts from an old desktop. He management and expertise. The hospital advises governments on medical equipment skeleton. You can also peel away the and aesthetic feat, was used for 130-some She is now the communications director h went from machine to machine in kind, doesn’t have the relevant knowledge or interventions. For more information, P layers of the pregnant torso to reveal years, but its high cost and unwieldy at Brown’s Watson Institute for a

until more than half were fixed with the system to track and fix breakdowns. visit www.medinternational-us.org. K ren the uilippi (2) terus and, finally, the fetus. There size, not to mention the delicacy of its International Studies.

14 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 15

02-15BrMed_Winter13.indd 14-15 1/31/13 6:16 PM BIGSHOT by mike cohea

Breaking Dawn A rooftop vigil yields illuminating results.

You can’t capture great photos with- out having great access, so I’m always trying to go places where people aren’t usually allowed. The roof of the Sciences Library is a unique vantage point of campus, Providence, and beyond. This photo is from a time lapse, which uses still photos to speed up time visually, that I did on a brisk October morning for a video project. I was up there for about three hours, starting at 5:30 a.m., with my very patient facilities escort, Joe Souza, and my student worker. I dressed in layers and brought some coffee, but mostly I kept warm moving around a lot, checking my three cameras, adjusting exposures, and checking out the views. It was still fairly dark out, so I used a five-second exposure to capture all the available light from the east. It was dark enough that a lot of lights were still on, but enough light was coming from the horizon to illuminate campus. More than a few people have thought this was Photoshopped or computer generated, which is quite the compliment! WA

Mike Cohea is the University’s multimedia producer and photographer. His photos appear regularly in Brown Medicine and other University publications. To see his time lapse sequences, go to http://vimeo.com/52797966 and http:// vimeo.com/56075656.

16 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 17

16-17BrMed_Winter13.indd 16-17 1/31/13 6:19 PM By Edward Wing, MD opinion Jeffrey Borkan, MD, PhD Philip Gruppuso, MD and Paul George ’01 MD’05 RES’08

Med Ed 2.0 A new program will train the future primary care physician.

family in front of them, but also manag- and population health and, in part, their specialty clinics to nursing homes and ing primary care and leading physician resident Obama’s sec- ing the entire group of patients who connection with Rhode Island. The cur- patients’ homes. groups and health systems, teaching ond term assures fur- regularly see them, and the community riculum will be patient focused, driven The program will draw on Brown’s the next generation of physicians, doing from which their patient panel comes. by information technology, and team strengths in public health, as well as research, serving in government and ther implementation Paying attention to population health based. There will be a focus on active other parts of the University. There is health departments, or taking roles that of the Affordable Care leads to better individual care and learning with few lectures in a curricu- much to learn from other professionals are just emerging. We hope a significant vice versa. For example, ensuring near- lum that integrates topics in a seamless in health care—pharmacists, nurses, percentage will enter primary care resi- Act, and with it, the universal childhood immunization fashion. Our hope is for students to pur- nurse practitioners, physicians’ assis- dencies in Rhode Island and settle here. acceleration of sweep- rates across Rhode Island, helping all sue both an MD and a master’s degree tants, and social workers. We hope to We anticipate more than just the contri- those with diabetes get their glucose that adds rigor, scholarship, and broad- partner with other Rhode Island health butions of the graduates who stay. We ing changes in Amer- levels and blood pressures into the also expect that there will be a “halo ican health care. Amid normal range, or combating the pre- effect” that will energize, transform, and these changes, our current workforce may no scription narcotic addiction epidemic T omorrow’s doctors must be as facile attract new faculty and practitioners to would improve the health and wellness information technology, Rhode Island (both in primary care and longer meet the demands of the future health of the state as a whole. At the same time, in population health, in the range of specialties) as well as en- care system. With more insured patients it would reduce suffering for individual and care coordination as they are with ergize and transform health care groups, patients—and even save money. hospital systems, and emerging new and a greater focus on primary care and pre- Physicians need to understand what using a stethoscope. models of care through the involvement P is happening in the community to iden- of students, faculty, and practitioners. vention, we’ll need more comprehensive, tify such problems and to craft interven- Beyond our small state’s borders we whole-person, first-contact care provided tions. What are the rates of alcohol and ened horizons in population health to professional schools to expand interdis- hope to make a contribution to innova- by generalists such as family physicians, pri- drug abuse? What percentage of preg- their skills. ciplinary training experiences. tion in medical education. Our experi- nant women gets easily accessible pre- There will be additional leadership ment and experience should transfer to mary care internists, and pediatricians. natal care? Is there adequate education training as well as ongoing mentorship AN RISI G TIDE medical education endeavors around But the primary care of the near fu- of Brown University, with the support and nursing support for people living with from the best primary care physicians in B rown’s Medical School, founded in the nation. Through these and other ture can’t just be the primary care of the of Brown’s leadership, we are planning diabetes? What are the rates for heart the state. Rather than chopping up the early 1970s, has contributed greatly measures, we hope to fulfill the poten- present merely on a larger scale. In the for a unique primary care program for disease risks, and what programs exist clerkships (medical student rotations) to Rhode Island’s health care quality, tial of health reform and improve the emerging system, primary care doctors 24 additional medical students beginning to reduce smoking, hypertension, and into the usual six-week rotation blocks, research enterprise, and economic base. health of the individuals, families, and must be leaders in caring for communi- in 2015, pending regulatory approval. Its obesity? In short, doctors should exam- we’ll offer students “longitudinal” clerk- But these last 40 years have also produced communities we serve. WA ties and populations, in addition to pro- focus is described in its title: the Primary ine the population as well as the patient. ships of nine to ten months to combine unintended consequences, including an viders of excellent care to individuals. Care-Population Health Program. To This shouldn’t just be learned on the the core specialties such as internal imbalance of too few primary care phy- E dward Wing is dean of medicine Tomorrow’s doctors must be as facile in our knowledge this is the first program job. It is time to bring this philosophy medicine and surgery. This will provide sicians relative to specialists. and biological sciences. Jeffrey Borkan matters of population health, informa- of its kind in the United States. into medical education. The new program them with continuity of teachers and, We believe that the graduates of this is assistant dean for Primary Care- tion technology, and care coordination The new program is consistent with will combine the usual emphasis on ba- most importantly, patients. Students new Primary Care-Population Health Population Health Program Planning as they are with using a stethoscope. an emerging national realization, well sic and medical science, with training in will follow a panel of patients through Program will become leaders in health and chair of Family Medicine. Philip Medical schools must re-imagine medi- expressed in a recent Institute of Medi- population health, epidemiology, and the health care system—from inpatient care who can help solve some of the Gruppuso is associate dean for medical cal education. cine report, that primary care means health policy. Students will be selected hospitalizations, surgeries, and births problems we face. We expect that these education. Paul George is assistant At The Warren Alpert Medical School doctors not just treating the person or for their commitment to primary care to outpatient visits in primary care and students will do “practice plus”: provid- professor of family medicine.

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18-19BrMed_Winter13.indd 18-19 1/31/13 6:19 PM ZooM BY eileen O’Gara-Kurtis

Edward Wing. “He and his team have fore,” says Wing, “and our culture is one transformed the first two years of medical in which students support each other school here, developing an integrated and compete with themselves. I think Phil curriculum that follows a systems ap- has done a lot to advance that.” proach. For instance, students might study a blockage in the GI system through N ew paradigm, the lenses of anatomy, physiology, and enduring values biochemistry all together. And they’ve Gruppuso has been a valuable mentor built in a robust feedback loop, using as well as a talented leader, Wing says. student focus groups, so that we have a “Our students really respect him. They continuously improving curriculum. know how much he supports them.”

“  He and his team have transformed the first two years of medical school here.”

We’re now in the midst of implementing That’s probably because Gruppuso’s changes of a similar scale for the third and such a fan. “It’s been an extraordinary fourth years—giving students short- opportunity, working with our stu- ened and more consolidated clerkship dents,” he says. “They come to us so ac- periods and more flexibility in focus.” complished, and they’re all so brilliant IN HIS ELEMENT Curriculum innovations—along with and committed.” It’s also because he’s Phil Gruppuso, center, always admission policy changes, an “academy walked the walk; Gruppuso knows what makes time to offer guidance and structure” that organizes the student it takes to build a successful career in The Doctor’s Progress encouragement to students. body into three tightly knit “academies,” academic medicine. He’s shown here with, left to right, Associate Dean Philip Gruppuso makes overseen by advisers and mentors, and Gruppuso came to Providence for a Audrey Butcher MD’13, Kartik the transformative gift from The Warren pediatric residency at Rhode Island plans to continue teaching and learning as part of Venkatesh ’06 PhD’11 MD’13, Jenna Alpert Foundation that made the Medical Hospital in 1977 and built a career at Lester MD’14, and Jonathan School’s state-of-the-art physical home Brown—complementing his clinical a medical school he helped to transform. Hernandez MD’14. possible—have turned Brown into a practice and leadership roles first by magnet for creative, mission-driven med- teaching biochemistry, then by leading T his summer, Philip Gruppuso will step classroom, where he’ll continue to deliver in fetal development. And, oh, there’s career in pediatric endocrinology. It’s a ical students. Class size has increased the MD/PhD Program, and finally by down as associate dean of medicine for 20 or so lectures every fall on topics in also the 200-year-old house just over worldview that has informed his leader- from 70 to 120 students, about half of becoming associate dean of medicine medical education. But he’s not going far. biochemistry and nutrition. And you’ll the line in Massachusetts, where he and ship during a time of unprecedented whom enter via the Program in Liberal for medical education eight years ago. You’ll still be able to follow the sound find him in his lab, where he’ll continue his wife, Martha Manno, raised their growth and ferment at Alpert Medical Medical Education (where Gruppuso When then-Dean Eli Y. Adashi re- of Gruppuso’s tinkling jazz piano to his NIH-funded research on regulation two daughters—the one that serves as a School. also made changes to enhance students’ cruited Gruppuso, today’s Alpert Medical

downtown Providence clubs, where he’ll of cell growth. really interesting continuous restoration patricko’connor preparation for medical school), with the School was still a dream. continue to indulge his 30-year passion At press time, he’s waiting to hear project. T ransformation rest arriving from other top universities “I was recruited before the Alpert for bringing syncopated vitality to the about another major grant that will allow Gruppuso approaches life as a rich “Phil has been responsible for some and via unique life and career paths. gift, so—although everybody knew city’s soundtrack—and to the occasional him to collaborate with colleagues at blend of interlocking passions—all built major changes and transitions,” says Dean “Our community is more diverse, we needed a new building—there was on-campus gig. You’ll find him in the Brown to study environmental factors on the foundation of a three-decade of Medicine and Biological Sciences dynamic, and exciting than ever be- nothing definite,” Gruppuso remembers.

20 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 21

20-23BrMed_Winter13.indd 20-21 1/31/13 6:23 PM ZooM RESIDENTEXPERT BY heather M. Cassidy, MD

“I was hired with the charge of leading a that we’re experiencing, to teach them “I think about the transitions I’ve comprehensive redesign of the curric- how to keep up with the science over the seen in my career—training in the Life Preserver ulum. But the scope of what has hap- course of their careers, how to find and PICU, working in acute care medicine, There’s more than one way pened here over the last eight years has manage information.” dealing with trauma and death and been beyond what any of us could have dying, taking care of very sick patients, to save someone. anticipated.” I’ t s about the patient and seeing the psychosocial and behav- Gruppuso points to the structural Gruppuso has already been through ioral sides of managing diabetes in chil- Perhaps it was growing up with Chris changes in the curriculum—particularly one major career transition in the last dren—and I realize that what it’s given that fostered my ease with those condi- the launch of the integrated curriculum, year. In 2012, he stopped seeing patients me, fundamentally, is a deep respect for tions we cannot cure. Surely we knew the introduction of the scholarly con- as a practicing pediatric endocrinologist. the patient,” he says. “Take the epi- early on that my brother’s develop- centrations program, and an incipient mental delays would not melt away; major initiative in training future leaders there would be no fix-it pill, no miracle in primary care (see page 18)—as his “O  ur job, as physicians, is to be compassionate procedure, and he would grow up to be a major contributions. But it’s all built on true man-child: young at heart and of a single mission: educating the best doc- and thoughtful and supportive.” mind. We adjusted in hundreds of tiny tors possible. ways so that his—and our—lives would “Our job is to provide our students be the most full. with the fundamental skills they need He’d nurtured many patients into young demic of childhood obesity that we’re Years later, in medical school, a and to instill values that will dictate how adulthood. And the health care system seeing. We had no inkling, 20 years ago, speaker asked our class how many of us a surgeon, as is my father. Much of their each patient fresh and without judg- they take care of patients—being a had changed, with physicians being that this was coming. There tends to be would like to save a life. We tentatively satisfaction with medicine and their ment. I challenge myself to hear not just gifted communicator, being altruistic, called upon to navigate an increasingly judgment of parents when you see a kid raised our hands, our eyes flicking un- connection with their patients lies in the story, but also the questions swirl- putting the patient first,” he says. “It’s complex practice environment and see who’s overweight. But it’s complicated, comfortably for a census of our neigh- “the fix”: the ability to tangibly and ing underneath and above it. Indeed, also increasingly imperative now, in the more patients in a compressed schedule. and it’s not appropriate to blame any- bors’ responses: Was this a trick question? physically correct what ails the patient. part of the craft of medicine is inferring midst of this explosion in knowledge It was time to open another chapter. body. Our job, as physicians, is to be The teacher went on: What does that look I find purpose in helping patients what the patient needs from us, both in compassionate and thoughtful and sup- like to you? What does it mean? weave their lives around what we cannot terms of reaction and results. Above all, portive, and give parents the tools they It was our first formal lesson in medi- cure. As a general internist I get to be a I challenge myself to find ways to com- need to raise healthy kids.” cine’s ambiguities, crafted to wake us to teacher, a scholar, a social worker, and a municate with those patients—like my The key to being a great doctor, says the assumptions and desires we each social innovator. A stoic power exists in brother—who are “hard” and may not tell Gruppuso, is that respect. “What you’re bring to the bedside. For me, “saving a maximizing quality of life. But for me to their stories in the ways we are trained doing is not about you. It’s about the life” raised specters of adrenaline and help a person do that, I must understand to hear … or who may not be able to tell a patient. You have to know what you’re procedural heroics, neither of which that person—her hopes, her responsi- story at all. I have found that often, for doing, be able to communicate, and put were my kin. And the eleventh-hour bilities, and what she needs from me, these most vulnerable patients, their yourself in the shoes of people whose diagnosis—while no doubt satisfying— her doctor. primary care doctor is one of a precious experience may be very different than harkened to television melodrama in my With my patients, the real work lies few communicating that their health— yours.” mind. So I must confess: when I raised in uncovering the context of their ill- their life—is important. And though it It’s a lesson he intends to keep shar- my hand that day, I was not entirely ear- ness. We heal what we may, but just as took me a while to see it, this may be its ing with students for a long time to nest. Of course, if given the chance, I importantly we wrap their lives around own, no less urgent, type of “save.” WA come. WA would run the code. But I had come to that which persists. Here knowledge’s that classroom seeking a quieter type of power stands strong, and the role of Heather Cassidy earned her medical JAZZD HAN S

E ileen O’Gara-Kurtis is the founder and H patient encounter that existed in gray doctor as teacher is vital: patients may degree at the University of Colorado A

Gruppuso and his band nk

president of Silver Branch Communications. ornley tones rather than black and white. regain some degree of control as they School of Medicine. She is a chief R an have an annual gig h

She is a frequent contributor to Brown dall In medicine, we each have to under- come to comprehend their illness. medical resident in Brown’s Internal at Match Day.

Medicine. blair t stand our style of “save.” My husband is I challenge myself to sit down with Medicine residency program.

22 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 23

20-23BrMed_Winter13.indd 22-23 1/31/13 6:23 PM testingAmericans with HIV now have normal life 19143 expectancies, thanks to the availability By eileen o’gara-kurtis of effective antiretroviral therapies.B ut more photography by jesse Burke than 50,000 new cases of HIV are reported every year. Thousands are infected and don’t know it. And people are still dying from AIDS. Brown researcher-advocates are taking to the streets in some of America’s hardest-hit neighborhoods—like Philadelphia’s zip code 19143­—with a lifesaving message: Get tested.

S FTreet- IGHTING WOMAN Amy Nunn, pictured in the lee of Providence’s Point Street Bridge, divides her time between research at Brown’s Center for AIDS Research and Southwest Philadelphia, where she is work- ing with community leaders to stop the spread of HIV/AIDS.

winter 2013 | brown medicine 25

24-31BrMed_Winter13.indd 24-25 1/31/13 6:24 PM “T  here is now absolutely no question that getting people into treatment, and getting viral load down, significantly reduces risk of transmission.” “This is about social justice,” says Assistant Faith in Action, to do something about it. Their Do One Thing campaign, Professor of Medicine (Research) Amy Nunn, launched in June 2012, has now tested ScD. “This is about geography and poverty more than 3,000 people for HIV and recently also began testing for hepatitis and where you live.” C. Screening happens in a mobile testing Nunn is talking about her work in of HIV/AIDS in zip code 19143. About unit, at clinics, and at a Walgreens that Southwest Philadelphia, where a small 2 percent of residents were living with offers free testing every Friday. The effort army of religious leaders and city officials, the virus—an incidence rate closer to that is supported by a public-awareness cam- along with students, local residents, and of Sierra Leone than the United States, paign that encompasses billboards, door- other volunteers, have joined her in a and above Philadelphia’s already-high to-door canvassing, social media, and a crusade to get residents of zip code 19143— (about five times the national average) commitment by local clergy to preach an HIV “hot zone”—tested for the virus. citywide incidence. Most alarming: prevention from the pulpit. “Maps tell the story, and tell us where residents of 19143 were dying of AIDS at “Do one thing,” the ministers and we ought to focus our efforts,” says Nunn. nearly twice the citywide rate. imams say. “Get tested.” “Many people don’t know they live in a “There was a clear unmet need for hot zone, and may think they’re not at testing and treatment,” Nunn recalls. Stu at s: unknown risk because they haven’t had a lot of part- Nunn, who splits her time between U niversal testing is the new gold stan- ners. However, that’s no longer a good cri- her work in Philadelphia and research at dard in HIV prevention. terion for assessing true risk for HIV.” Brown’s Center for AIDS Research Since the advent of antiretroviral Nunn’s work in the community began (CFAR), recruited a powerful community- therapies in the 1990s, HIV has become a in 2010, when she took a sobering look based coalition, the core of which is a manageable chronic disease. Physicians at maps that revealed the grim truth group of activist clergy called Philly now routinely treat patients who have lived with the virus for decades—long enough to be more challenged on a daily basis by age-related conditions than by HIV. But thousands of HIV-positive Ameri- Beth Rutstein, a Penn medical student, urges Jhanee Franklin to be tested for cans remain untested and untreated. HIV. The Do One Thing campaign deploys more than 80 volunteers who go door The Centers for Disease Control and to door to distribute information and help residents get tested for HIV. Prevention (CDC) believes that 75 percent of infected Americans know their HIV status. The other 25 percent are thought Research shows that people who know year’s top breakthrough, showed that dren’s Hospital and serves as an epidemio- to be responsible for more than half of their HIV status practice safer sex and people who adhere to drug therapy have logical consultant to the Rhode Island the 50,000 new infections recorded every make other positive behavioral changes. a 96-percent lower risk of infecting Department of Health with special focus rer

year in the United States. i Testing also leads to treatment, which others—confirming what the medical on HIV. “The essence of CDC’s redi- qu

The concept of building a national n has game-changing implications for community had long intuitively known. rection is to make testing routine for i TES R C

a o HIV strategy on testing has been gaining hia both individual and population health. “There is now absolutely no question everyone.” p l l B e a momentum for several years. The CDC d By reducing viral load, or number of that getting people into treatment, and p recommended routine HIV screening in hila copies of the virus in the blood, treat- getting viral load down, significantly Power of advocacy h o t

2006. Last November, the US Preventive o ment dramatically reduces the odds of reduces risk of transmission,” says Alexander’s own epiphany as a physi- g r

Services Task Force endorsed routine a transmitting HIV. A groundbreaking Assistant Professor of Pediatrics Nicole cian advocate came in 2006, when she p h testing for all Americans between the ages y 2011 study by the HIV Prevention Trials Alexander, MD, MPH ’11, who co-directs treated an HIV-positive 4-month-old at In c . Pastor Mark Tyler, right, preaches about HIV/AIDS in March 2012. of 15 and 65, and all pregnant women. MICHAEL S. WIRTZ/p Network, heralded by Science as that the pediatric HIV clinic at Hasbro Chil- Hasbro Children’s Hospital. It was a

26 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 27

24-31BrMed_Winter13.indd 26-27 1/31/13 6:24 PM “ Geographically, 40 to 50 neighborhoods account for about half of all HIV infections in the United States.”

scenario she had never seen during 80-percent decrease in new infections HIV risk is “sexual networks”—the way Sa h ring experience training in pediatrics and internal medi- among injecting drug users over rough- people are linked, directly or indirectly, and gaining knowledge cine in New York City, where routine ly the same period. Universal testing is through sexual contact. People whose Ask Nunn how she got involved in fight- prenatal HIV testing was in place. The the next frontier. We’re now piloting an risk is elevated simply by virtue of where ing HIV in Southwest Philadelphia, and baby’s mother had given birth in Rhode initiative to include offering HIV testing they live, or through their sexual net- she will start by giving you a brief, self- Island, where HIV testing was “opt-in” in all routine pre-admission testing at works, slipped through the cracks, too. deprecating tour of her curriculum rather than “opt-out” at the time, and she The Miriam Hospital, and we’re actively People like the residents of zip code vitae: “I couldn’t get a job after college,” had not been tested. Mother and child had involved in Rhode Island’s efforts to 19143. she says, in her rapid-fire Arkansan ca- not received prenatal and post-delivery promote testing.” dence. “So I kicked the can for a while, treatment that can reduce a baby’s risk The ubiquity of lightning-fast, on- Mappn i g HIV and then I went to Guatemala.” of contracting the virus from 40 percent line-initiated sexual hookups makes T he story of HIV in America mirrors More precisely, Nunn was awarded a to 2 percent. routine testing even more critical, Flani- the broader narrative of our national Fulbright Fellowship to study women’s The experience spurred Alexander gan says. “We need to introduce routine struggle with health disparities. One’s health in Guatemala—followed by mas- to earn an MPH from Brown’s Public HIV testing in the context of people’s chances of getting the virus—as well as ter’s and doctoral degrees from the Health Program and become a passionate everyday lives. Do we want people to get the likelihood that it will progress to Harvard School of Public Health, with a advocate for testing. As part of a state- treatment for addiction? Of course. Are AIDS, even in this age of effective treat- dissertation (later published as a book) wide coalition of health care providers we worried that having multiple casual ment—has much to do with one’s neigh- on the politics and history of AIDS treat- and community advocates, she helped to partners is driving this epidemic? Yes. borhood. ment in Brazil. She became passionate change Rhode Island’s HIV testing law We want people to know their HIV The higher the HIV incidence rates about Philadelphia’s HIV crisis when to “opt-out,” with documented verbal status, for the sake of their own health in one’s social networks, the greater her husband, German Velasco, was consent replacing written consent, for and the protection of the community.” one’s chances of encountering an HIV- training in endocrinology at Thomas pregnant women. Before the legislative The new focus on testing marks a positive partner. And the factors that Jefferson University. “I’m interested in change in 2007, 53 percent of expectant seismic shift in the US approach to HIV/ contribute to health disparities—poverty, social movements and how effective mothers in Rhode Island were tested for AIDS. Since the early days of the pan- housing status, race and ethnicity, and leadership can advance the fight against HIV; today, 100 percent are tested. Alex- demic, prevention efforts have focused residence in an area with limited access HIV/AIDS,” she says. “If you take the ander is now a leader in the state’s push on behavior change. First defined as a to education, transportation, employ- long view, the most important factors to achieve the CDC’s five-year goal of killer of gay men, HIV was thought best ment, health services, and other social driving effective policy response in both “getting to zero” new HIV cases. addressed by promoting protected sex in determinants of health—often culmi- Brazil and the United States have been “At Brown, our research and advocacy that community. As the virus cut a wid- nate in unmet need for HIV testing and political leadership and activism.” to tackle the HIV/AIDS epidemic locally ening swath, prevention continued to treatment, which in turn contributes to Philly Faith in Action promotes HIV testing from the pulpit, in Flanigan recruited Nunn to Brown has yielded dramatic results,” says Pro- focus on reducing at-risk behaviors such higher “community viral load.” the neighborhoods, and through compelling use of media. from Harvard. While excited about com- fessor of Medicine Timothy P. Flanigan, as needle sharing and unprotected sex. “Geographically, 40 to 50 neighbor- ing to Providence, she was equally com- MD, who serves as scientific director of Testing also became largely a function hoods account for about half of all HIV mitted to continuing her work in Philadel- HIV care at the 25-year-old Miriam Hospi- of behavioral profiling. Pregnant women infections in the United States,” says Race is also a critical factor. Although Zip code 19143 is 83 percent black/ phia. For Flanigan, there was an obvious tal Immunology Center, the largest pro- and “high-risk” patients were most likely Amy Nunn. “Those neighborhoods tend blacks/African-Americans don’t engage African-American. Nearly 25 percent of synergy of mission. vider of HIV/AIDS care between New York to be offered an HIV test, usually on an to have limited access to health services in higher-risk behavior than people of neighborhood residents live at or below “Amy’s doing what research univer- and Boston. “Our work in Rhode Island’s “opt-in” basis. People who didn’t meet and more limited access to HIV testing other races, CDC data reveal rates of the poverty level. Nearly 15 percent have sities are meant to do,” he says. “We’ve Adult Correctional Institutes has resulted subjective risk assessment criteria, or and treatment—resulting in higher viral HIV infection seven times greater in no health insurance. Two community had significant success in Rhode Island, in a nearly 90-percent drop in new HIV didn’t disclose high-risk behavior, load for the community and greater like- black men than in white men. Black health clinics serve 64,000 people. and we’ve learned a lot. Amy’s work in infections among incarcerated people slipped through the cracks. The proto- lihood that people will come into con- women are infected at nearly 15 times Epidemiological data put HIV on the Philadelphia will yield more important over the past 10 years. Our advocacy for cols also didn’t address the fact that HIV tact with the virus, even if they don’t the rate of infection of white women. map in Southwest Philadelphia. The im- knowledge. We’re committed to going needle exchange and the legal purchas- infections tend to cluster geographi- engage in high-risk behavior. Where you Diagnosis and treatment also tend to perative, Nunn says, is to make sure it’s wherever we can help and learn, around ing of needles has helped to drive an cally, and that an important factor in live may be as important as what you do.” come later in the black community. on the radar of the people who live there. the world and across the US.”

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24-31BrMed_Winter13.indd 28-29 1/31/13 6:24 PM 1/31/13 6:24 PM A 31 W at www. is the founder and rtis brown medicine | u K e L arn more phillyfaithinaction.org and www.1nething.com.

’ O winter 2013 “It “It will take about $1 million to fund i n our E leen Gara- years for her and her team—consisting of four paid staff members and 80volunteers,supported finite a bypool about of about $300,000 in grant funding—to reach every resident of the five census tracts of zip code 19143. But she has an ambitious, long-term plan. it, but our five-year plan is to efforts to expand includetesting for other con- ditions,” she says. “Our goal is to place HIV prevention in the broader context effort to of improve a population health in medically underserved com- munities.” president of Silver Branch Communications. She is a frequent contributor to Brown Medicine. V i - I . V I Nunn has begun to publish on the Nunn estimates that it will take a few i B llboards and other media tell the story:tested easy it’s for H and essential to be ing testingdoor-to-dooring viaa campaign; and in other hard-hit areas. experience of engaging clergy as vital partners in HIV testing and prevention. Her next goal is to launched in Philadelphia apply to other cities the model theandAmerican to South. want“We to build the scientific evidence base that will demonstrate a geographic model focused on dramatically scalingdestigmatizing routine HIV testing and and treatment and reducing racial dispari- says. she ties,” “Ithink our can model be replicatedand exported other heavilyto impacted communities.” most heavily impacted communities. the on boots have advocates Nationwide, ground City, inwhere NewHarlem York United’s BLOCKS campaign offers HIV testing block by block and Bronx Knows is promoting testing borough-wide; in San Diego, where Lead the Way is push - HIV geo HIV e only thing we can’t do is nothing.”

h . T g n i Th n do more. e h “Our community has a dispropor- From the beginning, the group avoided “If they want to talk about risky be- “There is a very broad spectrum of o o h community.  h graphically is gaining traction on both the policy and grassroots levels. Both the CDC’s new High-Impact HIV Pre- strategy and the vention Obama Admin- istration’s National HIV/AIDS Strategy call for allocation of resources to the D T ne e concept of fighting in front of the altar and got front his of congregation. tested in tionate HIV infection churches rate, must and actively our embrace need to respond the from both the public health and pastoral care perspectives,” Broadnax says. “We have a responsibility to educate, destigmatize, and eliminate misinformation about everything from how HIV is spread to what takesit to get tested.” issues that could be faith divisive community, in maintaining the like focus, laser- instead, testing. on havior, that’s great—but it’s even more important to discuss testing,” says. “In Nunn public health, we sometimes drop interventions into communitiesrather than working with communities to develop tailored solutions. I would never presume to tell a pastor or imam what to say. They know sense their for congregations.” what makes ways to respond to HIV in our commu- nity,” Broadnax says. “We can all talk to our young people, give somebody a ride to a clinic, distribute literature, try to reduce stigma, or help demystify testing. The only thing can’t we is do nothing.” T “ t ere is avery broad spectrum of ways respond to H to

Crtesa ol Ba photography Inc. - ttp://brownmedicinemagazine.org h “Many of us weren’t aware of the full BroadnaxSunday, One chaira placed mons, talking points, guides, and and using scripture them to their congregations get to encourage tested. intensity of the HIV epidemic community in our until Amy presented data,” says her Broadnax. “We saw it asclarion call action.” to a the Black Greater Boston, and other Ministerialfaith leaders, Alliance Nunn conducted of focus meetings groups that led and to the Philly founding Faith of in Action, Brown’s a Global coalition Health of Initiative more and than 70 clergy group made a members. transformative The commit- ment to promoting HIV prevention—working testing and with Nunn develop faith-friendly to educational ser nfection in the area. V i - I ite, second from right, march with other pastors h W Nunnstarted of Office Mayor’sthe in Working with Broadnax, who had the epidemic,” she explains. “Philadel- phia ranks near the top of American faith number of for cities insti the list of tutions, which play an incredibly influ- ential role in the community. Scientists have to do a better job of bridging the gap between mobilizing the scientific and medical communities and engaging faith leaders.” Faith-Based Initiatives, where its then- Mar- executiveDr. Rev. director,thelate guerite Handy, an African Episcopal Methodist minister, championed cause the and introduced leaders Nunn of Philadelphia’s to most the promi- nent black churches—including Handy’s own Broadnax Jay pastor, ’84. worked on HIV/AIDS issues as part of

rch 2012 toraise awareness of high rates of H a M winter 2013 | l l a in Philadelphia began oadnax ’84, center,and Pastor Arthur r B st Philadelphia in e r W a brown medicine Nunn is a white child of the South. “African-American churches are the l u The daughter of activist parents, says that her she worldview was deeply im- experiencesat studenther pacteda byas Little Rock Central High School, which had become a crucible of the civil rights movement when it was desegregated by the National Guard in racial 1957. disparities in “Ending HIV infection,” she says, “is another chapter in America’s social justice struggle.” C N nn’s c workion from Pastor Jay 30 with the demise of the firewall between science and spirituality. backbone of many heavilycommunities in the impacted United States, and enlisting clergy is critical in addressing 24-31BrMed_Winter13.indd 30-31 B asic and clinical researchers team up to find translational solutions for treating male infertility. The Origin By nick charles Photography by Karen pohilippi f Man I n the beginning there is love. Unfortunately, for some couples, their DNA is not in sync with their feelings. When biological complications prevent couples from conceiving, they typically experience the gamut of emo- tions, from sadness to intense anxiety. At the same time that they cope with their pain, most couples try every- thing to find a successful resolution. MGC A I NUMBER “We see couples all the time who can’t conceive,” says Mark Sigman, Kathleen Mark Sigman, MD, chief of urology at Rhode Island and Hwang, and Kim Boekelheide, The Miriam Hospitals and Krishnamurthi Family Pro- left to right, are part of a fessor of Urology. “Once it’s been determined that it’s not team searching for molecular a female problem, a semen analysis is ordered. If the semen causes of male infertility. analysis comes back abnormal, we decide if we can do

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32-37BrMed_Winter13.indd 32-33 1/31/13 6:26 PM anything to reverse the problem and make “  the semen analysis can tell us that human samples and investigate inter- the man fertile again. If we can’t find a esting questions.” cause in order to determine a treatment, the semen is abnormal, but it can’t tell Sigman says, “Ed has developed great the only option is to do in vitro fertiliza- expertise in these techniques and has really tion or intrauterine insemination.” us why it’s abnormal.” moved our projects forward by deter- According to Professor of Medical Sci- mining the best approaches to utilize.” ence Kim Boekelheide, MD, PhD, “About Back in the lab, Dere purifies the 15 percent of couples are infertile. ... Half Project. Researchers also consider ge- that Sigman and Hwang collect from sperm in the semen samples by lysing, of the time it’s because of a male factor netic, lifestyle, and environmental causes patients for changes in the epigenome, or rupturing, the somatic cells and wash- problem, which means more than 7 per- as they try to determine why couples the compounds that “tell” the genome ing away the seminal fluid. This ensures cent of men aren’t producing sperm that can’t conceive. what to do and where and when to do that the molecular profiles obtained have the capability to fertilize an egg.” “Collecting samples from our clini- it; and sperm transcriptome, which is from the sample are solely from the The problem is often spermatogen- cal practice for research purposes gives the complete set of RNA, including mes- sperm cells. Semen samples can have esis—the formation and development of us the opportunity to develop sperm senger RNA (mRNA) and microRNA sperm counts ranging from a few million sperm. So in addition to sending patients’ molecular biomarkers that may more (miRNA), in a cell. These factors will to hundreds of millions. After analyzing semen to the lab for analysis, Sigman accurately reflect fertility,” Hwang says. serve as more sensitive predictors of for DNA methylation (the attachment of recruits his patients to participate in a “This will potentially allow us as clini- male infertility. That’s because the RNAs methyl groups to the DNA, which affects major study that, researchers hope, will cians to better evaluate and counsel inside the sperm could contribute to gene expression) as well as the RNA con- determine the molecular causes of sperm patients for male factor infertility.” its health and fertilization capability. tent, Dere looks at the traditional semen abnormalities that hinder conception. Lifestyle factors, like smoking, alcohol analysis for possible correlations. “Currently the semen analysis is the SHW O US A SIGN consumption, body mass index, or pre- “If we find that men with low sperm E dward Dere is correlating physical traits and genetic markers to best diagnostic tool to assess spermato- B oekelheide and Sigman created the scription medication use also may alter motility also had consistent changes in tease out predictive DNA profiles. genesis in men,” says Kathleen Hwang, Human Biomarker Project, which is the transcriptome and reduce sperm their DNA methylation profile, we would MD, assistant professor of surgery (urol- funded by the Lifespan health care sys- function. have a predictive biomarker,” Dere says. Dere to focus on a subset of genes that possibly 480,000 data points,” Dere says. ogy). Yet that analysis may come back tem and the Krishnamurthi endow- “There are epidemiologic studies Boekelheide and Dere also focus on are identified from the sperm transcrip- “If you multiply that by 400 patients, normal in men who can’t conceive, she ment, to understand the molecular traits that suggest that smokers have reduced sperm mRNA, which is delivered to the tome profile. that’s a lot of data points. That’s where adds. Indeed, the measurements in a that may cause male infertility. “Identi- fertility,” Sigman says, “but we don’t oocyte, or egg cell, and may serve an “These projects are very high tech,” statistical analysis and computational typical sperm analysis—including count, fying these biomarkers is a priority for have a good way of identifying it. Having important function in fertilization or Sigman says. “They involve techniques techniques really come into play.” motility, morphology, semen pH, and anyone working on male infertility re- a biomarker for the effects of smoking embryogenesis. For this purpose the that couldn’t be done a decade ago. Now Sigman doesn’t yet know whether volume—are relatively unreliable. search,” says Hwang, who came to Brown would be very useful.” He says epi- researchers use transcriptomic assays, we’re able to look at thousands of genes biomarkers will replace semen analysis “The semen analysis can tell us that in 2011 to do research and clinical work. genetics, or heritable changes in gene an analytic procedure that allows for the and changes in gene expression on little or turn out to be supplemental. “It the semen is abnormal,” Sigman says, A biomarker is an indicator of a bio- expression, are not easily identified by simultaneous measurement of levels of computer chips.” would give us an understanding of the “but it can’t tell us why it’s abnormal. logical state that is measured to assess traditional parameters, making the all the genes in the genome, as well as The research also involves a great cause of infertility that we didn’t have There could be a lot of different things a certain condition. In this study, “that molecular biomarkers invaluable. polymerase chain reaction (PCR)-based deal of biostatistical analysis. “With the before,” he says. “Ideally, it would allow causing an abnormality. We can’t tell by state could be decreases in sperm con- It was the opportunity to work with arrays, which offer gene expression methylation studies, one single experi- us to ask the questions: Is there a signifi- looking at the analysis what’s causing it centration and/or motility that lead to Sigman and Boekelheide on the human analysis. These lab techniques allow ment on one patient would generate cant male problem, and if so, what might or what we can do about it.” decreased fertility or infertility,” says aspect of the research that brought Dere be causing it?” To try to find what underlying mo- Edward Dere, PhD, a postdoctoral re- to Brown. “I felt that by working with The Human Biomarker Project has the lecular characteristics, or biomarkers, search associate who earned his doctor- human samples, my research would “These projects are very high tech. potential to address two lines of inquiry: of sperm may be impacting male fertility, ate in biochemistry and molecular biol- have a more direct impact than if I only Sigman’s research on male infertility Sigman and Hwang began collecting ogy from Michigan State University. He worked with animal models,” Dere says. They involve techniques that couldn’t and Boekelheide’s interest in testicular semen samples from 200 to 400 patients joined the research team in 2010. “Because of the collaborative nature of toxicity, including medications that can for a study called the Human Biomarker Dere analyzes the semen samples our team, we’re able to readily obtain be done a decade ago.” harm the testicle—a concern of pharma-

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32-37BrMed_Winter13.indd 34-35 1/31/13 6:26 PM ceutical companies. “We’re hoping that background and interest in research the clinical translational challenges the basic science experiments could help from a urologic perspective.” that Sigman faces as a practicing urolo- us identify certain patterns that indi- Sigman first did research in the area gist. “We think of ourselves as a model scar cate there’s testicular injury,” Sigman of immunologic male infertility during of how to develop the research capacity Tactics says. “From there, we might learn what his residency at the University of Virginia. of Brown and its affiliated hospitals,” kinds of things cause injuries, including His work led to a project for the FBI’s Sigman says. A chance discovery may help of tissue, scars will form; in the abdomen, those adhesions environmental toxicants and medica- Department of Forensics, where he devel- The pair believes Brown could repli- form to the bowels, she says. Patients requiring repeated tions. Knowing what the risk factors are oped antibodies to detect sperm in cate that model across other subspe- prevent problematic adhesions surgeries may suffer inadvertent injuries to their bowel due and if there’s anything that we can do to these scars, necessitating further treatment. about it would help me clinically as I that form after surgery. “When I stumbled across this,” she says, “I thought, ‘If we treat patients. Kim’s expertise has been “  our goal is to develop a self-sustaining found something that could actually prevent post-operative a valuable resource for this type of trans- scarring, that could change the way we operate and how lational research.” research machine that can continue this I n addition to her efforts on the Human Biomarker Project, patients can heal.’” Boekelheide leads several research Kathleen Hwang, MD, is working on a project with a seemingly The connection between surgical adhesions and urology initiatives on testicular damage caused translational research.” broader scope. The assistant professor of surgery (urology) (let alone male infertility) wasn’t immediately apparent, but by toxicants, including an animal model brought the research initiative to Brown in 2011 from her Hwang, who estimates that she dedicates 40 percent of her involving bisphenol A exposure. BPA, a fellowship in male reproductive medicine and surgery at the time to this project, ultimately connected the dots. chemical found in common plastic prod- crime scenes. “That’s what got me inter- cialty areas. “I think the big picture is how Scott Department of Urology at Baylor College of Medicine. “One of the things that Mark Sigman and I do as ‘fertility ucts, is the subject of a national consor- ested in the field [of male infertility],” we put the pieces together across the The study investigates the role of ghrelin, a peptide that is pro- people’ are vasectomies and vasectomy reversals,” Hwang tium study to determine the severity of Sigman says. “I also wanted to continue various institutions that make up Brown duced in the stomach, in wound healing and in post-operative says. “The failure rate with vasectomy reversals is caused with its effects. The team is also gathering doing research along with clinical care. medicine,” Boekelheide says. “That has inflammatory response. Her findings could help to prevent the new anastomosis,” or rejoining of the vas deferens. During preliminary data to submit a grant for a After that, I did a two-year fellowship in allowed us to do basic to clinical transla- scarring associated with testicular and abdominal surgery. this part of the surgery, “a scar tends to form very quickly,” she human model subproject to the Human male reproductive medicine and surgery tional research in an effective way.” “It’s a phenomenal translational proj- Biomarker Project on how bariatric sur- at Baylor College of Medicine in Houston, Through basic research and applied ect, looking at a tremendous clinical gery may affect sperm biomarkers. just doing male infertility.” clinical practice, Sigman, Boekelheide, problem,” says Mark Sigman, MD. The application of the peptide ghrelin Boekelheide became interested in Hwang, Dere, and the other scientists For now, Hwang is using an animal BENCH TO BEDSIDE male infertility research during his resi- working on the Human Biomarker Project model to try to answer her clinical ques- could reduce post-surgical scarring after Sigman came to Brown to study male dency at Duke University. After gradu- are making strides to help couples start tions, which are based on her operating- reproduction and infertility in both a ating with an MD/PhD in anatomic and their families. And, incidentally, they room experience with adhesions, or vasectomy reversal. research and clinical setting. After be- clinical pathology, he joined Brown’s fac- may be building a model that the entire scars. “Her original impetus to go down coming chief of urology in 2009, one of ulty in 1984 to focus on research and University can copy for future, ground- that path was because she was working his main goals was to grow the research teaching. breaking research projects. on infertility-related surgery and adhesions that arose there,” says. If this happens, the lumen, which is the inside of the vas arm of the division. He and Sigman are combining their “The people involved, both at Life- says Kim Boekelheide, MD, PhD. deferens or epididymis, the tubular part of the spermatic duct Although Sigman and Boekelheide strengths, Boekelheide says: “I bring a span and Brown, have been very support- Hwang says she “stumbled upon” the project during her system, can become blocked, preventing the sperm’s release had been collaborating for nearly 20 years, basic research lab that has focused on ive and like the concept,” Sigman says. fellowship in Houston. “I was looking at ghrelin to see if it from the testes. they wanted to develop a more robust animal models of testicular injury and “Our goal is to develop a self-sustaining would prevent damage or interference with the sperm pro- Hwang is now investigating how ghrelin affects wound research initiative. “Our history goes male reproductive health effects using research machine that can continue to duction process in an undescended testicle (cryptorchidism) healing and whether an application of ghrelin to the vas back a long way,” Boekelheide says of his animal models. Mark brings a clinical pursue this kind of translational re- model in rodents,” she says. “Then I discovered that the mice deferens during the anastomosis can indeed minimize scar relationship with the veteran clinician practice in urology and his interest in search.” WA that were treated with ghrelin, compared to the control treated formation. “That would potentially increase the success rates and expert in male infertility. “When male factor infertility.” mice, had almost no post-surgical adhesions. of pregnancy in couples who still can’t conceive because of Mark came to Rhode Island Hospital Since 2000, they have published four N ick Charles is a national medical “Post-surgical adhesions are the bane of the surgeon’s exis- problems with scarring after a vasectomy reversal,” she says. and Brown University in 1989, as a prac- papers together on various topics, from science writer and a contributor to Brown tence,” Hwang continues. Any time a surgeon opens any kind “Our goal would be to help couples conceive naturally.” —N.C. ticing urologist, he already had a strong basic research in Boekelheide’s lab to Medicine.

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32-37BrMed_Winter13.indd 36-37 1/31/13 6:26 PM the By Kris Cambra

photography by scott kingsley simsThe exam rooms are artificial. The patients are actors. But the learning experiences are real.

ecades ago, learning specialists determined that when teaching people to do something where the stakes are high and it’s important to do it correctly— say, for instance, flying a plane—it’s effective to train them in a JUH MP RIG T IN Each Doctoring group of eight students is assigned to a seminar room simulated environment that mimics the real deal. Since caring for and an exam room. Four students can head to the exam room to work with patients is also a pretty high-stakes endeavor, it made sense to design a standardized patient, while four stay with a social-behavioral faculty D member to work on interviewing or counseling skills. Director of the an entire suite in the Alpert Medical School building that simu- Doctoring Course and of Clinical Curriculum Julie S. Taylor, MD, helps lates an outpatient physician’s office. Amed Logrono ’12 MD’16 don his white coat for the first time.

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38-43BrMed_Winter13.indd 38-39 1/31/13 6:28 PM AER YOU READY FOR YOUR CLOSE-UP? Above and below: Gabi DuVernois ’11 MD’15 performs an eye exam on her SP. SPs undergo training, but most come with innate talent, as actors from the local theater scene. Alpert Medical School has one of the highest rates of SP-student interaction among medical schools.

“It’s hard for students to engage with ‘fake patients.’ … The suite makes it more real for them, helps them step into this professional role.”

In each exam room, there’s a tall, reclining table for patients, blood pressure HUMAN TOUCH cuffs and otoscopes attached to the wall, and a computer. These rooms are extra Above: Assistant Professor wide, allowing a small group of students and mentors to stand comfortably depending of Emergency Medicine on the teaching exercise. There are video cameras that record exchanges between (Clinical) Michelle Daniel, students and the actors who serve as their “patients,” and they provide a live feed to left, course leader of the control room, where all of the rooms can be scanned at once. Doctoring Year 2, helps All of this is used to hone Alpert medical students’ patient interviewing and Erica Alexander ’11 MD’15 physical exam skills. With the guidance of their teachers, students are able to practice with the cardiovascular what they are learning on the standardized patients (SPs). It’s safe—for the students exam. who aren’t paralyzed by the fear of making a mistake with a real patient, and for those real patients at the mercy of a doctor in training. The only flaw in the authenticity of the space, says Dana Zink, RN, who oversees the Clinical Skills Suite and recruits, trains, and manages the SPs, is “it’s a lot nicer than the offices where many of our faculty work.”

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38-43BrMed_Winter13.indd 40-41 1/31/13 6:28 PM COMMAND CENTER Above: In the control room, monitors give a thumbnail view of all the exam rooms. If a faculty member or director Dana Zink, RN, needs to observe AL TernATE VIEW an interaction, they can focus Above: Social-behavioral on one room. Zink says this is science faculty like Lou Pugliese, a useful tool when she’s training MEd, are social workers, new SPs, as they can watch nurses, ministers, counselors, successful encounters. All and more. A longtime Doctoring interactions are recorded and mentor, Pugliese organizes the students can review the footage assisted-living facility portion to improve their technique. of the course, where students interview and follow a resident’s Silk purse? progress over the course of Left: No, it’s a sow’s ear. The suite the year. is also used during the Clinical Skills Clerkship, which teaches T DAP AN SWIPE third-year students suturing Left: Since all students have (like Patrick Mulvaney MD’15 is iPads, the cases can be viewed doing here), blood draws, and onscreen, obviating crinkled- other procedures to prepare them paper checklists. for their hospital rotations. WA

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38-43BrMed_Winter13.indd 42-43 1/31/13 6:28 PM

MOMENTUM ALUMNI

CHECKING IN WITH BROWN MEDICAL ALUMNI

T HOse WERE THE DAYS CAST AND CREW ALBUMIt was the fall of 1981, and Left: MFA acting student Nikki Massoud and medical student Minoo these Program in Medicine Ramanathan, left to right, react to a monologue. Above: Deborah Salem freshmen were about to Smith’s easy-going style helps the students come together. spend the next seven years together. How many will feelings,” she says. “It’s those moments come back for their 25th All the World’s a Stage when you realize maybe our career Reunion this May? Actors and med students explore each other’s paths aren’t so divergent.” Because the classes were held down- realities. town at the theater, Ramanathan says L ast year, playwright Deborah Salem gram. But this innovative class brought she welcomed the break from her eat- Smith delved into the world of medicine together seven Alpert medical students breathe-sleep medicine life. A turning in her play Love Alone, staged by Provi- and ten MFA actors. “Theater is a surpris- point in the semester, however, came dence’s Trinity Repertory Company. ingly natural fit for these two com- when the medical students hosted the Professor of Emergency Medicine Jay munities because theater is about actors in the anatomy lab. There, on their Baruch (see Brown Medicine, Winter 2012), humanity—you get to see real people own turf, the med students were the who co-directs the scholarly concentra- performing in live time and the realness experts. tion in medical humanities and bioethics, of them is in your face,” she says. That meeting strengthened the mu- brought nearly 200 medical students to The students read works with medi- tual respect between the groups, Smith see the play. The moving drama, which cal themes and analyzed how context says. “It helped deepen, for the actors, the examines the impact of a death caused changes the meaning of a story. For ex- understanding of how courageous and by medical error on a patient’s family ample, how does the language in a medi- complex the study of medicine is.” and the doctor, sparked lively conversa- cal examiner’s report differ from the The success of the course was due in tions that Baruch wanted to sustain. way a widow might talk about her hus- large part to Smith’s ability to move com- So he asked Smith to design a course. band’s death? The students had weekly fortably between the groups, Ramana- classnotes at the Southcoast Family MediCenter use of brain stimulation to treat OCD and The result was last semester’s “(Play)writ- writing assignments; some wrote non- than says. “We united around the writ- in New Bedford, MA. affective disorders such as depression. ing and Medicine.” The class was made fiction, while others worked on scenes ing process. No matter what background possible by a gift to support the medical from plays or spoken works. you come from, there are rules that 1975 humanities from George Bray, MD ’53. Minoo Ramanathan ’11 MD’16 says make your writing better.” D onald Derolf ’72, family medicine phy- 1977 HWVO ’ E YOU BEEN?

Smith was the first Bray Visiting Scholar; students often found ways their profes- At the end of the semester, Ramana- CHIVES sician and former teaching fellow, instruc- S teven Rasmussen ’74, P’13MD’17 has R this semester’s scholar, Liz Tobin Tyler, sions overlapped when they discussed than and actor Matt Russell co-produced A tor, and assistant professor in family med- been appointed chair of the Department Career news, weddings, births, JD, MA, presented a series of lectures on their writing. “Operating Theater,” a public reading of icine at Alpert Medical School, has joined of Psychiatry and Human Behavior at your classmates want to know. Go n Mu nk f SCHOOL r L a

health care and justice. “A lot of medicine is a performance, selected pieces written by students in A Southcoast Physicians Group in the Alpert Medical School. Steve had served to med.brown.edu/alumni and Smith, the playwright-in-residence at where you’re taking on a professional the course. To watch the performance, practice of Drs. Michelle Boyle, John J. as interim chair since 2009. He is interna- click on “Updates and Class l li

Trinity Rep, teaches acting and directing persona. And with actors, it’s all about visit http://vimeo.com/55902639. n ( Hand, Richard V. Morgera, and Wendy tionally known as an expert in obsessive- Notes.”

W 2) students in the Brown/Trinity MFA Pro- being in tune with your emotions and —Kris Cambra A aLPERT MEDIC P. Regan. He has begun to see patients compulsive disorder and pioneered the

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44-c3BrMed_Winter13.indd 44-45 1/31/13 6:30 PM al umnialbum

on ealyumeni Dear Fellow Alumni, Hari Naidu with Dean Greetings from the Brown Medical School Alumni Edward Wing by ANSDS, races to understand the disease by dissect- Association Board of Directors! Several years ago, the Zombies Go Viral ing squirming specimens—including a former colleague. Board redefined its mission to focus on three themes: under way, and your BMAA has a voice on the search The undead are a consuming “This is the trope behind zombie novels: How do we connecting with students, engaging alumni, and committee. We seek a strong individual to take our passion for this alum. determine that someone is as good as dead?” Schloz- advising the School and the dean of medicine and bio- Medical School to the highest level, so please send us man says. The theme lends itself, in a campy way, to logical sciences. Your Board has been very busy! We names of worthy candidates if you know them! S teven Schlozman MD’94 is the world’s foremost similar questions raised by post-modern literature like now “live” with the students in the new medical school Finally, we would like to connect more with you, our expert on the neurobiology of zombies. Waiting for Godot, he adds. “What are we waiting for? building, seeing and interacting with them throughout fellow alumni. There are so many ways for you to stay OK, zombies aren’t real. But if they were, Schlozman What constitutes living?” the year. Students serve on the Board, and we are an connected and influential within the Medical School: has the sound medical hypotheses to explain their insa- The zombie theme seems especially popular in integral part of the White Coat Ceremony, graduation, serve on the BMAA or a subcommittee; participate tiable hunger for human flesh, why they shamble about anxious times. “We have always lived with uncertainty, and various events aimed directly at providing them in events; host visiting students; help students find with arms extended, and how they can ambulate at but perhaps more so since 9/11,” Schlozman says. “We with as many resources (both tangible and intangible) research or other experiences at your institution; and all—seeing as they’re dead. didn’t know who or what to believe and we started that a robust alumni body can possibly give. Our provide financial support to ensure our School remains According to Schlozman’s first novel, The Zombie seeing everyone as a possible enemy. Increasingly the students see a real alumni presence. strong and competitive. Your Board has done all this Autopsies: Secret Notes from the Apocalypse (Grand Central modern world makes us feel like we are dealing with Board members meet with the dean two to three and more, and we’ve seen the benefits of contributing to Publishing, 2011), a new virus causes Ataxic Neurode- zombies.” times each year, and are involved in shaping medical our alma mater. We would love to engage you in doing generative Satiety Deficiency Syndrome, turning humans Schlozman is a prolific writer; he’s working on a education and guiding the interaction of the School the same! into zombies. Though Schlozman invented ANSDS, his sequel to Zombie Autopsies and submits articles to with the University and medical communities. We help Please let me know if you have ideas on how we can exploration of the brain is accurate, delivering neurobi- Psychology Today, blogs for Boston Magazine, and main- guide the long-term vision and goals of the Medical have even more impact or if you want to be more involved. ology lessons alongside page-turning suspense. The tains StevenSchlozman.net. Though literature and School through service on various prominent commit- Sincerely, book has a cult following and is selling well. writing are his first loves, by day he works in psychiatry. tees. As you know, Dean Wing will be stepping down at Srihari S. Naidu ’93 MD’97 Zombies are everywhere lately—in novels, movies, He is the associate director of training for the Massa- the end of the academic year after a very productive and President, BMAA and the television series The Walking Dead. Unlike chusetts General Hospital/McLean Program in Child impactful tenure. A national search for a new dean is [email protected] vampires, their more seductive counterparts in the realm Psychiatry and the primary child psychiatrist for the of horror, zombies are unlovable. Their flesh hangs off organ transplant service. He’s also co-director them in tatters and they’re dumb of medical student education as dirt. So why the fascination? in psychiatry for Harvard Medical Zombie stories are entertain- School, where he teaches and is efficiencies. Norman is an associate ing vehicles for social commen- in charge of the psychiatry cur- Mary Ellen Davies Fisher’s daughter is professor at the University of Vermont tary, Schlozman suggests. George riculum. College of Medicine. Romero’s Night of the Living Dead, Lately zombies have become a freshman at Brown. “It’ll be fun to see which kicked off the genre 45 years light-hearted metaphors for epi- ago, has an anti-war message and demics and other disasters, and campus after so long.” 1989 deals with racism. Its satiric sequel, Schlozman’s “expertise” is in M ary Ellen Davies Fisher and Don Dawn of the Dead, takes place in a demand. The CDC referred to Fisher PhD’88 write that daughter Jessica shopping mall, a metaphor for con- ANSDS in a disaster preparation

is a freshman at Brown. “It’ll be fun to see g sumerism and greed. blog; and on a Discovery Channel n 1981 a governor-appointed member of the campus after so long,” they write. Contact Schlozman wrote The Zombie program, The Zombie Apocalypse, blishi

N orman Ward was named president of Clinical Utilization Review Board, which them at [email protected]. u Autopsies with “tongue deeply in Schlozman discusses his made- p

l a

the Vermont Medical Society during its is tasked by the Department of Health r cheek,” but it has a sinister tone: up virus. Ever the scientist, t n 199th annual meeting in October 2012. Access with examining medical services D avid Lyden, PhD, has received the e Instead of a cartoonish band of though, he wants to be clear: the c

d n

Norman is medical director of case provided under the state’s Medicaid 2012 Biomedical Research Collaborationn R T M shuffling corpses, the enemy is virus, and zombies, are not real! a A r T g

management at Fletcher Allen Health program in order to ensure adherence Award from The Hartwell Foundation. y within. The protagonist, infected —Mary Stuart F a

Care and a physician at its South Burl- to current clinical best practices and David, an associate professor in the rtes cis u

ington Family Practice clinic. He is also identify opportunities for increased departments of pediatrics and cell and co

46 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 47

44-c3BrMed_Winter13.indd 46-47 1/31/13 6:30 PM al umnialbum developmental biology at Weill Cornell royalties on products in order to support disease is the ultimate cause of death in

Medical College, shares the award with NumMedii Inc.’s cutting-edge work children with progeria,” she said. The on ealyumeni Jack D. Bui, MD, PhD, of the University turning raw data from journals and labs drug also has potential benefits in incit- of California, San Diego, for their proposal into an algorithm to analyze the poten- ing weight gain and developing bone “Overcoming Cancer Metastasis: Exo- tial of a compound as a drug. Atul also strength. This work has brought the Then it was back to Highland somes as Metastatic and Anti-Metastatic recently participated in a TEDx event field one significant step closer to devel- Nothing Capital to develop the next great Factors.” The researchers will use the called “7 Billion Well: Re-Imagining oping a cure. Ventured idea. In 2010, Gardner and col- three-year, $635,000 award for research Global Health,” organized by TEDx San leagues launched Kyruus, a Big on metastasis in childhood cancer. Francisco and University of California, Jennifer Lane ’95 has joined the staff as a A new platform Data startup that helps analyze, Graham Gardner San Francisco. general and bariatric surgeon at Hall- harnesses Big Data. manage, and engage large networks mark Health System Center for Weight of physicians. (“Big Data” is a buzz- 1993 Management and Weight Loss Surgery, Graham Gardner ’95 MD’99 knew he probably wouldn’t word for the tremendous amounts of information that John Montgomery ’82 was appointed 1997 part of Lawrence Memorial Hospital, in stay in medical practice for long. While he had chosen a can be collected in data sets.) “We analyze billions of data vice president and medical officer for the Joshua Garren ’91 AM’96 has joined the Lawrence, KS. Jennifer completed her res- career in medicine to help make a difference, he recog- points from thousands of sources to highlight the relative Florida branch of Humana Inc., a nation- staff of Oklahoma Cyberknife, a cancer idency in general surgery at Tripler Army nized that he could have an equal, if not bigger, impact strengths and weaknesses of every physician,” he says. ally established health care company treatment center using innovative tar- Medical Center in Hawaii and served for outside of clinical care. He’d watched his father launch a “We then build applications to help organizations opti- that provides insurance products and geted radiation technology. While train- several years in the US Army as a general successful biotech company and felt the irresistible mize their compliance, network development, and refer- health and wellness services. Montgom- ing at Brown, he worked on the first surgeon, including deployments to Afghani- allure to “help create things that hadn’t been there before.” ral management strategies.” ery accepted this role to lead clinical pro- radiosurgery system in New England. stan and Iraq. She recently finished a fel- After internal medicine residency and cardiology He likens it to the approach to building baseball grams for the commercial lines through- He completed neurosurgery training at lowship in minimally invasive bariatric fellowship at Beth Israel Deaconess in Boston, Gardner teams shown in the movie Moneyball: “Only when you out Florida after working with Humana New York University. surgery at Tufts Medical Center, is a fel- went to business school at Harvard. He joined Highland understand the statistics can you build a team that best low of the American College of Surgeons, Capital Partners after graduation. coordinates care for patients.” and is a member of the American Society “That was a great platform to build companies from,” While he enjoyed medicine, Gardner says he doesn’t “To discover that some damage to the blood of Bariatric and Metabolic Surgery and Gardner says. What’s more, he could meld his interests miss day-to-day practice. “While I was taking care of the Association of Women Surgeons. by crafting companies that drove health care forward. patients, I couldn’t do anything else but that. It was too vessels in progeria can be slowed or partially His first success story was Generation Health. Their important not to be the first and last thing I did every reversed is a tremendous breakthrough.” A deline Winkes ’94 and her family—hus- product created a formulary of genetic tests that insur- day. Outside of medicine, I can develop tools to make band Tim and daughters Katie and Ellie— ance companies could use to implement testing for benefi- health care delivery better. are thrilled to welcome another member ciaries. Gardner was chief medical officer of the compa- “I hope I’m still making a difference, just in a different into the world, Thomas Matthias Kunkel. ny through its acquisition by CVS Caremark. way.” —Kris Cambra as the regional medical director since October 2010. He was also nominated 1998 chair-elect of the board for the American L eslie Gordon ScM’91, PhD, associate 2002 Cancer Society’s Florida division. professor of pediatrics (research) at Alp- R obert Meguid ’97 completed a cardio- ert Medical School and mother of a child thoracic fellowship at the University surgery at the University of Colorado tember 22, 2012, in Cambridge, MA. with progeria, is lead author of a study of Washington in Seattle and has taken Denver. He and his wife, Cheryl, relo- 2009 Andrew is a third-year resident in inter- 1995 that presents exciting results of the first- a faculty position in cardiothoracic cated last July. S arah E. Wakeman ’05 and David G. nal medicine at Massachusetts General A tul Butte ’91 MMS’95, co-founder of ever clinical trial to treat progeria with a Munson, MD, were married September Hospital, and Katherine is in her intern- NumMedii Inc., recently partnered with drug, farnesyltransferase inhibitor, orig- 2005 8, 2012, in Old Lyme, CT. Sarah is chief ship year at Boston Medical Center. drug developer Aptalis Pharma Inc. in inally intended to treat cancer. Progeria f ollow us! resident in the medicine department at the pursuit of developing new treatment is a rare rapid-aging disease that leads to B rian M. Kwong ’01 and Catherine Massachusetts General Hospital. David options for gastrointestinal disorders fatal atherosclerosis at an average age S. Wong ’01 were married August 18, is a staff physician at the Boston Health 2012 R E and cystic fibrosis. NumMedii Inc., led of 13. “To discover that some aspects of www.facebook.com/ N 2012, in Sausalito, CA. The Rev. Janet M. Care for the Homeless Program. Kumar Vasudevan ’08 has begun his RD A G in conjunction with Atul’s wife, Gini damage to the blood vessels in progeria BrownMedicine Cooper Nelson, chaplain of Brown Uni- residency in neurosurgery at Emory M A

Deshpande, utilizes Big Data technolo- can not only be slowed but even partially H versity, officiated. Brian is an emer- Healthcare, part of Emory University. A R G

2010

gy to help pharmaceuticals optimize reversed within just two-and-a-half http://twitter.com/ Y gency medicine physician in Oakland,

drug development. Aptalis will provide years of treatment is a tremendous brownmedicine R CA, for the Kaiser Permanente Medical A ndrew M. Brunner and Katherine D. Katherine D. Thomspon See A ndrew U

upfront and milestone monies as well as breakthrough, because cardiovascular CO Group.TES Thompson MD’12 were married Sep- M. Brunner MD’10.

48 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 49

44-c3BrMed_Winter13.indd 48-49 1/31/13 6:30 PM al umnialbum O bituaries residents discharged. Jack is also the director of Ellis from Glens Falls Hospital, where LLC at Bristol Hospital. She addition- AL UMni otrophic lateral sclerosis (Lou Gehrig’s the Lesotho-Boston Health Alliance, an he was most recently director of the ally served as a hospitalist and director disease). Jake graduated from Moses initiative to improve the health care sys- department of emergency medicine. of Nocturnal Medicine with Hospital ATA K. ERDOGAN ’98 Brown School (1993), Yale University 1986 tem in Lesotho, Africa, through part- Internists of New London LLC, Lawrence MD’02 (1998), and Tulane University Medical B rian Jack, a former faculty member nership with government and health & Memorial Hospital, New London. A ta K. Erdogan, 36, passed away in School (2012). After receiving his medi- at Brown, was recently appointed chief officials in the region. 2004 August 2012 after a prolonged battle cal degree, he completed his orthopedic of family medicine at Boston Medical E lizabeth Tillman joins the practice of with cancer. He graduated from Phillips surgery residency at Brown University, a Center and Boston University School of the Hospital of Central Connecticut. 2009 Academy in 1994 and from Brown’s Pro- fellowship in orthopedic trauma at Brown, Medicine. In 1997, he became vice chair- 2003 She does so following her work as the Krzysztof Kopec has accepted a posi- gram in Liberal Medical Education. He and a fellowship in total joint replace- man of family medicine at the hospital, M atthew Miles has joined Ellis Medical medical director of Hospitalist Practice tion in gastroenterology at the Hospital completed internal medicine and cardi- ments at the Scripps Clinic in San Diego, where he led Project RED, intended to Group as medical director for its new and Hospice, chairman of Section Inpa- of Central Connecticut. Prior to this, he ology training at Northwestern in 2009. CA, finishing his training in 2009. He improve communication about medica- $10 million care center in Clifton Park, tient Medicine, and medical director/ completed an internship and residency He then joined the Bluhm Cardiovas- then joined the medical staff of the tion and follow-up care to patients being NY. Matthew joined Schenectady-based owner of Hospital Internists of Bristol at Rhode Island and The Miriam Hospi- cular Institute at Northwestern. Sansum Clinic in Santa Barbara, CA, tals in internal medicine and a gastroen- His Brown classmates Saori A. Mura- where he specialized in complex joint terology fellowship at Lahey Clinic in Bur- kami and David Bae are leading an effort replacement surgery. lington, MA. He is a 2006 graduate of the to establish the Ata K. Erdogan Memo- The son of Clinical Assistant Profes-

on ealyumeni Robert Wood Johnson Medical School. rial Term Scholarship at Alpert Medical sor of Orthopaedics Thomas F. Bliss, School in his memory. In a letter to their Jake said he always knew he would be an Jason Salter, family medicine physician class, they wrote: “Those fortunate orthopedic surgeon. His deep love of the Behind the Music and former associate professor of com- enough to have known Ata will always field, and of medicine broadly, was un- Alum is one half of a songwriting duo. munity and family medicine at Alpert remember his generous spirit, his amaz- wavering. In an interview with Santa Medical School, has joined Southcoast ing strength, his infectious smile, and Barbara Street Medicine after his diag- L ooking for some kids’ music you won’t be embar- Physicians Group in the practice of Drs. his love for those around him. He was nosis, he said of his career: “I could en- rassed to blast in your minivan? Check out The Colored Carlos A. Correia, Felicia Freilich, and truly a wonderful human being who joy it for my whole life. I got a tremen- Pencil Factory, a collection of family-friendly tunes from Jessica C. Inwood. He has begun to see epitomized perfection as a physician, a dous amount of satisfaction from doing Brooklyn-based bluegrass band Astrograss. The 16-song patients at Southcoast Family Medicine friend, a brother, and a son.” what I did. And it was worth all the sacri- CD features traditional American folk songs (“Shortenin’ in Fall River, MA. He is survived by his parents, Drs. fices. I am very grateful for the one year Bread,” “Cluck Old Hen”) and new tracks from song- Mehmet and Remziye Erdogan; and a I had to practice.” writing team Jordan Shapiro and Joe Grossman MD’12. brother, Mete. During his career, Jake garnered the Grossman, an intern in the Beth Israel Deaconess 2011 Gifts in Ata’s memory can be sent respect and admiration of all who had Medical Center Internal Medicine Residency program M ichael Lasser was appointed medical to Brown University, Ata K. Erdogan the privilege to know him. A lifelong (see Brown Medicine, Fall 2011), has been writing songs director for the Center for Robotic Sur- with Shapiro since 1995, when they were freshmen at the gery at Jersey Shore University Medical University of Michigan. “[T]hroughout his eight years of schooling in vari- Center in Neptune, NJ. The not-for- “  ata was truly a wonderful human “For our senior thesis in April 1999, we produced/ ous locations, we have kept on honing our craft together, profit teaching hospital has been ranked directed a major multimedia rock opera called Joe’s writing songs for various bands I’ve been involved in, among the best cardiac surgery provid- being who epitomized perfection as Garage … a theatrical adaptation of the Frank Zappa mainly Astrograss,” Shapiro says. ers in the Northeast and has the only a physician, a friend, a brother, and a son.” album of the same name,” Shapiro says. After gradua- The Shapiro/Grossman songs on The Colored Pencil trauma center and stroke rescue center tion, many of the seniors who worked on the show moved Factory include the whimsical “Freak Out” and the funny in the region. His work in robotic surgery to New York City, where they worked on an original the- “Grave Diagnosis.” It’s not all fun and games, though. will help bring breakthrough and non- ater piece for two years. The poignant “Minutes into Flowers” laments the funda- invasive surgical techniques to the med- Memorial Term Scholarship, Office of Quaker, Jake was committed to helping “Fortune Cookie Dreams, the multimedia rock opera Joe mental problem with children: they grow, too quickly. ical center’s roster. He assumes the role Biomedical Advancement, Box G-ADV, those less fortunate. Even before gradu-

and I wrote together, premiered at an off-off-Broadway “Why is time so slow/while we grow taller and stronger?/ CO of director following his recent comple- Providence, RI 02912. ating from high school, he established U

theater in August 2001,” Shapiro says. In 2004, after Why is time so fast/when we want it to last longer?” RTES tion of fellowship training in Robotic with a friend a summer camp for under-

years of writing, rooming, and struggling together, Joe The CD is available at www.astrograssmusic.com/ kids. Y and Laparoscopic Urologic Surgery and J Ames MOTT BLISS, privileged children in Providence. After

W A

entered the world of medicine. —K.C. L Endourology at Albert Einstein College MD RES’07 receiving the diagnosis of ALS, Jake dis- DM

A of Medicine/Montefiore Medical Center , 37, died Novem- continued the practice of surgery, but N James (Jake) M. Bliss I A ! in New York City. WA ber 10, 2012, of complications from amy- continued to volunteer with Doctors

50 brown medicine | winter 2013 http://brownmedicinemagazine.org winter 2013 | brown medicine 51

44-c3BrMed_Winter13.indd 50-51 1/31/13 6:30 PM O bituaries Without Walls-Santa Barbara Street Department of Anesthesia in 1985 and dent of the Holocaust Survivors Group Medicine. “I found that I could still be a had served as chief of that department and on the board of directors of Temple doctor with the homeless population,” since 1988. He was a member of the Bet Knesset Bamidbar and the Jewish Jake said. “While I was going through board of directors of the American So- Family Service Agency. Bruno is survived the transition of accepting my fate and ciety of Anesthesiologists, the Rhode Is- by his wife, Linda, three sons, and seven struggling with life-and-death issues, land Society of Anesthesiologists, and grandchildren. they really helped me by allowing me to the Society for Pediatric Anesthesia, help them.” among others, and a fellow of the Amer- WARREN WILLIAM Jake, above all, was known for his ican Academy of Pediatrics. He completed FRANCIS, MD many close friends and the love he held his internship and residency in pediat- W arren William Francis, 88, died in for his family. He spent the last year of rics at Rhode Island Hospital, where he October 2012. After graduating from Magic at Alpert Medical School his life much as he spent the previous served as chief resident. He also com- Princeton University and Columbia Uni- 36—committed to having fun, making Left to right: Dominic Wu ’12 MD’16, Rachel Dunlap MD’16, Adam Driesman ’12 MD’16, and Vickram Tandon MD’16. the most of every moment, and improv- ing the lives of those around him. He The Bliss family asks that those inspired Wouldn’t it be grand if you could turn a $10 bill into $100? leaves his wife, Dr. Laurel A. Bliss, and by Jake’s life volunteer a morning to their his daughter, Devon A. Bliss, of Santa Alpert Medical School students are! Barbara, CA. Jake was born in Rehoboth, community in his memory. MA, the son of Dr. Thomas F. Bliss and the late Josselyn Hallowell Bliss. Abeel A. Mangi ’93 MD’97 is challenging medical students to support the Brown Medical Annual Jake is also survived by his brothers Fund. He’ll match each and every student gift to the BMAF with $100! If 150 student supporters and sisters and many nieces and nephews. pleted a residency in anesthesia at the versity College of Physicians and Sur- The Bliss family asks that those in- Hospital of the University of Pennsyl- geons, he served on active duty (1950-52) step up, they’ll earn $15,000 for Alpert Medical School this year. spired by Jake’s life volunteer a morning vania in Philadelphia, and a fellowship in the United States Naval Reserve to their community in his memory. in anesthesia and critical care medicine aboard the destroyer USS Compton. He at The Children’s Hospital of Philadel- came to Rhode Island in 1952 as a surgi- You can track the Student Challenge, with donor totals by class, at RIC HArd A. BROWNING ’75 phia. Rick was an avid golfer and enjoyed cal resident at Rhode Island Hospital, http://brown.edu/go/Med_Student_Challenge. MD’78, PMD’12 playing platform tennis. He is survived where he practiced general surgery and R ichard A. Browning, 59, passed away by his wife, Lisa, and their three chil- vascular surgery until his retirement in on November 13, 2012. He was the for- dren, Chris, Karen MD’12, and Lauren. 1997. He served as surgeon-in-charge, We all know that medical students lead demanding lives, but they are making the Brown Medical mer chief of anesthesia at Rhode Island First Surgical Service, from 1981 to Annual Fund a priority—and so can you! Through this challenge, medical students are showing Hospital and The Miriam Hospital and faculty 1996. He was president of the staff of that they know participation, at any level, is key. served as clinical professor of anes- Rhode Island Hospital and chairman of thesia at Alpert Medical School. Brown- BRO UN BORENSTEIN, MD the Executive and Medical Affairs Com- Please join the growing number of student supporters and make your gift today. ing joined the Rhode Island Hospital Bruno Borenstein, 70, of Providence mittees in 1975. In 1983, he became Give online at www.gifts.brown.edu. and Las Vegas, passed away in August clinical associate professor of surgery 2012. His career focused on the care of in the Brown University Program in Visit http://bmaf.brown.edu for more information. cancer patients, the elderly, and the ter- Medicine. He was appointed Rhode minally ill. He was a clinical assistant Island State Police Division Surgeon in professor emeritus of medicine at 1965 by Governor John H. Chafee, and Questions? Contact Bethany Solomon, director of the Brown Medical Annual Fund, Brown University, chief practitioner of received the Colonel Everitte St. John at [email protected] or (401) 863-1635. an oncology practice, medical director Chaffee Award for outstanding service of several hospice organizations in in 1997. He is a past president of the Rhode Island, and an internist at the VA Princeton Alumni Association of Rhode Hospital in Las Vegas. Bruno was pas- Island. Warren is survived by his wife sionate about Jewish history and earned of 59 years, Constance Anne (Kuhl) R ichard an MA from Hebrew College in Jewish Francis, three children, and seven Browning studies. In Las Vegas, he served as presi- grandchildren. WA

52 brown medicine | winter 2013 http://brownmedicinemagazine.org Office of Biomedical Advancement • Box G-ADV • Providence, RI 02912 • http://biomed.brown.edu/adv

44-c3BrMed_Winter13.indd 52-3 1/31/13 6:30 PM Brown Medicine Box G-ADV Providence, RI 02912

Office of Continuing Medical Education 233 Richmond Street, R-156, Providence, RI | [email protected] | 401-863-2871

For a list of live and on-demand, web-based activities, please visit brown.edu/cme.

The Warren Alpert Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education to physicians. For the purpose of enhancing the quality of health and health care, the Office of Continuing Medical Education collaborates with: • Alpert Medical School faculty • Affiliated hospital clinicians • Local, regional, and national health care societies • Rhode Island Department of Health • Other agencies interested in planning formal CME activities

Please contact us if you are interested in collaborating with the oἀ ce to develop a CME-certified activity.

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