Dear Alumni and Friends:

It is sometimes easy to forget, as we no access to quality health care or advanced procedures (page make our way in haste through the 30). Dozens of surgeries performed within a week are not bustling halls, clinics, labs and lecture uncommon for short-term missions, but that impact is com- rooms of the Medical School, that med- pounded many times over by giving medical personnel in icine at Michigan reaches far beyond the these countries the opportunity to observe improved tech- Ann Arbor campus and satellite clinics niques and updated methods of care. Helping to establish eye of the U-M Health System. This issue of banks in Mongolia, providing doctors with the latest tech- Medicine at Michigan highlights two of niques for helping children with disabilities in Malawi, work- the extraordinary ways in which the ing to secure needed equipment and supplies for communities brilliance and commitment that charac- in Guatemala — in ways such as these, U-M health care pro- terize our school and health system are fessionals are sharing their knowledge and skills. taken to some of the farthest reaches of In an age when disease can travel as fast and as far as jet air- our planet, often to those who need it most desperately. planes, and cultures merge in the conduct of global business, It is at once remarkable and to be expected, given the caliber it is the obligation of any great academic institution to bring of students who study medicine and biomedical research at its resources to bear on problems and issues outside the strict the U-M, that many of the international initiatives which bear confines and limits of its campus, city or state. In concert with the Michigan name started at the student level (page 20). teaching students to provide medical care in the context of the From isolated ideas and individual efforts has grown a coor- individual patient — accounting for and accommodating cul- dinated approach to international experiences, forming a tural factors such as religion, lifestyle, ethnicity and socioeco- powerful program we know as Global nomic status — it behooves us to REACH (Research, Education and provide students with the opportunity Collaboration in Health). The pro- “It behooves us to share what we to experience and help improve health gram’s mission is to facilitate collabo- care and social conditions in other ration among Medical School faculty, have learned and what we can countries. It behooves us also to students and our global partners for do, to improve lives lived far from march forward in the world — in a the benefit of patients worldwide. culturally sensitive fashion — to share our own backyards, and to con- what we have learned and what we Under the auspices of Global REACH, can do, to improve lives lived far from students network with other students tinually raise standards of care our own backyards, and to continu- and faculty members to organize wherever we can.” ally raise standards of care wherever excursions to Central America, Africa we can. and Asia, to small communities where health care is often virtually nonexistent. To learn, to educate, The education that comes from international experiences is to treat and hopefully cure: These are the reasons students invaluable to our students. The good that is accomplished by undertake missions to assess and improve health conditions in these missions — those of students and those of seasoned places too poor to accomplish such strides on their own. From physicians — is immeasurable. Everyone associated with the conducting clinics and vaccination programs to educating U-M Medical School can and should feel great pride in the communities on local diet and nutrition, our students are dedication and heroic efforts of all who are seeking to making a difference worldwide, without regard to geopolitical improve health care and conditions throughout the world. boundaries, and learning in the process how to achieve maxi- mum medical benefit from minimal health care resources. Sincerely, Throughout the Health System, teams of physicians, residents and nurses likewise organize travel to nations lacking our resources, volunteering their Michigan expertise in diagnosis, Allen S. Lichter (M.D. 1972) treatment and surgery to people who otherwise have little or Dean Published three times a year by the University of Michigan Medical School and the Office of Medical Development and HOST Alumni Relations

a Student… Allen S. Lichter Dean Medical School James S. Thomas Associate Vice President for Medical Development … Help Launch a Career! and Alumni Relations U-M Health System Jane Myers Managing Director and Director of Communications Remember your search Office of Medical Development and Alumni Relations for just the right resi- dency? The travel? The costs? Editor: Richard F. Krupinski By providing a welcome Science Editor: place to stay for a fourth- Sally F. Pobojewski year medical student Assistant Editor/Photo Editor: exploring residency pro- Marie Frost grams in your area, you can help defray significant student Editorial Assistant: Robin Johnson costs and stay in touch with a new generation of physi- cians studying medicine at Michigan. Contributing Writers: John Barton, Whitley Hill, Gary Libman, Jeff Mortimer, Nancy Ross- Flanigan, David Wikins In the last academic year, 267 alumni volunteered to be Contributing Reporters: part of the U-M Medical School’s HOST (Help Our Nicole Fawcett, Kara Gavin, Krista Hopson and Mary Beth Reilly Students Travel) Program, representing nearly every state of the U-M Health System’s Office of Public Relations and Marketing Communications in the nation. The program matched 84 percent of student requests with alumni hosts and was a great success in the Art Director and Designer: Kathryn M. Moody of BMC Media views of students and hosts alike. Graphic Designer: Martin Soave of BMC Media Your participation in this year’s HOST Program can make an important difference in the lives and careers of mem- Illustrator: Shayne Davidson of BMC Media bers of the Class of 2006 as they undertake the same dif- ficult and exciting process and decisions that you once Photographers: Paul Jaronski, Marcia Ledford and Martin Vloet of U-M Photo experienced. Services; Gregory Fox; Marie Frost; D.C. Goings; Darrell H. Hoemann; David Paul Morris; J. Adrian Wylie To find out how you can become a HOST volunteer and learn more about the program, call or e-mail B.J. Bess, MAGAZINE HONORS 2004 CASE DISTRICT V AWARDS: director of alumni relations, at (734) 998-6044 or Gold Medal, School and College Magazines [email protected], or visit www.medicineatmichigan.org/ Bronze Medal, Cover Illustration, Summer 2003 alumni/host. Office of Medical Development and Alumni Relations 301 E. Liberty, Suite 400 Alumni helping alumni keeps the Michi- Ann Arbor, MI 48104-2251 gan tradition going strong. Volunteer to (734) 998-7705

HOST today! Printed in the U.S. © 2005 The Regents of the University of Michigan

www.medicineatmichigan.org/magazine LETTERS

clinic. I had already received my Ph.D. in On completion of my internship I zoology (genetics). At Ann Arbor I was entered the Army and was tracked down able to meet with Drs. James V. Neel, by Dr. Neel at Fitzsimons Hospital in Harold F. Falls, and Charles Cotterman, Denver in August of 1947, and was attend meetings with them, and meet vis- asked if I would be willing to join him in iting dignitaries. organizing the genetics program that was to be part of the Atomic Bomb Another feature of my internship at Ann Casualty Commission in Japan. Thus, I Arbor was my month in Obstetrics, then was involved in the start of that program located in an old mansion adjacent to in November of 1947. I decided to doc- the main hospital. I was the sole intern ument my experiences there by keeping a and I lived in the small attic room on the daily diary and taking photographs third floor. I was there for the month of (about 500). The librarian at the Texas December, and my only time off the library where records of the ABCC were entire month was three hours on being filed learned of my diary and Christmas Eve to be with my wife and asked for permission to copy it and some son! As an intern, I had to do all routine photographs about five years ago, and I lab work, and did the nighttime deliver- was happy to oblige. I realized that no ies (12). The delivery room was similar one else had documented the early start to the little circular amphitheaters pic- of ABCC as I had, and I am therefore in tured in old books. Incidentally, I saw the process of having my records pub- the professor of ob/gyn only once that lished by Elan Press. Memories of Medicine month, since he occupied himself with gynecological work in the main hospital. Ray C. Anderson, M.D., Ph.D. at Michigan A memorable experience for me (Residency 1947) The articles on genetic counseling in the occurred during one of the early evening Sun City, Arizona fall 2004 issue of Medicine at Michigan deliveries with about six medical stu- [email protected] brought memories back to me. In 1946 I dents in attendance. As the infant’s brow applied for a rotating pediatric intern- appeared, first one student, then another, ship at Michigan largely because of the fainted and slipped under the rail along- presence of Dr. Lee R. Dice’s heredity side my stool! Photo: Courtesy Ray Anderson Photo: Courtesy Ray Anderson Photo: Courtesy Ray

Anderson (fourth from left) on a matsutake (“pine mushroom”) hunt with friends just east of Hiroshima on October 17, 1948. According to Anderson (front row, center) and members of his genetics staff on the roof of the Hiroshima Anderson, these mushrooms are very expensive and highly sought Red Cross Hospital on January 10, 1949 after today.

4 Spring/Summer 2005 Global Grad It is wonderful to read in Medicine at Michigan of my colleagues and teachers! I enclose news of a recent, unexpected award that has come my way, presented

in Toledo on February 19, between my Photo: PictureQuest missions to Mindanoa and Sudan (see Class Notes, page 56). I hope it represents a theme carried forward from my “Maize and Blue” days in encouraging medical students toward a global outreach. I will be returning to Haiti in late spring. Please visit my online journal at http://home.gwu.edu/~gwg. Cheers! Glenn W. Geelhoed (M.D. 1968) Derwood, Maryland

Readers, please share your thoughts, comments and questions with us. Send your letters to: Letters to the Editor Medicine at Michigan 301 E. Liberty St., Suite 400 Ann Arbor, MI 48104-2251 E-mail: [email protected] Or submit them online at: www.medicineatmichigan.org/ magazine ‘These Letters may be edited for clarity, style or length. Things I Do Promise …’ On June 3 in Hill Auditorium, members of the Class of 2005 vowed loyalty to In the next the profession of medicine and to practice their art with honor, embarking upon the next phase of their careers as physicians and medical scientists. They join thousands of other Michigan-trained M.D.s throughout the country ISSUE as esteemed alumni of the U-M Medical School. of Medicine at Michigan: U-M research into the promise and perils of bone mar- Rear Admiral Susan Blumenthal, M.D., former U.S. assistant surgeon gen- row transplantation, and its translation to eral, delivered the commencement address, ‘The Hippocratic Oath: Ancient clinical care ... the lifelong importance of Lessons for 21st Century Global Health Challenges,’ prior to the presenta- mentors ... health care delivery that tion of awards and diplomas. A complete list of faculty and student awards crosses cultural and social barriers. Also: can be seen at www.medicineatmichigan.org/magazine. Residency matches nanotargeting of anti-cancer drugs; statins for this year’s graduates can be found on page 48. and lower colon cancer risk; and a look back on Michigan’s first pacemaker.

Medicine at Michigan 5 IN MEDICINEMOMENTS AT MICHIGAN

“I told him that the doctors taking care of him would be excellent, and he looked at me and said, ‘I have only one doctor, and that’s you.’”

look at that picture and still remember my excitement, probably because it was similar to what I feel now as I approach my residency. I was honored to have “Ibeen accepted into medical school, to know that I would one day be a doctor. “The past four years have been filled with life- changing moments — some subtle, some not so subtle. There was a patient last year who was diagnosed with metastatic brain cancer. He was a wonderfully humorous patient who always kept a positive outlook. He reminded me a lot of my maternal grandfather. One morning I was in his room with my entire team — other students, resi- dents and the attending — explaining about the surgery and radiation he would undergo. I told him that the doctors taking care of him would be excellent, and he looked at me and said, ‘I have only one doctor, and that’s you.’ “I realized then that my dream of becoming a physician was basically realized. I have lots more to learn — in fact, I’m not sure I’ll ever know enough — but that connection, that feeling of having an impact on someone’s life, was what I had strived for. “The idea of being the responsible party for patients’ lives is somewhat daunting. I remind myself that I’m just moving on to the next phase, one where I have more opportunity to help others, to learn about medicine and to grow into an excellent clinician. I know residency will have its rocky spots, just like medical school, but I also truly believe that the journey will shape me into a ‘great doctor.’”

Interview by Whitley Hill Photograph by J. Adrian Wylie

6 Spring/Summer 2005 Danielle Turner-Lawrence, from the Kalamazoo area, is a member of the Class of 2005 who begins her residency in emergency medicine this fall at the Carolinas Medical Center in Charlotte, North Carolina. Turner-Lawrence appeared on the cover of the spring 2001 issue of Medicine at Michigan just prior to beginning her medical studies, for a story about the Medical School’s admissions process.

Medicine at Michigan 7 ABOVE THE HURON

Gene Therapy Regenerates Functioning Auditory Hair Cells U-M RESEARCH FINDINGS COULD UNLOCK FUTURE ADVANCES IN THE TREATMENT OF HEARING LOSS

illions of people with the most common type of hear- Ming loss — caused by aging, infections, drugs, diseases or exposure to loud sounds — are one step closer to an effective treatment, thanks to scientists at the University of Photo: Martin Vloet Michigan Medical School. In research published in the March 1 issue of Nature Medicine, U-M scientists used gene therapy to grow new auditory hair cells and restore hearing in deafened guinea pigs.This was the first successful restoration of auditory hair cells in an adult animal, and it made international news. Reporters from around the world sought interviews with Yehoash Raphael, Ph.D., associate professor of otolaryngol- ogy at U-M’s Kresge Hearing Research Institute. For the last 11 years, Raphael has been searching for a way to regener- ate functioning auditory hair cells. Unlike hair that grows on our bodies, hair cells are the sen- sory cells of the auditory and balance organs in the inner ear. They get their name from microscopic hair-like projections that grow from each cell. Certain diseases, drugs and expo- sure to loud sounds can damage or destroy hair cells. This breaks the connection between sound waves and the brain’s auditory processing center and makes it impossible to hear. Raphael used a “pro-hair cell gene” called Atoh1, which nor- mally is active only during embryonic development. “Our goal was to find a way to activate Atoh1 in mature non-sen- sory cells in the inner ear, causing them to develop into new hair cells,” Raphael says. Masahiko Izumikawa, M.D., a research fellow in Raphael’s laboratory, used an adenoviral vector to deliver the Atoh1 gene to non-sensory cells in the deafened inner ears of adult guinea pigs.The animals were deaf because their orig- inal hair cells were destroyed by ototoxic drugs. Eight weeks later, the scientists found new auditory hair cells in the Atoh1-treated ears of the research animals. To find out whether the guinea pigs’ new hair cells were working, the scientists used auditory brainstem response tests, similar to hearing tests given to people. These tests Yehoash Raphael measure auditory thresholds — the lowest level of sound

8 Spring/Summer 2005 intensity that generates a response in the brainstem. “Four weeks after treatment,

Photo: Martin Vloet the threshold levels indi- cated profound deafness. But at eight weeks, average Misfolded Molecules: thresholds in Atoh1-treated ears were lower (better) at all frequencies than in the Key to Diabetes? control ears. This is the most exciting finding of our study,” niversity of Michigan scientists may have found a new culprit in dia- says Raphael. Ubetes: improperly folded molecules of proinsulin, the precursor mol- Masahiko Izumikawa Restoring auditory threshold ecule for insulin. levels is an important advance, but Raphael cautions that it Too many misfolded molecules can clog a cell’s internal waste disposal is not the same as restoring normal hearing. “At this early system, putting stress on cells and even killing them. If this happens stage the structural and functional repairs are incomplete, with proinsulin in the pancreatic beta cells that produce insulin, it could and the hearing of these animals is likely to be distorted,” be an important factor leading to the development of diabetes, accord- he says. “For this and other reasons, it will be several years ing to Peter Arvan, M.D., Ph.D., the William K. and Delores S. Brehm before Atoh1 gene therapy is ready for human testing.” Professor of Type 1 Diabetes Research.

Pancreatic beta cells make insulin Photo: Paul Jaronski by folding long molecules of proinsulin into a specific shape, so chemical bonds can form, and then chopping them up to make active insulin. If the folding process is defective, the cells

Photo-illustration: Shayne Davidson Photo-illustration: Shayne must work extra hard to generate additional insulin needed to regu- late the amount of glucose in the bloodstream. According to Arvan, this continual stress on beta cells could explain why people with diabetes make less insulin and why the cells eventually die. Destruction of Peter Arvan pancreatic beta cells is the hall- mark of both type 1 (juvenile) and type 2 (adult) diabetes. In a study published in the Journal of Biological Chemistry, Arvan’s research team found that normal rat and human beta cells produce misfolded, as well as normally folded, proinsulin. But mice with gene mutations that made them prone to diabetes and mice that produced mutant forms of proinsulin had much higher levels of misfolded mole- A digitally enhanced scanning electron microscope image of a new cules. Misfolded molecules were much less likely to leave the cell. hair cell generated in the mature guinea pig cochlea by Atoh1 “We’ve shown that misfolded forms of proinsulin are made under nor- gene therapy. mal conditions, and in higher abundance under diabetic conditions,” The research was supported by the National Institute on Arvan says. “The next step is to see how they affect cell function.” Deafness and Other Communication Disorders of the National Institutes of Health, a gift from Berte and Alan Hirschfield, a —KG gift from General Motors and the United Auto Workers, the Center for Hearing Disorders, and GenVec Inc., a biopharma- ceutical company in Gaithersburg, Maryland. GenVec pro- Read an expanded version of the story: vided its proprietary adenovector with the Atoh1 gene insert. www.med.umich.edu/opm/newspage/2005/insulin.htm —SFP For more information on the Brehm Center and U-M diabetes research: For an expanded version of this story: www.med.umich.edu/brehm www.med.umich.edu/opm/newspage/2005/haircell.htm For more information on deafness and hearing loss: www.nidcd.nih.gov/health

Medicine at Michigan 9 ABOVE THE HURON

Simulation Station WHERE MEDICAL TRAINEES CAN PRACTICE SURGERY AND OTHER PROCEDURES AGAIN AND AGAIN — WHILE DOING NO HARM TO PATIENTS

ands-on training at the operating table is Hinvaluable, but it presents distinct limita- tions. Medical students and residents are restricted to the cases that present them- Photo: Martin Vloet selves. Learning through trial-and-error is not an option when a patient’s safety is on the line. And minimal opportunity exists for the repeti- tive practice needed to master surgical and clinical procedures. That’s why the University of Michigan Medical School has created the Clinical Simulation Center. Established last year, the Simulation Center brings together high-tech teaching tools and innovative curricula to deliver realistic, intensive and risk-free training. For example, the center is home to a full-size mannequin, known as a human patient simula- tor, equipped with software and sophisticated electrical, mechanical, hydraulic and pneumatic devices which realistically replicate human physiology. He (or she — the patient simulator has interchangeable genitalia) speaks, blinks his eyes, and has a heartbeat. His pupils dilate Pamela Andreatta in the Clinical Simulation Center, where Jim Cooke, M.D. (Residency 2000), and third-year and constrict to light, his chest rises and falls resident Catherine Bettcher, M.D., are working with an infant mannequin with each breath, and his pulse can be felt in his neck, wrists, thighs and feet. Instructors program the patient simulator to “We can create any medical scenario we want. present specific symptoms and create medical scenarios for students to respond to. The Students respond to it, and the system responds to mannequin can be intubated, ventilated, anes- the students’ actions. You can’t get that in real life.” thetized, catheterized and medicated intra- venously — and he will mirror human —Pamela Andreatta responses to the treatments. His heartbeat can be set to mimic arrhythmia. If he goes into car- diac arrest, students can perform CPR or use a defibrillator. If his lung collapses, they use a director of the Clinical Simulation Center. “You The center also is equipped with infant and needle to reinflate it. A tube can be inserted can’t get that in real life.” pediatric patient simulators, mock operating/ into his chest to remove gas trapped in the trauma rooms, and procedural simulators which The Simulation Center also has a full-sized lungs or fluid around the heart. allow doctors-in-training to practice laparo- female mannequin which simulates childbirth. scopic surgery, hysteroscopy, endoscopy and Called Noelle, this patient simulator replicates “We can create any medical scenario we want. other clinical procedures. Audio-video equip- a variety of medical situations, since instruc- Students respond to the scenario, and the sim- ment records simulations from a variety of tors can alter fetal head descent, cervical dila- ulator responds to the students’ actions,” says angles for review and debriefing. Pamela Andreatta, an assistant professor in tion, placenta location, the speed of delivery, the Department of Medical Education and and fetal heart sounds and heart rate. The goal of patient simulation is to provide med- ical students and residents the opportunity to

10 Spring/Summer 2005 ABOVE THE HURON

Bexxar: Vloet Martin Photo: Effective First-Line Treatment for Lymphoma

exxar, a cancer therapy developed by scientists at the U-M BComprehensive Cancer Center, is an effective first-line treat- ment for patients with advanced-stage follicular lymphoma — a cancer previously considered to be incurable — according to a study published in the February 3 issue of the New England Journal of Medicine. Of 76 patients enrolled in the study, 95 percent responded to the treatment and 75 percent had a complete response, meaning no evidence of cancer remained. More than three-quarters of patients with a complete remission were disease-free after five years. According to Mark Kaminski, M.D., professor of internal medicine and director of the study, results from a one-week treatment with Bexxar rivaled those of other treatments for follicular lymphoma. Plus, Bexxar treatment took less time and produced fewer side effects. The drug was approved by the U.S. Food and Drug Administration in 2003 for use in patients with follicular lymphoma after other treatments have failed. The new study evaluated Bexxar as a first-line treatment for the disease. Kaminski and his colleague Richard Wahl, M.D., formerly at the U-M and now at Johns Hopkins University, developed the Bexxar regimen. The University of Michigan holds patents for the Bexxar therapeutic regimen, which is marketed by GlaxoSmithKline under a licensing agreement. —NF Mark Kaminski Read an expanded version of this story: www.med.umich.edu/opm/newspage/2005/bexxar.htm For patient information about non-Hodgkin’s lymphoma: www.cancer.med.umich.edu/learn/lymphomainfo.htm

practice critical procedures earlier in their train- so they can hone their skills to perfection and The Clinical Simulation Center is located in ing and more often before performing them on have complete confidence,”she says. the Towsley Center at the U-M Medical School. patients, Andreatta says. This helps ensure that For more information, call (734) 936-8305 or Clinical simulation is quickly being integrated the necessary motor skills and cognitive visit www.med.umich.edu/umcsc. into the U-M Medical School curriculum across processes become ingrained, which enables disciplines,Andreatta says, and faculty are con- trainees to focus on more substantive issues ducting research to evaluate the validity and when they treat patients — thereby improving effectiveness of this instructional approach. both the quality of care and the learning expe- rience. “We want to provide our students, our —DW faculty and our staff with access to procedures

Medicine at Michigan 11 ABOVE THE HURON

Help Your Heart,

Photo: Martin Vloet Save Your Brain HEART ATTACK PREVENTION MEASURES MAY ALSO HELP PRESERVE MEMORY FOR PATIENTS WITH ALZHEIMER’S AND DEMENTIA

edications and lifestyle changes that help prevent a heart attack Mor stroke could also prevent or slow the memory loss and con- fusion of dementia, according to U-M researchers. For some people with a condition called mixed dementia, controlling blood pressure and cholesterol could help more than memory-preserving drugs. Mixed dementia is a combination of Alzheimer’s disease and vascu- lar dementia, caused in part by problems with blood flow in the brain. It may affect as many as 20 percent of the 6.8 million Americans with dementia. Doctors now think that many people with symptoms attrib- uted solely to Alzheimer’s — memory loss, confusion, wandering, trou- ble following instructions — may have mixed dementia. “The effects of high blood pressure and high cholesterol damage small blood vessels in the brain and can cause death of brain cells over time,” says Kenneth Langa, M.D., Ph.D. (Residency 1997), an assistant professor of internal medicine and assistant research sci- entist in the Institute of Gerontology. “In addition, the Alzheimer’s disease process itself can affect the walls of blood vessels in the brain, making strokes more likely,”Langa says. “Strokes can cause dementia through the death of large areas Kenneth Langa of brain tissue, or through the build-up of damage from multiple small strokes caused by atherosclerosis in small arteries in the brain or the Medical School larger carotid arteries in the neck.” Langa and the research team reviewed all recent studies on mixed Again in the Top 10 dementia, vascular dementia and Alzheimer’s. They analyzed hun- U.S. News and World Report’s annual dreds of articles, noting any results from drug studies that were rele- survey of graduate schools ranks the vant to mixed dementia. The researchers concluded that efforts to U-M Medical School among the treat cardiovascular risk factors, especially high blood pressure, may top 10 research-oriented medical be more effective than memory drugs in protecting brain function. schools in the nation for the fifth —KG consecutive year. This year, the school took ninth place. Read an expanded version of the story: www.med.umich.edu/opm/newspage/2004/mixeddementia.htm The school also ranked in six of eight medical specialties: family For patient information on Alzheimer’s disease and dementia: medicine (fourth), geriatrics www.med.umich.edu/1libr/aha/aha_alzhdis_crs.htm (sixth), women’s health (seventh), internal medicine (eighth), drug/alcohol abuse (14th) and pediatrics (18th).

12 Spring/Summer 2005 ABOVE THE HURON Born to Run? LOW EXERCISE CAPACITY LINKED WITH

INCREASED RISK OF CARDIOVASCULAR One of Britton’s rats on the treadmill. DISEASE Photo: Martin Vloet f just thinking about exercise makes you exhaustion forces them to stop, while low- Scientists from the Norwegian University of Itired, perhaps you have something in com- capacity “couch potato” rats give up after only Science and Technology, the Medical College mon with Steven Britton’s rats. They have been 14 minutes. of Ohio and Williams College, who collabo- selected and bred over 11 generations to con- rated in the study, found a close association In a study, published in the January 21 issue centrate genetic differences related to innate between low aerobic exercise capacity and of Science, Steven Britton, Ph.D., and Lauren aerobic exercise capacity. As a result, the rats high scores for risk factors linked to metabolic Gerard Koch, Ph.D. — professor and assistant differ substantially in their ability to use oxygen syndrome — physical changes, like insulin- professor, respectively, of physical medicine efficiently and generate the energy it takes to resistance and more abdominal fat, often seen and rehabilitation in the U-M Medical School run for long periods of time. in people who later develop cardiovascular dis- — reported that low-capacity rats had more ease and diabetes. For example, the high-exercise-capacity rats in cardiovascular disease risk factors, including generation 11 can run continuously on a high blood pressure and vascular problems, “Essentially we are breeding for genes that code treadmill for 42 minutes on average before than rats bred for high exercise capacity. for low levels of proteins involved in mitochon-

“We think impaired mitochondrial function Photo: Martin Vloet may be the link between low aerobic capacity and disease.” —Steve Britton

drial function,” Britton says. “We think impaired mitochondrial function may be the link between low aerobic capacity and disease.” Studies with thousands of people have found low aerobic exercise capacity to be the strongest predictor of mortality among all risk factors for cardiovascular disease, Britton adds. So increasing exercise capacity is impor- tant for anyone who wants to reduce their risk of dying from a heart attack or stroke. “You may have to work harder, and you’ll never reach the level of a professional athlete, but almost everyone can improve their aerobic capacity and health status with regular exer- cise,” Britton says. —SFP

For an expanded version of this story: www.med.umich.edu/opm/newspage/2005/ Steve Britton and Lauren Koch borntorun.htm

Medicine at Michigan 13 ABOVE THE HURON

U-M Health System Designated as a National Neuropathy Center Photo: Martin Vloet he U-M Health System has been designated by the Neuropathy Association — a Tpublic, charitable, nonprofit organization established in 1995 — as one of four neuropathy centers in the United States. Neuropathy is a painful nerve disorder affecting up to 20 million Americans. Its tingling, numbness and pain in the hands and feet affects half of all patients with diabetes, as well as people with other con- ditions that cause nerve inflammation and damage. As a national center, the U-M will receive funding to coordinate the care and support of neuropathy patients, educate doctors about the best diagnostic and treatment options, raise public awareness and pursue research on neuropathy. The center will bring together many of the neuropathy-related research and clinical efforts already underway at Michigan. “We look forward to offering patients more coordinated diag- nosis and care, and access to clinical trials of promising treatments,” says Eva Feldman (Ph.D. 1979, M.D. 1983) the Russell N. DeJong Professor of Neurology, who will direct the center. —KG For patient information about neuropathy: www.med.umich.edu/1libr/aha/aha_perineur_crs.htm For more information on the Neuropathy Association: www.neuropathy.org Eva Feldman

Women Wait Longer for Angioplasty

fter a heart attack, time is vital. An be related to the fact that women are less Aemergency angioplasty to re-open likely to have the “typical” symptoms of clogged blood vessels and restore blood heart attack, such as crushing chest pain flow to heart muscle can reduce the risk of and left arm pain. Also, women may be death by 50 percent, but only if it’s per- more likely to attribute their symptoms to formed within 90 minutes of the patient’s something other than a heart attack, arrival in the emergency room. because they don’t realize their own risk for a heart attack. Unfortunately for women, they receive this life-saving procedure an average of 13 min- “Heart attacks happen to women, as well as utes later than men, according to a study of men,” Moscucci says. “Both men and 1,511 Michigan heart attack patients con- women must recognize and react to symp- ducted by Mauro Moscucci, M.D., associate toms as quickly as possible. Emergency professor of internal medicine in the U-M medical professionals must work harder to Mauro Moscucci Cardiovascular Center. Add the extra 20 ensure that women receive the same imme- minutes that it took for the average woman diate diagnosis and treatment as men.” Read an expanded version of this story: to reach the ER, and the result is an addi- www.med.umich.edu/opm/newspage/ tional 33 minutes of wasted time and dam- The study is part of the Blue Cross Blue 2004/womenheart.htm aged heart muscle, compared to male Shield of Michigan Cardiovascular patients. Consortium, a multi-hospital initiative to For patient information on heart attack study and improve angioplasty care. in women: The reasons for these gender differences in www.med.umich.edu/1libr/wha/ emergency treatment aren’t clear, but may —KG wha_svmyoinf_car.htm

14 Spring/Summer 2005 ABOVE THE HURON

Understanding Depression GENETIC BRAIN DIFFERENCES COULD SHED LIGHT ON TREATING DEPRESSIVE DISORDERS

ndividuals with severe clinical depression U-M Molecular & Behavioral Neuroscience Institute Photo: Simon Evans, Iwho died while they were depressed had lower levels of molecules called fibroblast growth factors, and associated receptors, in their brains than people without the disease, or those with the bipolar form of depression, according to a study by U-M researchers. Since fibroblast growth factors have never been associated with psychiatric illness before, the discovery suggests a whole new direction for understanding depression and developing new depression treatments. It may even help scientists understand how some antidepressant medications work in the brain to ease symptoms, and why there is wide vari- ation in how depressed people respond to dif- ferent antidepressants. The results of the study were published in the Proceedings of the National Academy of Sciences by researchers from the Pritzker Neuropsychiatric Disorders Research Con- The intensity of colors in this microarray data from the Pritzker Consortium study represents the level of sortium. The research team consisted of scien- activity of specific genes in brain tissue. tists from the University of Michigan Molecular & Behavioral Neuroscience Institute, formerly known as the Mental Health Research mediate the cross-talk between different cell For an expanded version of the story: Institute, and researchers from the University of types in the brain. www.med.umich.edu/opm/newspage/2004/ California and Stanford University. As a result, they can be seen as mediators of depressedbrains.htm “This finding comes from an unbiased search a property that neuroscientists call “neural For patient information about depression: to find which genes best differentiate major plasticity” — the ability of the brain to adapt to www.med.umich.edu/depression depression brains from normal and bipolar stress, experience, disease and the effects of brains,”says senior author Huda Akil, Ph.D., the drugs. Gardner C. Quarton Distinguished Professor of Neurosciences in Psychiatry. “The family of “We can’t say whether these growth factor gene genes that was most different and showed the expression changes are a predisposing factor highest significance as a coherent group was for depression or a consequence of the dis- the fibroblast growth factor family.” ease process itself,” says Simon Evans, Ph.D., U-M research investigator. “There may be peo- Fibroblast growth factors stimulate cell growth ple out there with compromised fibroblast in many areas of the body and are involved in growth factor systems, but if they don’t experi- the growth of multiple tissues at various stages ence stressful life events they may never of life. They have potent effects during embry- develop major depression. We need to study onic, fetal and child development, and can the system further to unravel the answer to this modify the size and structure of particular question.” brain regions. They are also involved in the repair of adult tissues after injury and may —KG

Medicine at Michigan 15 ABOVE THE HURON

Vitamin D Gains Respect ONCE REGARDED AS JUST ANOTHER NUTRIENT, VITAMIN D IS VITAL FOR GOOD HEALTH AND HOLDS PROMISE FOR THE TREATMENT OF DISEASE

veryone knows that vitamin D builds strong Ebones by helping the body absorb calcium. But new research indicates that it’s essential for nearly every other part of the body, too. Photo: Martin Vloet Vitamin D deficiency is now recognized as a significant problem in developed countries like the United States. Clinical studies have found intriguing associations between low levels of vitamin D and diseases like diabetes, cancer, depression, hypertension, osteoporosis, mus- cle disorders, multiple sclerosis, arthritis and heart disease. These associations have made this essential nutrient the subject of many basic science research studies. “People used to think vitamin D was just one in a long list of nutrients in your morning multi- vitamin pill, but now we know how important it is, and how much promise it holds for develop- ing future therapeutic drugs,” says Robert Simpson, Ph.D., a professor of pharmacology in the Medical School. Simpson has spent 25 years studying the secrets of vitamin D, and he says it’s gratifying to see it finally getting the respect it deserves from the scientific community. “Vitamin D isn’t really a vitamin at all,” Simpson says. “It’s a substance the body con- verts into a hormone called 1,25 dihydroxyvit- amin D or calcitriol. The process begins with sunlight.When ultraviolet light from the sun hits your skin, it reacts with a steroid molecule in skin cells to create vitamin D. It’s transferred from the skin to your liver and kidneys where it is metabolized into calcitriol, the activated form of the vitamin.” Simpson was the first scientist to identify the docking site, or receptor, calcitriol uses to affect heart muscle cells called cardiomy- ocytes. He and other scientists have found the same receptor on many other types of cells. When calcitriol binds to the vitamin D receptor, Robert Simpson, Ph.D., Stephen Hershey, M.D., and Dina Bauer, Ph.D., who is holding one of the lab’s sponta- it sends a signal to the cell’s nucleus telling it neous hypertensive heart failure rats

16 Spring/Summer 2005 ABOVE THE HURON

to turn on, or turn off, certain genes. This In studies conducted by other researchers, makes calcitriol one powerful hormone, patients with heart failure were found to have because it can alter gene activity in most cells vitamin D levels as much as 50 percent lower and affect the function of many organs in the than similar patients without the disease. body. Ultimately, Simpson hopes his research will Simpson believes that the ability of our cells to lead to new drugs for heart failure. He’s trying respond to vitamin D’s signal developed early to identify genes that are active in cardiomy- in human evolution as a sort of internal “wake- ocytes and figure out how they are regulated

In studies conducted by other researchers, patients with heart failure were found to have vitamin D levels as much as 50 percent lower than similar patients without the disease.

up call” triggered by exposure to sunlight. After by the vitamin D hormone. He’s also looking all, our ancestors didn’t just hang around the for slight genetic differences in the human cave all day. They were outside hunting and gene for the vitamin D receptor to see if these gathering food, in a dangerous environment differences are more common in people diag- indoors than outside, taking daily vitamin D where survival could depend on every organ in nosed with heart failure. supplements can help, according to Simpson. the body operating at peak performance. “But too much can be toxic,” he warns. “So Because it is so vital for good health, Simpson don’t take more than the recommended dose In 2004, Simpson received a $1.2 million says it’s important to make sure you get without consulting your physician.” grant from the National Institutes of Health to enough vitamin D. The federal government rec- study the relationship between the vitamin D ommends adults get 400 international units of —SFP hormone and a condition called cardiac hyper- vitamin D every day. The recommended trophy, or progressive heart failure, which amount for adults over age 55 is 800 interna- affects nearly 5 million Americans. tional units. Since only a few foods — like for- For more information on sources and recom- tified milk, egg yolks and salmon — contain Heart failure can develop when damage from a mended amounts of vitamin D: vitamin D, Simpson says it’s difficult to get an http://ods.od.nih.gov/factsheets/vitamind.asp heart attack or chronic high blood pressure adequate supply through diet alone. makes the heart work harder than it should for long periods of time. As a result, the heart gets “Sunlight is the best source,” he says. “Fifteen larger, and its cells don’t contract and relax minutes of direct exposure without sunscreen together. This makes the heart less efficient at several times a week is enough to allow your pumping blood. Over time, cardiac muscle skin to produce the recommended dose.” dies, scar tissue forms and the heart gets Of course, if you are at high risk for skin can- weaker. Although drugs can help slow the cer, you need to check with your doctor and process, doctors currently have no way to stop weigh the risks and benefits of sun exposure the heart’s gradual deterioration. carefully. Born and raised in sunny southern “In our laboratory, we study rats and mice that California, Simpson includes himself in this either can’t make enough vitamin D hormone category. “I’ve had several pre-cancerous or lack the vitamin D receptor,” Simpson says. lesions removed from my face,” he says. “So I “These animals have abnormally large hearts follow my dermatologist’s recommendation and cardiac muscle cells, similar to what physi- and use sun-blockers. But I also take vitamin cians see in people with heart failure. We think D supplements every day.” that a lack of vitamin D hormone leads to If you have dark skin, live in a northern climate defects in the heart’s extra-cellular matrix where it’s cloudy much of the winter, have a resulting in inefficient contractions.” history of skin cancer, or spend more time

Medicine at Michigan 17 ABOVE THE HURON

Caring for the Whole Patient U-M’S PSYCHONCOLOGY PROGRAM ADDRESSES THE PSYCHOLOGICAL AND SOCIAL ASPECTS OF BEING A PATIENT WITH CANCER

ill Howe calls them his “dark times,”the days when con- Vloet Martin Photo: Bcerns about his cancer diagnosis and treatment over- shadowed everything positive and pleasant in life. On days like those, “you’re vulnerable to your worst thoughts,” says Howe, 58, who was diagnosed with aggres- sive prostate cancer four years ago. “You worry about how you’re going to arrange treatments, pay for treatments, deal with the insurance company, support your family. At its worst, it’s like trying to draw a map of an underground cave without a light. You’re kind of lost.” Howe found his way to brighter days with help from the U-M Comprehensive Cancer Center’s PsychOncology Program, headed by Michelle Riba, M.D., a clinical professor of psy- chiatry in the Medical School and current president of the American Psychiatric Association. With a staff that includes psychiatrists, psychologists, social workers, child and family life therapists, nurses, physician assistants, art therapists and complementary therapy professionals, the program is committed to helping patients — and their families — deal with the social and psychological effects of cancer, cancer treatment and cancer survivorship. “People think of the cancer diagnosis as the most stressful event, but there are, unfortunately, many other situations and reasons for patients and families to become distressed dur- ing the course of cancer treatment and afterward,”says Riba. “A new MRI scan, the results of various tests, three-month or six-month checkups all become additional stresses.” Certain treatments can even affect mental functioning, and the effects can be dev- astating, as Howe discovered. “You start to lose your ability to mul- Bill Howe titask, your mental sharpness, your PsychOncology, says Riba, looks at this whole range of mental and emotional issues energy,” he says. related to cancer, in the context of the patient’s life before, during and after diagno- “You’re at the top of sis and treatment.And with a new PsychOncology Clinic located in the Cancer Center, your game, in your patients can get quicker, more convenient access to mental health professionals, most productive often the same day as their oncology appointment. years, and all of a sudden you can’t Helping clinicians to know when patients need emotional support is another part of do it any more. PsychOncology’s mission.“We would love to see all patients and families evaluated for Your confidence is distress at the very beginning of their care and then on a regular basis,”says Riba.With smashed, and you that goal in mind, she helped develop the National Comprehensive Cancer Network’s think, what is going guidelines on psychological distress, which include screening tools and answers to Michelle Riba on with me?” such questions as, “How do you know when distress is normal — or more serious?”

18 Spring/Summer 2005 ABOVE THE HURON

Sometimes, without meaning to, physicians “He called me on the phone and, in about a cancer patient’s perspective,”he says,“you know add to patients’ distress, so another aim of the five-minute conversation, said I’d have to come they understand what you’re telling them — your PsychOncology Program is to educate doctors in and get radiation. It was so matter-of-fact — thought processes, your anger, your resentment. about avoiding that. For example, Riba recently like a conversation in the Meijer checkout lane.” Having someone tell you that the thoughts lectured hematology-oncology fellows on how you’re having are normal is such a relief. His experience at the U-M, on the other hand, to break bad news. has been far more empathic, Howe says, and “If you are a cancer patient and ask yourself Hearing that doctors are getting that sort of he credits Riba and the PsychOncology ‘Should I reach out to someone?’ ... you proba- training is good news to Howe, who’ll never for- Program for much of that difference.“When you bly have your answer.” get the way one physician — not from the U-M have someone to talk to who deals with cancer —NR-F — delivered the news that his cancer was patients every day and who understands the worse than the doctor had initially thought. Second Opinions Help Radiologists COMPUTER-AIDED DIAGNOSIS IMPROVES CANCER DETECTION RATES

ot all lumps, nodules and masses are Vloet Martin Photo: Ncancer. To determine whether a lump is malignant or benign, radiologists study its texture, border and shape when they review the CT scan. Researchers at the U-M Comprehensive Cancer Center are develop- ing computer-aided diagnosis methods to make that assessment easier. “Our system is designed to help the radiol- ogist,” says Lubomir Hadjiyski, Ph.D., a research assistant professor of radiology in the Medical School. “From our experiences in evaluating computer-aided diagnosis for breast cancer, we know that radiologists with computers are able to detect more cancers than radiologists by themselves. We expect that computer-aided diagnosis for lung cancer will produce similar results.” In Hadjiyski’s diagnostic system, current and previous scans are fed through a computer program designed by U-M researchers to evaluate the size, texture, Berkman Sahiner, Ph.D., associate professor of radiology, Lubomir Hadjiyski and Heang-Ping Chan, density and change of nodules over time. Ph.D., professor of radiology The computer analyzes the images with cancer. The radiologist then compares the Food and Drug Administration approval computer-vision techniques specifically two results and makes a final decision. before they can be offered clinically. designed for a given type of cancer or dis- ease. Based on all the information, the “The radiologist is not perfect and the com- —NF computer determines how likely it is that puter is not perfect, but working together Read an expanded version of the story the nodule is cancerous. they detect more cancers,” Hadjiyski says. at: www.med.umich.edu/opm/newspage/ At the same time, the radiologist examines Hadjiyski’s computer-aided diagnosis pro- 2004/computer.htm the images and evaluates the likelihood of grams for lung and breast cancer need For patient information about lung cancer: www.cancer.med.umich.edu/learn/lung.htm

Medicine at Michigan 19 A GRASSROOTS STUDENT INITIATIVE ALLIES WITH THE MEDICAL SCHOOL TO ORGANIZE INTERNATIONAL EXPERIENCES THAT GIVE STUDYING MEDICINE AT MICHIGAN A

BY JEFF MORTIMER

This is no mere starry-eyed notion. The burgeoning number of U-M Medical School students who have n the last four years, University of Michigan organized and participated in overseas projects uni- medical students have opened clinics in the versally describe those experiences as transforma- Dominican Republic, performed surgery in tive, and the school itself is recognizing and Honduras, worked with HIV/AIDS victims in supporting their efforts through the Student IThailand and Ghana, and immersed themselves Alliance for Global REACH, launched last fall as in the Cuban health care system. They’ve also led the institutional response to a growing and increas- teams overseas that have included undergraduates, ingly visible trend. Call it the “trickle up” effect. students in engineering, public health, and social Global REACH (Research, Education and work, as well as physicians and faculty members, in Collaboration in Health) is itself a four-year-old an attempt to address the cultural and societal Medical School initiative that focuses on increasing issues that have an impact on health care. educational exchanges among students and faculty, Why are they so involved in international experi- facilitating international research collaborations, ences? Because they believe it will make them better conducting its own international research, and pro- physicians, and the world a better place. viding opportunities for visiting scholars to benefit from Michigan expertise. ➤

20 Spring/Summer 2005 Pictured above: Seth Blumberg, Priya Saigal and Tammy Chang. Photos: Martin Vloet

Medicine at Michigan 21 In 2004, Global REACH and the grow- With an appointed executive board, reg- director and senior research associate at ing cadre of internationally active first- ular meetings, and an official liaison with Global REACH. “Just as student interest and second-year medical students found the Global REACH office, the Student was taking off, we were in a position to each other — and there’s been no look- Alliance has created a framework that be of help. And that’s very gratifying.” ing back since. students hope will sustain and facilitate When it came to extending the pro- international activities over time. Students were looking for a way to gram’s reach to facilitating such student expand international health opportuni- Priya Saigal, a second-year student from sojourns, David Stern, M.D., Ph.D., ties, while at the same time avoiding South Barrington, Illinois, and one of the director of Global REACH and an asso- “reinventing the wheel” with each new students who was instrumental in the ciate professor in the departments of academic year and new entering cohort early days of the Student Alliance, says Internal Medicine and Medical Edu- of students. And Global REACH was they were excited at the prospect of com- cation, was an easy sell. He had seen the well-positioned to help students work bining forces with a formal organization explosion for himself. within the parameters of the institution that was already in place. “We realized “There’s an overwhelming interest on the to facilitate such things as fund raising, that we had a chance to form a sustained part of our medical students — and, identifying opportunities, lunchtime lec- effort, rather than year-by-year.” more and more, also our residents — to tures, and evening symposia. Hence, the engage in international work,” Stern Student Alliance for Global REACH was “It was a wonderful confluence of says. “Three years ago I gave a lecture to born. events,” says Cheryl Moyer, research Photo: Marie Frost

David Higgs, Sarah Battistich, Derek Richardson and Ann Poznanski discuss their Global REACH experiences.

22 Spring/Summer 2005 That groundwork is the result of the work of countless students, including many who may never directly benefit

Photo: Martin Vloet from the framework they helped estab- lish. Battistich, Saigal and Seth Blumberg, who is in the Medical Scientist Training Program and will soon finish his Ph.D. in biophysics before returning to medical school, are prime examples. Unlike Saigal and Battistich, Blumberg hasn’t taken part in an overseas medical mis- sion, but his motives and passion for the work fit the profile. As an engineering and applied science major at the California Institute of Technology, he began to seriously con- sider medicine as a career only after he had to take a year off for cancer treat- ment. But, as with many of his col- leagues in what could fairly be described as a movement, Blumberg was thinking more globally than locally. “As a cancer patient, I discovered I was on the receiv- ing end of a lot of community service Global REACH’s David Stern and Cheryl Moyer efforts,” he says. “I was really blown away by the generosity of the commu- nity, and very appreciative too. I saw first-hand how community efforts can medical students about how to do inter- “This was all outside their regular first- help people deal with various challenges national work, and 20 or 30 people and second-year curriculum,” says Moyer. and setbacks, so I was eager to take that showed up. The last time we had a lunch- “This was on their lunch hour. The energy lesson and do something positive. The eon seminar on international opportuni- level was incredible, but there was no for- purpose rather than the process became ties, 120 people came. The medical mal link with the administration. more important for me.” students see global health as a leading “Now we’re helping students work issue in their lifetime as physicians.” As an undergraduate, he worked on a within the system for maximum bene- Navajo reservation in New Mexico. In “I’m guessing that over half of our first- fit,” she says. “We do as much as we can his first year as a doctoral student, he year medical students, at the end of this to support them financially and logisti- tutored at-risk youth and worked with summer, will have had some interna- cally, understanding there may never be drug addicts in Philadelphia’s inner city. tional experience,” says Moyer. “The enough money to support all of their As a first-year medical student, he trav- difference between three years ago and activities.” eled with a group of other students to today is stunning.” “We put so much work into the trips help out in a foster care program in St. The students themselves laid the founda- that was just getting lost and having to Louis. tion, not only by envisioning and organ- be renewed and recycled every year,” And, as a visitor to his parents’ native izing their trips, but also by funding says Sarah Battistich, a second-year stu- South Africa, he had also seen the inter- them through bake sales, shoveling dent from Tracy, California. “Now with national dimension of unmet needs. driveways, finding sponsors and, often, the central office, a lot of groundwork “Those visits left quite an imprint on me dipping into their own resources. has been laid that people can build on.” in terms of seeing the large scale of poverty,” he says. “Visiting the Soweto Township in Johannesburg and seeing a disparity of living conditions that was “I saw first-hand how community astronomical — then comparing that to how we live in the United States. efforts can help people deal “All those experiences gave me a sense of the degree of inequality in access to all with various challenges and sorts of necessities, including housing and food as well as health care,” says setbacks, so I was eager to take that Blumberg, “and made me want to do what I could to help balance the field a lesson and do something positive.” little bit.” For now, he’s trying to balance —MSTP student Seth Blumberg the field on the home front, working ➤

Medicine at Michigan 23 with Global REACH program director Kate Durand and fellow students David Lessens and Jason Cheng on ways to redistribute unused medical supplies to the places and people who need them. “We want to partner with World Medical Relief, a nonprofit based in Detroit that picks up supplies and sends them to vari- ous international groups,” Blumberg says. “Then we want to work with faculty and staff to increase awareness of what kind of supplies can be used, and hopefully encourage better conservation and increase our ability to help international projects. Another element is to set up a way for Michigan groups, either students or faculty who are doing medical mis- sions, to get access to supplies they need to support their trips.” Blumberg says future goals of the Student Alliance also include alumni involvement, increasing collaboration between students and fac- ulty, and community outreach programs on international health such as high school presentations and campus-wide symposiums. A 45-minute very steep, very rocky walk from Rancho al Medio, Dominican Republic (where Global REACH is based during their visits), ends at one of the One of the students who was instrumen- main water sources for people in the community. Here, Global REACH students tal in building the global bandwagon is (including Tammy Chang) and members of Manos A Tiempo (top right corner) look Tammy Chang, of Flint, who is now in on as a mother washes clothes (top, center) and a girl cools herself by taking a her third year of medical school, after dip (foreground). Two boys (bottom right) fill oil cans, cooking oil containers and taking a year off to pursue a master’s in buckets with water to carry back home, a daily necessity for the community dur- public health. She was a principal organ- ing the warmest part of the year. izer of student trips to Cuba in 2003 and 2004 as well as one this spring to the ers; that’s how changes happen,” Chang “We do focus on things that can be Dominican Republic, and was the says. “Doctors aren’t used to working on taken care of in one or two visits — founder of Health in Action, a campus- teams. Throughout their entire training, infections or parasites. But, most impor- wide, student-run organization that is they have to depend on themselves, and I tantly, we teach people how to not get now under the umbrella of the Student think that really holds us back in what we those illnesses. If they’re having consti- Alliance for Global REACH. can do as a profession.” pation, we don’t give them laxatives. We “When I entered medicine, I wasn’t tell them about foods in their own com- Chang is decidedly not one to be held munity that they can eat that will allevi- really in the mind-set of becoming a back, and Health in Action’s roster of researcher or someone who would focus ate a lot of their symptoms. We can’t students in engineering, social work and really treat the hypertension, so we work specifically on one topic,” she says. “The public health, in addition to medicine, hard to form collaborations with local very soul of why I went to medical shows that she follows her own advice. hospitals and clinics, so those long-term school was that I felt passionate about chronic diseases can be treated by local using all the things I learned to help as “We have a long-term collaboration physicians. We try to be the glue, really.” many people as possible. In medical with Manos A Tiempo (Hands on Time), school, they train you very well to take a nonprofit in the Dominican Republic with the objective of helping developing care of each individual patient, but I felt tudents are quick to point out the need to do more than that. We need areas there help themselves and make themselves sustainable,” she says. that these ventures are mutu- people who are excited about basic sci- ally beneficial. They believe ence and the treatment of each patient Making a community “a healthy place for kids to grow up” entails a long-term they gain as much in educa- individually but, for me, what would use tional value as they give in my skills the best is to work on the level commitment to long-term solutions. S services. “Our purpose for the trip to of population and community.” “A lot of medical missions are there for Cuba is not to necessarily heal or cure,” That requires teamwork, a leitmotif of only one week. What can you really do says Battistich. “We go more as learners international ventures. in one week?” asks Chang. “Cure every- and partners in collaboration. Although one? Make the illiterate literate? Some we work very hard obtaining donations “It’s all about doctors working with people think we’re naive, going on a lit- of drugs and medical supplies, our intent politicians, economists, public health peo- tle vacation and patting ourselves on the is not to be saviors or healers. This is a ple, engineers and local community lead- back. That is absolutely not the case. critical difference between many ‘med-

24 Spring/Summer 2005 “I believe that even if they practice the rest of their lives in Ann Arbor, these students will practice better medicine because of the time they’ve been away on these missions. ” —Da vid Stern, director of Global REACH

See more photos at www.medicineatmichigan.org/magazine. Left: Sarah Battistich, Priya Saigal (front row, sec- ond and fifth from left) and other members of Global REACH gather around the supplies they’ve brought to donate to a pediatric hospital in Havana, Cuba. Below, left: Two girls in the Domnican Republic take a recess break following a literacy program led by Tammy Chang and the Global REACH team. Chang says, “These girls were insepara- ble. They were about to show us their dance rou- tine to a current pop song.” Below, center: Sarah Battistich administer s a steroid shot to a patient suffering from a swollen wrist that prevented him from working. Global REACH students often provide care in makeshift clinics during their travels; this one is located inside a school house in the Dominican Republic. Below, right: Ann Poznanski shares a gift — a set of Lisa Frank colored pencils — with some new friends at a clinic in Guatemala.

ical mission’ trips and what we are the occasional shuffling of class and therapy study led by Tim Johnson, M.D. attempting to establish here at the exam schedules that the trips necessitate. (Residency 1979), chair of Obstetrics University of Michigan. I believe the pri- Says Moyer: “Having fewer resources and Gynecology. “There’s a lot to be mary goal is to move beyond both med- and making do with what you have learned from Ghana and other develop- ical tourism and the idea that we as U.S. forces a degree of thinking on your feet, ing countries that have working health physicians can drop in for a week in which is not as much of an issue here care systems without spending as much some remote part of the world and cre- where you have all the tests, treatments as we do,” he says. “Expensive treat- ate real, lasting change. Instead, what is and supplies you could ever need. One ments are good but they need to be care- important is to establish persevering resident talked of being in a tent in fully measured. All the doctors in Ghana connections that empower local Honduras and needing a Foley Catheter are very aware of how much money the resources and communities as well as and using an empty IV bag instead — hospital has, and they have more of a utilize the resources we have to offer. In which worked perfectly. Such resource- public-health approach to medicine. the end, it is only these types of enduring fulness is a valuable lesson for students.” relationships that will garner real change “There’s a lot of talk of universal health in the world.” Derek Richardson, a second-year stu- care here,” Richardson says, “but if dent from Ann Arbor and a member of America is going to cover 45 million Humility isn’t all they learn, and the les- the Student Alliance board, spent last uninsured people, there will need to be sons seem important enough to warrant summer in Ghana working on an HIV some steps up in cost management.” ➤

Medicine at Michigan 25 Two- Way

StreetINTERNATIONAL EXPERIENCES ALSO BRING STUDENTS FROM FOREIGN COUNTRIES TO TRAIN AT THE U-M

ill a Pacific Islander develop a more effective Alice TelesnitskyCourtesy Photo: Wcholera vaccine? Will a Caribbean learn how to regulate immune responses to dengue? Will an Eastern European discover a better tuber- culosis drug? Will an African cure AIDS? Programs like the Michigan Infectious Disease International Scholars (MIDIS) could help answer those questions. The program provides basic bio- medical research training to students from dis- ease-endemic nations — students whose personal convictions and experiences make them unusually Clement Ndongmo dedicated to the war on infectious disease. The MIDIS program, headed by Alice Telesnitsky, Ph.D., associate professor of microbiol- ogy and immunology, has hosted researchers from all over the world. Clement Ndongmo, for example, was born in Cameroon and graduated from the University of Yaounde in bio- logical science, then embarked on a career as a medical laboratory scientist investigating HIV/AIDS. After graduate work at the University of Oslo in Norway and a fellowship at the Centers for Disease Control, Ndongmo came to the U-M as part of the international scholars program. “I joined the Telesnitsky lab to study how these recombinant viruses are generated in single cycle as well as spreading infection recombination assays,” Ndongmo says. “I’m particularly interested in non-homologous recombination by transduction of cellular genes. “The people in the lab are friendly and interactive, creating an environment very conducive to good, productive science,” he says. “The opportunity to work at Michigan is extremely rewarding.” —WH

For more information on MIDIS, visit www.umich.edu/~midis.

26 Spring/Summer 2005 “What is important is to establish persevering connections that empower local resources and communities as well as utilize the resources we have to offer. In the end, it is only these types of enduring relationships that will garner real change in the world.” —medical student Sarah Battistich

“One of the most incredible parts of hav- hether it predates or ical students are more interested in pub- ing international medical experience is results from their times lic health than they think. Until I applied realizing how resourceful people can be away, students with to medical school, I thought a degree in with very little,” says Ann Poznanski, a international interests public health was used only in hospital first-year student originally from Wput the practice of med- administration. Students on any one of Birmingham, Michigan. Poznanski was icine in the context of communal ends, these foreign trips bring home an under- an associate professor of histology, perceiving it as a player rather than a standing of how broad and critical the embryology and anatomy at a medical panacea. field really is, and with it a stronger college in Arizona when she was inspired desire to help. In my opinion, this real- “Medicine is definitely one small piece to become a physician after taking part ization is otherwise very difficult to come among economics, public health and in a series of medical missions to by. For this reason, ideally I’d like to see social work,” says Richardson, whose Guatemala, first as a translator and then some form of international experience team in Ghana included both undergrad- as co-director of the program. eventually become a mandatory part of uates and a public health student. “It’s the curriculum.” “International health experiences are good training even for our careers in going to make us more conscious of America,” he says. “There needs to be a The vast majority of overseas trip partic- being able to use the resources that we lot more communication among all these ipants are first- and second-year stu- have and maybe fine-tune our clinical different fields. It’s a whole new perspec- dents. As Blumberg notes, “Once they skills in a way that’s less reliant on tech- tive on how to confront a lot of issues that become third-years, they’re totally over- nology,” Poznanski says. “It’s sort of a are going to happen in America soon.” whelmed with clinical responsibilities.” But for fourth-year students, Global temptation to want to use the toys, Saigal’s self-designed undergraduate and they are very cool toys, but physi- major at Duke was in public health and REACH awarded 34 $1,000 scholar- cians need to be educated about how to international development, and she also ships this year for international clinical be more resourceful and cost-conscious.” taught a course there on “the integration rotations, up from 10 a year ago. In an ever-shrinking world, where people of public health and medicine, where “It may only pay for the airfare,” says — and diseases — travel as fast as jets they have their boundaries and turf wars Stern, “but the idea behind it is that these can carry them, familiarity with other as well as where they can collaborate,” experiences help students understand cultures is increasingly invaluable. “We she says. “The U.S. spends more per what it means to be a doctor. When they can’t make a clear-cut distinction capita than any other nation in the world see the way health care is practiced in between cultures anymore,” says Saigal. on health care. One of the biggest rea- other countries, especially if they go to “There’s a lot of world travel, there’s a sons why, I feel, is that there aren’t developing or Third World nations, they lot of exchange of ideas, beliefs, prac- enough physicians that are involved in get a greater appreciation for the respon- tices. The U.S. is probably the world’s social change and health policy.” sibilities of the physician and the impact largest melting pot in terms of variety of David Higgs, a first-year medical student medicine can have in the lives of people. cultures, and I think in order to provide from San Diego, will be in Santiago, “Michigan as a university has always the best care for our patients in the U.S., Chile, this summer to work on an iron been outward thinking,” Stern adds. it’s very important to understand some deficiency project. (See “Painstaking “The Peace Corps started on the steps of of the cultural intricacies. And I believe Research Reveals Long-Term Impact on the Michigan Union. Global REACH the best time to develop these skills is Infant Iron Deficiency,” Medicine at shows that the Medical School and the during the medical training process.” Michigan, Winter 2001.) He says he Health System are awakening to the real- Says Stern: “Some of these students will chose Michigan in part because of its ization that, whether we’ve known it or continue to do international work, but I School of Public Health, where he plans not, we’re a global player, and that we believe that even if they practice the rest to earn a master’s in nutrition. have potential resources and opportuni- of their lives in Ann Arbor, they will prac- “International opportunities create an ties internationally. Other schools within tice better medicine because of the time awareness and appreciation not only of the university have been out there engag- they’ve been away on these missions.” cultural differences, but also of the ing in global action and cooperation for importance of public health in medi- years. It’s time for us to step up to the cine,” Higgs says. “I think a lot of med- plate and be a part of that.”

Medicine at Michigan 27 LOOKINGBACK

‘I Knew I Must Try’ ‘AFFRONTED AND DETERMINED,’ HUBERT EATON SUCCEEDED IN CHANGING LIFE FOR HIS COMMUNITY AND HIS COUNTRY

ubert Arthur Eaton earned his medical degree from the University of Michigan in 1942, at a time when very Hfew African-Americans were being admitted to medical schools, much less graduating from them. And although Eaton went on to become a highly respected physician and a courageous warrior in an unending battle against racial discrimination in his home town of Wilmington, North Carolina, the ties of this social pioneer to the University of Michigan have been largely forgotten. When Eaton is remembered, it’s usually in connection with his tutelage of Althea Gibson, a remarkably gifted athlete who became the first African-American to play her way into the rigidly segregated world of women’s professional tennis. Gibson, who died in 2003 at the age of 76, won two singles titles at Wimbledon and added two more U.S. Open champi- onships in the 1950s before shattering another color barrier by becoming the first black person to compete on the women’s professional golf tour. Hubert Eaton,Althea Gibson and Hubert Eaton Jr. Eaton, an accomplished tennis player himself, brought Gibson to Wilmington in 1946 and helped perfect her game on the “Back at the office,I got out of my car court he had built next to his home. He also convinced the somewhat rebellious a different Hubert Eaton.” teenager from New York City to continue her education by graduating from high Eaton, whose father and father-in-law That changed dramatically in 1947, school. Three years later the former high were also physicians, left Ann Arbor in when Eaton was summoned to the New school drop-out was admitted to Florida June 1942 as a newly degreed doctor Hanover County Court House in A&M College in Tallahassee as a scholar- determined to bring the highest stan- Wilmington to testify regarding a patient ship athlete in basketball and tennis. In dards of medical care to his patients. In involved in an insurance liability case her autobiography, I Always Wanted to returning to North Carolina, Eaton was (see “Healing a Nation,” Medicine at be Somebody, Gibson credited Eaton painfully acquainted with the pervasive Michigan, Summer 2000). As he took with helping her “cultivate the grace and and oppressive Jim Crow laws that the witness stand, the bailiff asked him dignity (she) needed to succeed both on divided the races, but he saw himself as to swear the customary oath on a Bible and off the court.” a healer and not a social engineer. — a battered Bible that was wrapped

28 Spring/Summer 2005 with a strip of dirty adhesive tape and And so did Eaton’s protracted battles feelings or bitterness over the way he labeled “Colored.” against injustice. But his dogged persist- was treated, and even spoke fondly of ence and unshakable faith in the legal the time he spent in Ann Arbor. He once “I was stunned,” he recalled in his mem- process eventually paid off. New told me that Army recruiters came to the oirs. “My eyes fogged, my ears hummed Hanover County schools were forced to medical school just before he graduated and a quiver ran down my spine. I desegregate and comply with the Brown — World War II was going on at the almost gasped.” vs. Board of Education decision. Eaton’s time — and they were really trying to As Eaton left the courtroom, he couldn’t efforts also gained staff privileges for convince the white students to join up. erase the image of that grimy Bible from black physicians at James Walker They just sort of ignored him, however.” his mind. “The charge built up in me by Memorial after an eight-year tug of war The elder Eaton earned his undergradu- years of racial prejudice had finally in the courts that ended in 1964. The ate degree in zoology at Michigan, com- exploded,” he wrote. “That my children case attracted national attention by pleting his studies in three years before should grow up in a community that articulating the principle that hospitals being accepted to the Medical School. required them to swear in court on a seg- using public funds cannot discriminate His wife, Celeste, earned a master’s regated Bible was unconscionable. on the basis of race — a precept that became a key element in the federal Civil degree while he was studying medicine, “‘I’m going to have to do something to Rights Act of 1964. and the family connections to the U-M change some of the things I have seen in don’t end there: A sister, Hazelle, came this town if I’m going to live in it,’ I said to myself. How I would accomplish this was not yet clear to me but I knew I must try. There were measly black Eaton’s eight-year court battle to gain staff privileges for schools, segregated hospitals, segregated black physicians at James Walker Memorial Hospital tennis courts, all-white government, seg- regated libraries, and segregated Bibles. attracted national attention by articulating the principle Back at the office, I got out of my car a different Hubert Eaton.” that hospitals using public funds cannot discriminate on The new Hubert Eaton became a tireless the basis of race — a precept that became a key figure in the struggle for civil rights and the fight to end racial discrimination in element in the federal Civil Rights Act of 1964. his community. He fought to eliminate segregation in a hospital where black patients were housed in a separate wing — victimized by inadequate care and “That victory,” Hubert Eaton Jr. says of to Ann Arbor in 1936, and went on to a substandard toilet facilities. He went the successful legal effort to overturn long career as a teacher. toe-to-toe with the local board of educa- Walker Memorial’s racist policies, “was tion when it refused to honor the order the one my father was most proud of. It Eaton died in 1991 at the age of 74. of the U.S. Supreme Court and desegre- had a tremendous impact all over the He was remembered as a driving force gate a school system that relegated black South, and I’m not exaggerating by say- behind the civil rights movement in and white students to separate and ing it was the medical equivalent of Wilmington. As a local newspaper put it, decidedly unequal facilities. Brown vs. Board of Education. It was a “Dr. Eaton was an affronted and deter- He stood his ground against sheriff’s precedent-setting suit that was very, very mined man. But he didn’t shout. He deputies who were members of the Ku far-reaching in forcing hospitals to murmured. He didn’t go into the streets. Klux Klan, then survived a change the way they regarded black He went into the courts. He persistently trumped-up murder charge and patients and doctors.” The prodded Wilmington toward doing what a politically motivated income younger Eaton was right. He helped make that tax audit. Eaton even learned earned his M.D. at inevitable transition peaceful and civil.” to play golf so he could help Meharry Medical The title of Eaton’s autobiography, desegregate a local course, School in 1969, Every Man Should Try, was inspired by and he persisted in a legal and did his resi- Jacqueline Kennedy’s remarks about her showdown with the local dency and internship assassinated husband at the John F. YMCA, which had refused at Harlem Hospital Kennedy Library exhibit: “John to desegregate its facilities before returning to Kennedy believed so strongly that one’s until the national organiza- Wilmington and aim should not just be the most com- tion threatened to revoke its joining his father’s fortable life possible — but that we charter. As Eaton recalled in practice. should all do something to right the his 1984 autobiography “I think my father wrongs we see. ... He believed that one Every Man Should Try, enjoyed his days at the man can make a difference — and that “The examples of discrim- University of Michi- every man should try.” ination seemed endless.” gan,” Eaton Jr. says. “I know he had no hard —JB

Medicine at Michigan 29 CALLED TO AND HELP HEABY WHITLEY HILL U-M physicians and nurses take Michigan medicine to developing countries — and in the process remember why they practice medicine in the first place

30 Spring/Summer 2005 Photo: Courtesy Karin Muraszko Photo: Courtesy Photo: Martin Vloet Martin Photo:

n 1964, Susan Thoms, M.D., then a Theresa Nairus, M.D. high school student at the Liggett (Residency 2001, School in Detroit, attended an event Fellowship 2002), she’s never forgotten: the screening clinical instructor in Iof a documentary film about the ophthalmology and hospital ship Hope that sailed to under- visual sciences. The privileged countries to deliver medical pair’s charge: to care to those in need. “It’s still vivid in set up Mongolia’s my mind,” says Thoms, clinical assistant mentoring program, professor in the Medical School’s Cyber-Sight, created Department of Ophthalmology and to save vision while Visual Sciences. “I thought, ‘I want to providing critical edu- do that someday.’” cational enrichment to physicians who are The idea haunted Thoms throughout desperate to learn. medical school and the early years of her practice. “I vowed that by the time I was Though deeply 50 I would do some kind of trip.” devoted to helping In 1996, when she turned 49, Thoms people in their contacted several organizations that country, Mongolian facilitate medical trips for physicians. ophthalmologists — Within a week, See International called along with physi- to ask if she’d be interested in taking a cians in most devel- laser to Mongolia; she did- oping countries — Theresa Nairus and Susan Thoms n’t hesitate. Thoms accom- simply do not have panied the laser to the the advanced educa- hospital in Ulaan Baatar tion and technical training of their from a participating American physician and instructed Dr. Chimgee American counter-parts. Explains Nairus, within 48 hours. Chuluuhuu in its use. Since “These doctors have no college education But the trip also had educational and then, it has saved the sight prior to attending medical school, and clinical elements. Thoms trained Dr. of hundreds. they study ophthalmology for only one Enkhmaa Purev to perform modern Last year, Thoms returned year.” Cyber-Sight establishes a high-tech cataract surgery. Nairus took three L to Mongolia through mentoring relationship between indige- corneas donated by the Eye Bank Orbis, an international organization nous and American physicians. Nairus Association of America so that she that seeks to end preventable blindness and Thoms took digital cameras and could train local physicians to perform by the year 2020. The group’s Flying Eye computers to the Mongolian capital of a transplant. Working closely with Hospital Plane brings top surgeons, staff Ulaan Baatar and instructed local oph- Dr. Munkhtsetseg “Muugii” Tsrendash, and state-of-the-art equipment directly thalmologists in their use. Today, the Nairus saw 60 patients over three to underprivileged countries. But other Mongolian doctors can photograph a days; 30 were candidates for a cornea Orbis missions have different goals. For patient’s eye, send the image and their transplant. Twenty-seven were turned her 2004 trip, Thoms was joined by questions to a Web site, and hear back away. ➤

Medicine at Michigan 31 “I had to be very selective about who Thoms and Nairus plan to continue their learned to work with limited resources, could get the most use out of a cornea for work in Mongolia and value the oppor- and they do a very good job.” Nairus is the longest time,” says Nairus. “One 16- tunity to share knowledge with physi- working with the Mongolian doctors she year-old boy showed up three days in a cians in developing countries. The now regards as friends to set up an eye row, in a suit, hoping to be picked.” The physicians they worked with were all bank so that no one who needs a cornea boy, unfortunately, lived too far away to women — 75 percent of Mongolian doc- — like a persistent teenage boy wearing receive the follow-up care that would tors are female — and they impressed the a suit — has to be turned away. have improved his chances for success, American doctors deeply. “They’ve and could not be chosen. irginia Nelson, M.D., a clini- cal professor in physical med- icine and rehabilitation in the Medical School, recently com- pleted her fourth trip to Africa Photo: Martin Vloet V with CURE International, an organiza- tion which establishes and operates teaching hospitals in the developing world to aid disabled children and their families. Nelson has visited hospitals in Kenya, Uganda, and Malawi, working closely with doctors as well as patients. Nelson, like Nairus and Thoms, seeks to make the greatest impact possible when she undertakes a medical mission. “CURE’s philosophy, and also mine,” she says, “is that if I can help one child, well, that helps one child. But if I can teach doctors in developing countries, that helps many children.” Some of this teaching is practical — pro- tocols for treating children with a wide variety of physical disabilities — and some of it reflects the need for wide shifts in a culture’s way of thinking about dis- ability. “This is such a new idea in Africa, and in much of the developing world,” says Nelson, of the view that disabled children have both potential and a place in the fabric of society. “People with disabilities have just been put in the back room or left to die.” In February of this year, Nelson traveled to Malawi, along with two U-M resi- dents and others, to spend three weeks at the newly opened Beit Trust CURE International Hospital in Blantyre, “a very nice, clean city,” says Nelson. Still, while the facilities were pleasant, the Virginia Nelson team had their work cut out for them. “We went in as consultants,” Nelson says. “The physicians had no clue what a “If I can help one child, well, that helps one rehab doctor does. Their cast room needed to be organized. They wanted us child. But if I can teach doctors in develop- to look at some length-of-stay data and chart organization and administrative structure. We did some teaching of physi- ing countries, that helps many children.” cians and nurses in the burn unit at nearby Queen Elizabeth Central Hospital, and some morning rounds —Virginia Nelson, regarding her work in Africa with the pediatricians there. It’s very

32 Spring/Summer 2005 interesting. The surgeons did not recog- humanitarian aid throughout the world mud and broken both bones in her fore- nize cerebral palsy, or rickets. They’d since 1958. In 2003, a Toledo ortho- arm five days before we came,” recalls just say, ‘This kid has a crooked leg.’” paedic surgeon named Glenn Carlson Hershberger. “She took a bus for three and his wife, podiatrist Kim Carlson, hours and got dropped off at the clinic. had traveled to Danli, Honduras, as part We put pins and screws in her arm from t’s not only physicians who feel of the program and performed 19 opera- donated kits and were able to put her called to help and heal thousands of tions in one hectic week. The couple was arm back together.” miles from home. In 2004, four ready to return to Honduras but needed In one week, the team saw over 200 Holden Neonatal Intensive Care a nursing staff. Hershberger and her patients and performed five surgeries. Unit (NICU) nurses traveled to a I coworkers signed on and spent months They gave out back braces, vitamins and small town in Honduras, and they came raising the funds to go. In August of last antibiotics — and delivered hundreds of back changed and charged. year, the team arrived in Danli and plastic buckets filled with food through- Nurse Brenda Hershberger learned of an almost immediately the tiny Clinicas San out the town and outlying areas. But for Ohio-based relief organization called Lucas was mobbed with people. every patient they were able to help, International Services of Hope/Impact “One of the patients was 19, a single there were many more they could not, which has sponsored medical and mother of two who had slipped in the given the limitations of time and equip- ment. Then they met four-month-old Photo: Martin Vloet Martin Photo: “I watched those doctors as they just ran from patient to patient and I thought, ‘If we had just one more doc- tor, how many more we could see!’” —nurse Brenda Hershberger, who plans to pursue an M.D.

Arianna. “The child had total anom- alous pulmonary venous return,” says Hershberger, “an uncommon heart defect in which the blood vessels go to the left side of the heart instead of the right. Doctors in the capital had told the mother that her baby was going to die. She came to us hoping there was some- thing we could do. Well, we work with Dr. Bove!” Edward L. Bove, M.D. (Residencies 1977, 1979), the Helen F. and Marvin M. Kirsh Professor of Cardiac Surgery, head of the Section of Cardiac Surgery and director of the Pediatric Congenital Heart Program at C.S. Mott Children’s Hospital, is a Brenda Hershberger, R.N. (center), with two of the nurses who traveled to renowned pediatric cardiac surgeon and Honduras with her, Marie Ahkao, M.S.N., N.P.P.(right), and Tamara Christensen, an internationally recognized expert on hypoplastic left heart syndrome. ➤ R.N. (left)

Medicine at Michigan 33 Photo: Courtesy Nick Boulis Photo: Courtesy The nurses got busy slicing through the “tons of red tape” that prevented the child from leaving Honduras. They committed to raise $10,000 if the U-M would cover the rest of the cost of Arianna’s surgery. Back in Michigan, they raised funds aggressively. And, in late December 2004, mother and child arrived in Ann Arbor where Bove and assistant professor of cardiac sur- gery Richard G. Ohye, M.D., repaired Arianna’s heart. Two weeks later, the infant was back home and doing well. Hershberger says she’s a different person from the one who first arrived in Honduras. The 43-year-old mother — and grandmother — is took her MCAT boards in April. “I want to go to medical school,” she says. “I watched those doc- tors as they just ran from patient to patient and I thought, ‘If we had just one more doctor, how many more we could see!’” The Holden NICU nurses are heading back to Danli later this year. Nick Boulis with 3-and-a-half-month-old Guatemalan patient Bryan and Bryan’s mother. Bryan underwent surgery to repair a congenital skull abnormality. he rate of spina bifida and other neural tube disorders in Guatemala is the highest in the world, according to the International Federation for T The answer came to him in the form of reached a conclusion that yes, this was Spina Bifida and Hydrocephalus. While there is a clear genetic basis for this, Kathy Kentala, then a U-M trauma something we wanted to do and that it another factor is believed to be the nurse. Kentala had worked with a relief was absolutely an ethical thing to do.” organization called Healing the prevalence of fumonisin, a toxin caused Ethical? In fact, the debate about the Children, which has branches in 14 by corn mold. When ingested, fumonisin appropriateness of such expeditions has states. She asked Boulis if he was inter- builds up in the body and blocks the only recently died down. “Is it ethical to ested in going to Latin America to work absorption of folic acid — critical to go there and implant a ventricular peri- on hydrocephalus cases. fetal development. In countries like toneal shunt and then leave?” muses Guatemala, where poverty is rampant, “I said, ‘absolutely,’” says Boulis, who Boulis rhetorically. The availability of corn is often improperly stored, grows today serves as associate staff physician follow-up care, which patients receive moldy, and is eaten by people for whom for the Center for Neurological treatment and which do not, the eco- the concept of wasting food is incom- Restoration at the Cleveland Clinic. “I nomic impact of the program, the safety prehensible. The U-M’s Project Shunt began long term work with Healing the of relief workers in areas of instability — was created to help Guatemalan babies Children. I raised money for a fact-find- these issues and more have demanded and children born with neural tube ing mission, to see if this was even feasi- discussion. “Whenever we as a First defects. ble. I got $3,000 from Elekta and Cordis World country intervene in the Third In 1997, Nick Boulis (Residencies 1995 — neurosurgery device companies — World, we have to ask ‘Can we do this in and 2001) was a U-M neurosurgery res- and arranged to fly to Guatemala to a culturally sensitive fashion?’ Instead of ident trying to figure out how to link his hook up with the Pediatric Foundation going there and saying, ‘Gosh, we’re passions for medicine, health and of Guatemala. I spent a week evaluating from the U.S. and we’re going to fix human rights. After graduating from patients in the foundation clinic — everything for you.’” mostly kids with neural tube defects Yale in 1988, and before entering Boulis returned to Ann Arbor and began (hydrocephalus, spina bifida and teth- Harvard Medical School, he had done to “beg, borrow or steal” for the trip to ered cord syndrome).” An anesthesiol- human rights work in Haiti and relief Guatemala. “All we would have there ogy resident and operating room nurse health care in Nicaragua, Costa Rica, was a ward,” he recalls. “A room with a joined him to tour local hospitals where and the Dominican Republic. He recalls, table, and maybe a light. Shunts, gauze, the foundation had hosted missions in “I had always wanted to do relief work saline solutions, cautery, sutures, suction the past, to determine what would be in Latin America, but I didn’t know how instruments, the equipment to sterilize — to do it as a neurosurgeon.” needed to deliver quality care. “We all

34 Spring/Summer 2005 Photo: Courtesy Karin Muraszko Photo: Courtesy

“The mothers come to you off the backs of trucks having ridden down moun- tains, carrying their children, smelling like wood smoke.” —Nick Boulis, who founded Project Shunt as a U-M resident

Three women look on from a boat in the lake district in Guatemala, where Muraszko’s team traveled on one of their missions. none of that existed, or we couldn’t In 1998, the physicians of Project Shunt and a vague idea, it makes me so proud. count on it.” Medical supply and shunt performed 18 surgeries in Guatemala, It rejuvenates my spirit and makes me companies agreed to donate equipment with no mortalities. Says Boulis, “The glad to be a doctor,” says Boulis. and shunts. Boulis learned that the mothers come to you off the backs of Detroit Veterans Administration had trucks having ridden down mountains, Still primarily a resident-organized effort, closed its Allen Park hospital and the carrying their children, smelling like the scope of Project Shunt has grown building was abandoned with all its wood smoke. When we first got there, under Muraszko’s watch. In addition to equipment intact. With permission to they lit fireworks and gave us a standing the surgical component — nearly 200 take whatever he needed, he loaded it all ovation. People had been waiting all operations since the project started — the into his Chevy Blazer and stored it in his night for us to arrive. We operated non- team distributes vitamins for at-risk basement. At the end of the year, his stop, ate and slept very little. mothers and works closely with local basement was filled with surgical equip- physicians and surgeons. “We’ve trained “It was one of the most powerful experi- ment which Healing the Children then and helped to train some pediatric general shipped to Guatemala. ences we had ever had.” surgeons so they can take care of these Boulis left Michigan in 2001, but contin- kids,” says Muraszko. “The foundation Early on, Boulis asked Karin Muraszko, now has a surgeon who can do some of M.D., now chair of the Department of ues his involvement with Project Shunt. “Every year it becomes harder to find these procedures. We spend time educat- Neurosurgery, to lead the medical team. ing their nurses, doctors and pediatri- Muraszko said yes. “She trusted this the time, but when I get down there I realize that it’s the most important part cians. We give lectures. And we work very midlevel resident and was willing to go hard with industry vendors to provide to a country where war had just ended of my career. When I think that it started them with supplies — suture ➤ two years before!” with donated equipment in my basement

Medicine at Michigan 35 Photo: Courtesy Brenda HershbergerPhoto: Courtesy Photo: Courtesy Nelson Virginia

A garbage dump in Danli, Honduras, where the poor went to look for food. Brenda Hershberger’s team provided the locals with white 5-gallon buckets (shown) containing corn, dehydrated barley soup, or dehydrated chicken/rice meal. Photo: Courtesy Nick Boulis Photo: Courtesy

Mothers hold their children tight as they wait to be seen by doctors at the CURE Bethany Crippled Children’s Centre of Kenya, where Virginia Nelson practiced in February 2003. The porch functions as a waiting room for the clinic, which was held in a cramped room in an abandoned hospital with one light bulb and no running water. Nelson eventually started seeing patients on this porch, where there was more room and better light.

Angel, a patient of Nick Boulis’ in Guatemala, Photo: Courtesy Susan Photo: Courtesy Thoms rests in his hospital bed. Photo: Courtesy Susan Photo: Courtesy Thoms

Theresa Nairus and Susan Thoms take a much- deserved break from their clinical duties in Mongolia.

See more photos at www.medicineatmichigan.org/magazine. Theresa Nairus screens an ophthalmology patient in Mongolia.

36 Spring/Summer 2005 Photo: Courtesy Karin Muraszko Photo: Courtesy

“Almost everyone who has been on this trip has come away with the same reaction,” says Muraszko. “You remember why you’re a doctor.”

Karin Muraszko with a patient in Guatemala materials, antibiotics, ointments, dress- instructor in neurosurgery, are currently humble tools and grow their own food ings and shunt materials. These are the key fund-raisers for the project. “I — people who love their kids and would extremely expensive.” don’t accept honoraria for lectures,” she do anything for them. On these missions, says. “Instead, I just put them into they meet in the middle and everybody But, she adds, the educational compo- Project Shunt.” Each year, she adds, the wins. nent of the mission goes both ways. team brings back goods from Guatemala “Almost everyone who has been on this and sells them to raise money. Bake sales “Three neurosurgery residents go down trip has come away with the same reac- help, as do contributions from others in each year with graded levels of responsi- tion,” says Muraszko. “You remember Muraszko’s department and elsewhere in bility. It’s a wonderful educational expe- why you’re a doctor.” rience — they’re seeing a very complex the Health System. spinal anomaly.” And, Muraszko adds, the profound limitations of the facilities force these young doctors to look at here’s something almost medicine in a new way. “What do they miraculously unifying about really need to get an operation done? these missions. On one side: Five thousand things? Or can you do a some of the world’s top physi- safe operation with less?” Tcians — people with years of expensive education and experience, In the United States, the surgeries the people comfortable with the most team does in one week would total, advanced medical technology and Muraszko estimates, between $2-3 mil- familiar with the latest research, people lion. Yet the price tag for sending some of who love their kids and would do any- the world’s top doctors and nurses thou- thing for them. On the other side: peo- sands of miles to operate on some of the ple with little more than the clothes world’s poorest — and most desperately they’re wearing, people for whom any ill — children, totals not quite $30,000. education at all is deemed a valued Muraszko and Suresh Ramnath, clinical prize, people who work with simple,

Medicine at Michigan 37 Medicine at Michigan 39 “When immune systems go awry, virtu- ally without exception the problem begins with the triggering of a strong inflammatory response,” Ward says. “All autoimmune diseases — such as rheumatoid arthritis, psoriasis, lupus or multiple sclerosis — are diseases in which the inflammatory response is unregulated, excessive and out of con- trol. So understanding the inflammatory system from A to Z will have huge appli- cations in any number of diseases or clinical situations.” Over six feet tall with the posture and presence of a military officer, Ward is a distinguished looking gentleman who always wears a dress shirt and tie under his freshly pressed white lab coat. Not one for rash statements or hyperbole, Ward is as precise and methodical when talking about his research as he is doing the work itself. Peter Ward’s fascination with inflamma- tion began more than 45 years ago while he was a student at the U-M Medical School. During a two-year research fel- lowship at California’s Scripps Institute, then five years of service in the U.S. Medical Corps and nearly 10 years as head of pathology for the University of Connecticut Health Center, Ward con- centrated on learning how acute inflam- mation affects the lung. Ward says he focused on inflammation in the lung because so little was known Peter Ward about what caused it or how to treat it effectively. While at the University of Connecticut in the 1970s, Ward made Mediating the many important contributions to the inflammatory frenzy ins, microbes or damaged tissue and field, including developing animal models broadcast biochemical “SOS” signals with injuries that trigger an inflammatory The inflammatory response has one all- calling for reinforcements. Complement response. Many of these models are still important goal: respond immediately to proteins join the fray triggering the pro- used in research by scientists today. In detect and destroy infection or toxic duction of powerful, pro-inflammatory addition, Ward published hundreds of material in damaged tissue before it can molecules and tissue-destroying enzymes. papers describing how substances pro- spread to other areas of the body. In its This intensifies the response and causes duced by immune cells called macro- zeal to protect the body, it will destroy as inflammation to spread to surrounding phages and neutrophils contribute to lung much tissue as necessary to accomplish tissue. Once activated, the feeding frenzy damage during an inflammatory attack. this goal. Left unchecked, a hyperactive will continue until the immune system inflammatory response can even react to sends an all-clear signal to indicate that In 1980, Ward returned to the U-M to the traumatic effects of accidents, burns the crisis is over. become professor and chair of the or surgery on the body and start attack- Medical School’s Department of ing healthy tissue. One of the most important discoveries Pathology, serving also as interim dean made by Ward and other scientists over from 1983 to 1985. Since then, he has Like everything else in the human the last 20 years has been the identifica- continued his focus on inflammation in immune system, the inflammatory tion of a network of natural anti-inflam- the lung, especially the importance of response is controlled by an incredibly matory mediators, produced by the messenger molecules called cytokines complicated communications network immune system to offset activity of pro- and chemokines, and the complement made up of multiple cells, cascading sig- inflammatory agents. This network of system — a group of about 25 related nal pathways and feedback loops. It “chill out” signals keeps inflammation proteins that patrol the bloodstream starts when scavenger cells called neu- focused on the area of local infection or ready to assist or “complement” the trophils arrive at the site of injury or injury, and prevents a runaway response immune response. infection. They surround and engulf tox- that can spread through the body. ➤

40 Spring/Summer 2005 Image: Courtesy Peter Ward Courtesy Peter Image:

In the normal lung (left), very thin walls in the upper and lower airways allow the normal exchange of gases between blood vessels and the airspace. The diseased lung (right) shows pathological changes. Upper airway diseases, like asthma, produce an influx of inflammatory cells, increased fibrosis and constriction of the bronchiolar airways. In lower airway diseases, such as interstitial pulmonary fibrosis, fibroblasts and mononuclear inflammatory cells lead to collagen deposits and a thickening of the lung walls.

Medicine at Michigan 41 “When you trigger an inflammatory them with scar tissue. Both the cause and future therapies to prevent the damage response, two types of mediators are pro- a cure for pulmonary fibrosis are that occurs from infection, especially duced,” Ward explains. “Some are strong unknown, and 40,000 people die from during sepsis.” pro-inflammatory mediators, while oth- its effects every year. Even though it’s a major killer, doctors ers tend to suppress or balance the inflam- According to Stewart C. Wang, M.D., know little about what triggers sepsis matory process. Most of our work has Ph.D., an associate professor of surgery and even less about how to treat it suc- involved acute inflammatory responses in in the Medical School who treats criti- cessfully. Patients at highest risk are the lung, but we don’t believe pathways cally ill patients in the U-M Trauma/Burn those recovering from traumatic injuries of inflammation in the lung are unique. Center, the lung also is particularly vul- or surgery, and those with serious infec- So learning more about these natural anti- nerable to collateral damage from the tions or chronic diseases. Unless it’s inflammatory agents should provide immune system’s attempts to fight infec- caught early, sepsis can kill a formerly information that can be applied to many tion elsewhere in the body. healthy adult in just a few days. situations where you hope to suppress the inflammatory response.” “The lung is such a vital organ, and it “Essentially, it’s a waiting game,” says must function at high capacity at all Ward. “There is no diagnostic test and Out-of-control inflammation has differ- times. As you get sicker, your body has only one drug approved for treatment of ent effects on different types of tissue. In to work harder, which means the lung patients with severe sepsis. All we can do the respiratory system, these effects can has to work harder to provide more oxy- is give broad-spectrum antibiotics with be disabling, as is often the case with gen,” Wang explains. “Also, because all traditional supportive therapy, and hope it asthma; or lethal, as in chronic obstruc- blood passes through the lung, it’s doesn’t progress to the stage where organs tive pulmonary disease. COPD, which exposed continually to inflammatory start to shut down. If you’re still alive after includes emphysema and chronic bron- signals carried in blood from other parts 28 days, you’ll probably be OK.” chitis, is caused by an inflammatory of the body. This makes the lung espe- reaction which modifies the upper air- cially prone to damage from sepsis, Four years ago, Ward expanded his ways and makes it difficult to breathe. which can lead to acute lung failure.” research on the inflammatory response

THE INFLAMMATORY SYSTEM IS SO COMPLEX THAT PETER WARD BELIEVES IT COULD TAKE A DECADE OR MORE OF INTENSIVE RESEARCH BEFORE SCIENTISTS UNDERSTAND EXACTLY HOW IT WORKS.

According to a 2001 study conducted by The enigma of sepsis to include what he calls “the enigma of sepsis.” Since then, he has discovered the National Heart, Lung and Blood Sepsis is the most dramatic example of that the complement system in labora- Institute, more than 12 million Ameri- what can happen to the human body tory rats with sepsis is hyperactive, and cans ages 25 and older have been diag- when it is attacked by an out-of-control the rats have abnormally high amounts nosed with COPD and as many as 24 inflammatory response. In the United of a pro-inflammatory protein called million show signs of impaired lung States this year, more than 600,000 C5a in their bloodstream. When the ani- function. It is the fourth leading cause of Americans will experience the deadly mals are given drugs to block C5a’s death in the United States. combination of symptoms — high fever, effects, their survival rates improve sub- elevated white blood cell count, rapid “Patients with COPD typically have a stantially. slow, progressive loss of pulmonary heartbeat, falling blood pressure and function over a period of many years,” confusion — that physicians call sepsis. “C5a is an intriguing protein,” Ward Ward says. “It’s been linked to smoking Even with the best possible intensive says. “It’s vital to the immune system’s and industrial air pollution. COPD is care, mortality from the most severe ability to fight infection in tissue, but if it difficult to treat because, for reasons we forms of sepsis can be as high as 40 per- starts cascading out of control and enters don’t understand, patients don’t respond cent. Sepsis kills more people each year the bloodstream, it’s an indication that to the anti-inflammatory effects of than breast cancer and prostate cancer bad things are going to happen.” combined. steroid drugs like cortisol. Non-steroidal In recent research, Ward and his team anti-inflammatory drugs treat symp- “The key is to detect sepsis early, before discovered that, once C5a is in the blood- toms, but do little to stop the progressive the infection gets out of control,” says stream, it blocks all the receptors on cir- tissue destruction.” Wang. “We need to figure out ways to culating neutrophils — preventing them Then there’s idiopathic pulmonary fibro- treat the complications of sepsis to from attacking invading bacteria and sis — another group of progressive lung reduce the mortality rate. That’s what is effectively paralyzing the immune diseases, in which inflammation slowly so promising about the work Dr. Ward is response. destroys air sacs in the lung and replaces doing. His research is giving us potential

42 Spring/Summer 2005 tory drug, which works by preventing the biological function of tumor necrosis fac- tor (TNF) — an important pro-inflam- matory molecule. When TNF binds to immune cells, it triggers the inflammatory response. Ward says these drugs reduce symptoms and can be effective, especially in rheumatoid arthritis, but their cost per patient ranges from $12,000 to $20,000 each year. “So here we are, 50 years after the anti- inflammatory effects of steroids were discovered, and there’s still no new pow- erful, reasonably priced drug that can be used across the board for these inflam- matory diseases,” Ward says. “It’s a real dilemma. There are serious questions about where the pharmaceutical indus- try will go from here in relation to anti- inflammatory drugs.” According to Ward, the pharmaceutical industry has traditionally developed drugs that interfere with the immune system’s pro-inflammatory pathway by binding to a cell receptor or blocking the actions of specific proteins or signaling molecules. He suggests it may be time for a different approach. “We need to explore novel strategies using nature’s own inflammatory regula- tory apparatus,” Ward says. “This Stewart Wang means concentrating on finding media- tors with anti-inflammatory effects.” The trick to Ward’s approach is figuring out how to turn on genes that control “We hope to find a way to block the generalized anti-inflammatory effects, production of these anti-inflammatory activity of C5a in animals with sepsis,” were developed in the 1950s. molecules. Right now, he has hopes for a Ward says. “If we are successful, it could protein called Stat3. Stat3 has a strong In the 1990s, several new anti-inflam- be an effective therapeutic intervention in anti-inflammatory effect, and scientists matory drugs called COX-2 inhibitors, humans. We also are investigating how to in Ward’s lab have shown that it reduces which are sold under trade names like measure the C5a receptor content of neu- tissue damage in rats with acute lung Celebrex, Bextra and Vioxx, were trophils. This could be the basis of an injuries. approved by the Food and Drug early diagnostic test for sepsis to help Administration. They were hailed as physicians identify patients who need miracle drugs for the treatment of immediate aggressive treatment.” ltimately, Ward believes the chronic inflammatory diseases, because answer to controlling inflam- they don’t irritate the stomach lining, The pharmaceutical mation’s dark side will be like aspirin or other NSAIDs often do. approach found in basic scientific “NSAIDs are effective at treating symp- research conducted jointly by Considering the number of people U toms, but we’ve learned they don’t have scientists from academic and corporate affected by inflammatory diseases, it’s much ability to suppress the inflamma- research laboratories. The inflammatory surprising that few new pharmaceutical tory response. The disease continues to system is so complex that Ward believes drugs have been developed to treat these progress,” says Ward. “Steroids are very it could take a decade or more of inten- medical conditions. The mainstays of effective, but they have serious side sive research before scientists under- treatment are still corticosteroids, effects. And long-term use of COX-2 stand exactly how it works. aspirin and non-steroidal anti-inflam- inhibitors is now associated with a matory drugs (NSAIDs) like ibruprofen. “It’s just like investing in the stock higher risk of strokes and heart attacks.” Aspirin’s anti-inflammatory properties market,” he says. “You can’t look for were discovered in the early 1900s. Recently, pharmaceutical companies short-term returns. It’s a long-term Steroids, the first class of drugs with introduced a new type of anti-inflamma- investment.”

Medicine at Michigan 43 By Sally Pobojewski ● Photos by Martin Vloet

In Support of Medical Research with Human Embryonic Stem Cells AN INTERVIEW WITH ROBERT KELCH

ety be appropriately very skeptical ini- n his roles as the University of Michigan executive vice president tially. I think if we can work together to for medical affairs and CEO of the U-M Health System, and as a really understand this complex topic and its potential, we will reach a consensus physician and scientist, Robert P. Kelch (M.D. 1967, Residency to move forward in a safe manner. 1970) has carefully considered the topic of human embryonic What have you found to be the Istem cell use in medical research from many perspectives. As the biggest misconception people debate intensifies at the state and national levels, Kelch shares his have about human embryonic stem cells? views and explains why he’s arrived at the conclusions he holds. First of all, a lot of people simply don’t understand the terminology. I find that it takes at least a half-hour to an hour to explain this complex subject, so if any- Why is it important to talk about within my imagination that we can have, one thinks you can do it in a 30-second research with human embryonic for certain diseases, much more effective sound bite, beware. And if you hear slo- stem cells? treatments in a reasonable period of gans designed to cause an emotional time, if we enhance our ability to do Research with human embryonic stem reaction, beware. It’s much more com- embryonic stem cell research now. cells raises important, complex and sen- plicated than you can convey with the sitive questions that should be consid- I ask people to imagine a woman in usual mass media messages. ered carefully and discussed widely. It is Michigan who has a disorder that could a particularly important issue for us at be cured with a cell line that is geneti- If you believe human life begins the U-M Health System, because several cally identical to her own body. Let’s say at conception, the destruction of of our scientists are studying human she is paralyzed, and these cells could be an embryo to create a new cell embryonic stem cells. Everyone has an differentiated into motor neurons for line is very troubling. How do obligation to learn the facts about this transplant into her spinal cord, which important social and scientific issue, so might allow her to walk again. you respond to this objection to they can make an informed decision. the research? Under current Michigan law, she would I know there are people who, because of Why are you so excited about the not have the right — in fact, it would be their moral, ethical, religious or philo- illegal — for her to use one of her sophical beliefs, believe that a human life potential for this type of research? ovaries — or implant the nucleus from I think about the therapeutic potential begins the moment an egg is fertilized in one of her skin cells into one of her egg the Fallopian tube, which occurs several for treating disorders like diabetes, cells, or into an embryonic stem cell — Alzheimer’s disease, Parkinson’s disease days before it implants in a woman’s to create this cell line. She would be uterus. I respect their position and or ALS. I’ve been in science long enough totally denied that opportunity. to know that sometimes we get so beliefs. And I don’t disagree that this excited we over-promise. But I am very During my 40-plus years in medicine early stage of development, which we excited about this, and I am, by nature, a and science, I’ve seen some of the most call a blastocyst, has the potential for pretty cautious guy. It is certainly well startling discoveries, and I’ve seen soci- human life.

44 Spring/Summer 2005 “I think if we can work together to really understand this complex topic and its potential, we will reach a consensus to move forward in a safe manner.”

But I disagree about what we ought to call them, which were created for in-vitro gated, for the sake of the greater good, to do with these very early products of con- fertilization. They are going to be dis- try to take advantage of this potential by ception, especially if they are not going carded by people who no longer have a allowing scientists, under strict ethical to serve a useful purpose. What do I need or the desire to implant them into guidelines, to use these frozen embryos mean by that? I’m talking about literally either their own uterus or someone else’s to propagate new human embryonic hundreds of thousands of frozen blasto- uterus. These discarded embryos have stem cell lines. And, of course, we would cysts or early embryos, as some would tremendous potential. I feel morally obli- like to do that here. ➤

Medicine at Michigan 45 “It’s inconsis- tent to say we have aspira- tions of becoming a leading state in life sciences research, and then prohibit the develop- ment of new lines of human embryonic stem cells.”

What we would like to do is take these to me is very meaningful. Let’s say a cou- adoption, or because they have an very early products of conception, ple is going through in-vitro fertilization, abnormality. Both types have a useful before the implantation phase, and but they want the early blastocyst to be purpose, if studied ethically — and they propagate cells from them in ways that tested for a genetic disease like Tay- would be studied ethically — by good will not stimulate them to develop into Sachs disease, for example. scientists. implantable embryos. We are trying to generate therapeutic cell lines of embry- We can do that now. We can take one lit- Why is it so important to the onic cells with all this broad potential, tle cell out of the blastocyst to make that diagnosis. If we could use genetically future of the university, the but do it in a way that creates cell lines Health System and the state of and not embryos. abnormal embryos to produce a stem cell line for research on Tay-Sachs dis- Michigan to have more embry- Embryonic stem cells give us the oppor- ease, we might learn how to correct the onic stem cell research here? tunity to study, at the earliest stage, dis- genetic defect. One reason is that we have a remarkable orders caused by a specific gene defect to Most embryos are discarded simply group of scientists working in the area of see if we could find a way to cure the dis- stem cell or developmental biology. We ease. Let’s take another example, which because they are no longer needed and people do not want to put them up for were one of the first of three federally

46 Spring/Summer 2005 funded human embryonic stem cell tilization clinics? As opposed to about extrapolating from other species research centers. It is just logical for us South Korean scientists who have to man, because we are much more com- to want to expand our work and pro- created new embryos using donated plicated, but we know it can be done. ductivity and not be restricted to a human eggs. This is not Star Wars research. greater degree than our peer institutions. [The South Korean research] troubles Second, we have the ability now to gen- me to some degree. First of all, there’s erate new stem cell lines and that is a really no need to do that in America, if tremendous step forward. But current we agree to use discarded embryos from The following Web sites contain laws make it impossible to do this in the fertility clinics, because there are so additional information about state of Michigan. This gives Michigan a many of them. Estimates indicate there national reputation of being a place that are 300,000 to 400,000 excess frozen stem cells: is less supportive of science. That makes embryos in fertility clinics. That’s more www.med.umich.edu/opm/ it more difficult to recruit and retain than enough to meet our needs. newspage/2005/stemcellqa.htm the best and brightest scientists and http://stemcells.nih.gov students. I think it would be highly unethical to recruit someone, pay someone, or give www.medicineatmichigan.org/ It’s inconsistent to say we have aspira- them financial incentives to donate an magazine/2002/winter/stemcell tions of becoming a leading state in life egg. That would trouble me greatly. On sciences research, and then prohibit the the other hand, if a woman wants to www.umich.edu/news/ development of new lines of human donate her own egg, or donate an egg to index.html?BG/stem_cells embryonic stem cells. We are being someone who is genetically related to viewed as a state with very restrictive her, that’s something for us to discuss. rules that is less supportive of science Personally, I don’t find that unethical. and scientists than other states. It’s important to keep in mind that soci- Why not just put more funding ety’s idea of ethical behavior does change over time. We are doing things into research with adult stem today that might have been considered cells? very unethical in the past, and we are We should put a lot of money into can- considering other things as we look to cer stem cells, cord blood stem cells, tis- the future. All the organ transplantation sue-specific [adult] stem cells, because we do now at one point in time was con- we are going to learn a lot from them. sidered unnatural and unethical. But everything we know — and we Donation of organs from a healthy per- know more today than we did just a few son to a person with an illness — all that years ago — indicates that tissue stem has evolved over time. When the tech- cells don’t have the potential of embry- niques for in-vitro fertilization were first onic stem cells. Remember an embryonic developed, many people considered it to stem cell has the amazing potential to be unethical. Now many of us, including give rise to all the tissues in the entire my own family, have been positively body. affected by that technology.

Are there areas of research that What area of medicine has the should legitimately remain off- greatest therapeutic potential for limits to scientists? human embryonic stem cell Yes. I’ve read a summary of the ethical research? guidelines recommended by the It’s hard to know where the first, most National Academy of Sciences. They dramatic, breakthrough will come. I sound very, very wise. Doing things in hope it comes for a disease like diabetes humans that we might do in animals mellitus, because it takes such a toll — would be unethical to me. Making what not only on the patient, but on their we call chimeras — mixing different families. We know it’s curable. We can genetic cell lines to develop an embryo cure it in inbred mice by transplanting with genetic backgrounds from different islet cells. We know it’s an autoimmune species. This is unethical when you are disease. So we know we need to have talking about human beings. Working islets that won’t be rejected by the host. on human embryos that are well beyond Another good example would be spinal the implantation phase is unethical. cord injuries. There are investigators in Do you agree that researchers California who have used stem cells to should be required to only use help rodents move better after spinal excess embryos from in-vitro fer- cord injuries. We have to be cautious

Medicine at Michigan 47 Photos by Paul Jaronski

The annual ritual of residency matching landed the U-M Medical School’s Class of 2005 at the following locations for the next stage of their training. This IT’S A MATCH! year’s Match Day event was held on March 17. MATCH DAY 2005

ANESTHESIOLOGY Eric Weaver Catherine Bluteau St. Joseph Regional Medical Center, University of Virginia, Charlottesville South Bend Matthew Charous McGaw Medical Center - Northwestern GENERAL SURGERY University, Chicago Ashley Agerson James Gephart Temple University Hospital, Philadelphia Mayo Graduate School of Medicine, Alexander Bondoc Rochester University Hospital, Cincinnati Mark Gjolaj David Costantino Stanford University Hospital and Clinics, Emory University School of Medicine, California Atlanta Patrick Guffey Kristopher Deatrick University of California - San Francisco University of Michigan Hospitals Bishr Haydar Catherine Lewis Massachusetts General Hospital, Boston University of California - Los Angeles Spencer Heaton Medical Center University of Michigan Hospitals Beth Narasimhan Daniel Johnson University of Vermont College of Medicine Massachusetts General Hospital, Boston Robyn Sackeyfio Hannah Kwon Emory University School of Medicine, University of California - San Francisco Atlanta Daniel LaValley Chad Stasik Duke University Medical Center, Durham Shands Hospital at the University of Clayton Smith Florida, Gainesville University of Wisconsin Hospital and Clinics, Madison INTERNAL MEDICINE Andrew Suh Carey Chicorel marks her match with the University of Chicago. Suma Amarnath New York Presbyterian Hospital, Cornell Boston University Medical Center University, New York City EMERGENCY MEDICINE Benjamin Tsai Maimonides Medical Center, Brooklyn Julia Becker January Tsai William Bagley Hospital of the University of University of Texas Medical School at St. Luke’s-Roosevelt Hospital Center, New Danielle Turner-Lawrence Pennsylvania, Philadelphia Houston York City Carolinas Medical Center, Charlotte Neel Chokshi Cynthia Woods Benjamin Bassin New York University School of Medicine Cleveland Clinic University Hospital, Cincinnati FAMILY PRACTICE Timothy Egan Lily Young Ian Butler Eric Becker New York Presbyterian Hospital, Columbia Emory University School of Medicine, Robert Wood Johnson Medical School, MidMichigan Medical Center, Midland University, New York City Atlanta Camden Candace Cato Jeremy Fields Lauren Butz Palmetto Richland Memorial Hospital, University of Iowa Hospitals and Clinics, DERMATOLOGY University of Alabama Hospital, Columbia, South Carolina Iowa City Birmingham Mohiba Khan Jennifer Dehlin Hemal Gada New York Presbyterian Hospital, Columbia Evelyn Chow Marquette General Hospital, Michigan Barnes-Jewish Hospital, Saint Louis Mount Sinai Hospital, New York City University, New York City James Dolan Rahwa Ghermay Katalin Kovalszki Gregory Folkert Sutter Medical Center, Santa Rosa Emory University School of Medicine, Barnes-Jewish Hospital, Saint Louis University of Michigan Hospitals Jennifer Manning Atlanta Heh Shin Kwak Senai Kidane Christ Hospital, Cincinnati Laura Heyns Alameda County Medical Center Stanford University Hospital and Clinics, Tania Martinez-Lemke Hospital of the University of California Daniel Korn University of Washington Affiliated Pennsylvania, Philadelphia Laurie Linden University of Michigan Hospitals Hospitals, Seattle Noa Holoshitz Henry Ford Health Sciences Center, Russell Rae Priya Pullukat New England Medical Center, Boston Detroit William Beaumont Hospitals, Michigan Tufts University Family Medical Residency, Christopher Howell Missale Mesfin Dorian Ramirez Boston University of Michigan Hospitals University of Michigan Hospitals Harbor-UCLA Medical Center Karen Saroki Jennifer Huang Asma Rafeeq David Somand University of North Carolina Hospital, McGaw Medical Center - Northwestern University of Michigan Hospitals University of Michigan Hospitals Chapel Hill University, Chicago Igor Siniakov Renee Theisen Sarah Vanston University of Michigan Hospitals University of Pittsburgh Medical Center Swedish Medical Center, Seattle

48 Spring/Summer 2005 Jocelyn Kim Kara Markham William Johnson Danna Gunderson Johns Hopkins Hospital, Baltimore Ohio State University Medical Center, University of Chicago Hospital University of Colorado School of Melissa Kovach Columbus Philip Zald Medicine, Denver University of Michigan Hospitals Kirsten Salmeen Oregon Health & Science University Sarah Holloway Keith Leung University of Michigan Hospitals Duke University Medical Center, Durham University of Pittsburgh Medical Center David Starks PATHOLOGY Yasmin Khan Keith Naylor Case Western Reserve University - University of Minnesota Medical School, University Hospitals of Cleveland Brian Bolton Minneapolis University of Chicago Hospital McGaw Medical Center - Northwestern Heather Osborn Bo Yu University, Chicago Yogangi Malhotra University of Iowa Hospitals and Clinics, Long Island Jewish Medical Center, New University of Rochester - Strong Memorial York John Miedler Hospital, New York Iowa City University Hospital of Cleveland John Piersma Emily Yu Monica Montemayor University of California - San Francisco Bret Mobley University of Michigan Hospitals University of Michigan Hospitals Stanford University Hospital and Clinics, Monica Prasad California Christina Olson Naval Medical Center, San Diego University of Michigan Hospitals OPHTHALMOLOGY Michael Roh Jason Rytlewski John Cropsey Brigham & Women’s Hospital, Boston Kurt Schumacher University of Texas Southwest Medical Wills Eye Institute, Philadelphia University of North Carolina Hospitals, Woojin Yu Chapel Hill School, Dallas Mark Dacey New York Presbyterian Hospital, Columbia Porama Thanaporn University of Texas Southwestern, Dallas University, New York City Kelly Walkovich Children’s Hospital of Philadelphia Emory University School of Medicine, Katherine Danek Atlanta Katherine Wang Cook County John H. Stroger Hospital, PEDIATRICS Kambiz Vahabzadeh Chicago University Hospital of Cleveland Cedars-Sinai Medical Center, Los Angeles Dana Aronson Roheena Kamyar University of Chicago Hospital University of Michigan Hospitals PHYSICAL MEDICINE & Sarah Balck REHABILITATION MEDICINE – PEDIATRICS Jesse McKey University of Texas Southwest Medical Amy Hepper Wills Eye Institute, Philadelphia School, Dallas Alice Han University of Michigan Hospitals Daniel Owens Stanford University Hospital and Clinics, Katherine Bates California Terry Platchek Loyola University/Hines VA Hospital, University of Michigan Hospitals Illinois University of Michigan Hospitals Carey Chicorel Heather Wolfe James Paauw University of Chicago Hospital PLASTIC SURGERY Texas A&M University - Scott & White Ohio State University Medical Center, Natalie Davis Robert Maniker Columbus Regional Health Sciences Education University of Michigan Hospitals Center, Temple University of California - San Francisco Andrew Watt Cynthia Puro Joshua Friedland-Little MEDICINE – PRIMARY University of Chicago Hospital Stanford University Hospital and Clinics, University of Miami - Bascom Palmer Eye California ➤ Quinn Pack Institute Michael Ginsberg University of Wisconsin Hospital and David Wu Albert Einstein College of Medicine - Clinics, Madison University of Michigan Hospitals Jacobi Medical Center, New York City Sarita Warrier Rhode Island Hospital - Brown University, Providence ORTHOPAEDIC SURGERY Victor Hakim Henry Ford Health Sciences Center, NEUROLOGICAL SURGERY Detroit Garni Barkhoudarian Seth Jerabek University of California - Los Angeles Massachusetts General Hospital, Boston Medical Center Robert Kohen Danny Fahim University of Michigan Hospitals Baylor College of Medicine, Houston Jeffrey Krempec Eric Peterson Carolinas Medical Center, Charlotte University of Washington Affiliated Hospitals, Seattle Scott O’Neal Jackson Memorial Hospital, Florida Mahesh Shenai University of Alabama Hospital, Rajiv Rajani Birmingham Emory University School of Medicine, Atlanta NEUROLOGY OTOLARYNGOLOGY Leo Chen University of California - Los Angeles Audrey Baker Medical Center University of Michigan Hospitals Jason Bloom Hospital of the University of OBSTETRICS – GYNECOLOGY Pennsylvania, Philadelphia Sheila Krishnan Cameron Budenz Beth Israel Deaconess Medical Center, New York University School of Medicine Boston Andrew Heaford Jennifer Mankowski University of Iowa Hospitals and Clinics, University of California - San Diego Iowa City Keith Naylor: “University of Chicago Hospital!” Medical Center

Medicine at Michigan 49 MATCH DAY 2005

PSYCHIATRY Charles Ashbrook University of California - San Diego Medical Center Lindsay Boynton New York Presbyterian Hospital, Columbia University, New York City Paul Dellemonache Brown University Psychiatric Residency, Providence Philip Saragoza University of Michigan Hospitals Srijan Sen Yale-New Haven Hospital, Connecticut

RADIATION – ONCOLOGY Siavash Jabbari University of California - San Francisco Philip Schaner University of Alabama Hospital, Birmingham

RADIOLOGY – DIAGNOSTIC Michael Fatt Johns Hopkins Hospital, Baltimore Jaime Grimley Virginia Mason Hospital, Seattle Anastasia Hryhorczuk University of Michigan Hospitals Cynthia Puro and guest. Puro matched with the University of Miami Bascom Palmer Eye Institute. David Karow University of California - San Diego Medical Center Kenneth Meng University of California - Irvine Medical INCOMING RESIDENTS 2005 Center Bethany Niell The University of Michigan Health System welcomes the following residents from other medical schools Massachusetts General Hospital, Boston who begin their training at the U-M this year. Edward Oliver Hospital of the University of Pennsylvania, Philadelphia ANESTHESIOLOGY Carl Heine Roland Short III Habib Rahbar Sarabjit Bedi Creighton University School of Medicine University of Alabama School of Medicine University of Washington Affiliated University College of Medical Sciences, Paul Hilliard Ashish Sud Hospitals, Seattle Delhi, India Wright State University School of Wayne State University School of Minchul Shin Spencer Bertram Medicine Medicine Morristown Memorial Hospital, New Jersey Ross University, West Indies Nicole Jeffreys Alejandro Tapia Jonathan Walter Julia Caldwell University of Utah School of Medicine Universidad Central del Este, Dominican University of Alabama Hospital, University of Cincinnati College of Brian Kopitzki Republic Birmingham Medicine Michigan State University College of Jennifer Thomas-Goering Andrew Woodrow Trenton Davis Osteopathic Medicine University of Health Sciences College of University of Michigan Hospitals Ohio State University College of Medicine Joanna Kountanis Osteopathic Medicine, Kansas City Tara Doherty Wayne State University School of Medicine Victor Truong SURGERY – PRELIMINARY Lake Erie College of Osteopathic Medicine Mackenzie Kuhl Creighton University School of Medicine, Nebraska Raymond Bailie Michael Drelles Michigan State University College of University of Michigan Hospitals Michigan State University College of Osteopathic Medicine Jacob Waidelich Kunjan Bhakta Osteopathic Medicine Charles Liu University of Wisconsin Medical School University of Michigan Hospitals Arkadiy Dubovoy University of Utah School of Medicine Nicole Wilder Crimean Medical Institute, Ukraine Chhaya Patel University of California - San Diego School of Medicine TRANSITIONAL Douglas Fetterman Michigan State University College of Jared Blum State University of New York at Buffalo Human Medicine Brooke Army Medical Center, San Antonio School of Medicine Kellie Reading DERMATOLOGY Pankaj Guglani Michigan State University College of Evans Bailey UROLOGY St. Eustatius School of Medicine Human Medicine University of Alabama School of Medicine Emilie Johnson Razmig Haladjian Scott Russell University of Michigan Hospitals American University of Beirut, Lebanon Wayne State University School of Medicine

50 Spring/Summer 2005 INCOMING RESIDENTS 2005

EMERGENCY MEDICINE Ahsanuddin Ahmad Mark Gibbs Mark Naftanel John Burkhardt University of Medicine & Dentistry of New University of Pittsburgh School of Duke University School of Medicine Case Western Reserve University School Jersey - New Jersey Medical School Medicine Rebecca (Naglik) Northway of Medicine Sik Ang Salil Goorha Michigan State University College of Patrick Carter University College Dublin University of Tennessee Human Medicine Tufts University School of Medicine Haritha Avula Sarah Gualano Duyhuu Nguyen Kent Collin Andhra Medical College - University of University of Chicago Rush Medical College Albany Medical College Health Sciences, India Seth Hartung James Passinault Jennifer Frankel Dhiman Basu University of Minnesota - Minneapolis Loyola University, Chicago University of Connecticut School of Calcutta National Medical College School of Medicine Uday Paul Medicine John Betjemann Israel Hodish University of Illinois College of Medicine Samantha Hauff Albany Medical College Hebrew University Kristy Phillips University of Washington School of Ashish Bhimani Susan Hungness Wayne State University School of Medicine University of Chicago - Pritzker School of Rush Medical College Medicine Kurt Hessen Medicine Sucharit Joshi Robert L Pompa University of Minnesota - Minneapolis Abhay Bilolikar Mount Sinai School of Medicine of the Ohio State University College of Medicine School of Medicine Wayne State University School of Medicine City University of New York Michael Rajala Nada Khogali Thomas Boyden Robert Keeton Albert Einstein College of Medicine - Michigan State University College of Loyola University of Chicago Stritch University of Mississippi Yeshiva University Human Medicine School of Medicine Kian Keyashian Khairy Reed Ashley Kinsey Deborah Bradley University of California - San Francisco University of Jordan, Amman, Jordan University of Kansas School of Medicine University of Cincinnati School of Medicine Eric Rich Rockefeller Oteng Sanders Chae Gazala Khan University of Washington School of University of Cincinnati College of Harvard Medical School Kilpauk Medical College Medicine Medicine Paul Chan Edward Kim Nadia Robertson Rebecca Prepejchal Johns Hopkins University School of State University of New York Stony Brook Duke University School of Medicine Wayne State University School of Medicine School of Medicine Reena Salgia Medicine Tae-Hwa Chun Yanping Kong University of Chicago - Pritzker School of Brett Russell Kyoto University, Japan Hebei Medical College Medicine Loyola University of Chicago Stritch Candace Correa Yong Kwon Shelley Sanetti School of Medicine University of Pennsylvania School of University of Alabama School of Medicine The David Geffen School of Medicine at Melinda Turner Medicine Eric Langewisch UCLA Johns Hopkins University School of Cotant Casey University of Iowa College of Medicine Michael Savona Medicine University of Utah School of Medicine Allen Lee Wake Forest University School of Stephanie Davis New York Medical College Medicine FAMILY MEDICINE Baylor College of Medicine James Lin Alexis Shanahan Susan Bettcher Mitul Desai Vanderbilt University School of Medicine University of Washington School of Medicine Ohio State University Rush University Medical College Kenneth Lyn-Kew Andrea Breese Parimala Dommeti St. Louis University Pratima Sharma Wayne State University School of Medicine Andhra Medical College - University of University College of Medical Science, Anne Maliszewski Delhi, India Andrew LaFleur Health Sciences, India Michigan State University College of Michigan State University Badih Elmunzer Human Medicine Megan Shaughnessy University of Miami School of Medicine University of Minnesota - Minneapolis James Lim Aaron Mammoser School of Medicine Temple University Syed Fehmi State University of New York at Buffalo The Aga Khan University Medical College School of Medicine Rosemarie Shim Kassandra McGehee Ohio State University College of Medicine Wayne State University Joey Fernandez James Mangan and Public Health Tanika Pinn State University of New York at Brooklyn Temple University School of Medicine College of Medicine Hadas Shiran Brody School of Medicine at East Kristin Manteuffel Dartmouth Medical School Carolina University Bradley Fields Loyola University of Chicago Stritch Indiana University School of Medicine Heather Simpson Carla Recker Saint Louis University Health Sciences Medical College of Ohio Sameer Gafoor Matthew Moeller Center Margaret Riley Northwestern University - The Feinberg Saint Louis University Health Sciences School of Medicine Center Marvin Singh The David Geffen School of Medicine at Virginia Commonwealth University School UCLA Gabriel Galang Mohan Monika of Medicine Ohio State University College of Medicine Michigan State University John Stracks Gabe Solomon University of Chicago - Pritzker School of Tejal Gandhi Ana Montoya Wayne State University School of Medicine Medicine Northwestern University Universidad Nacional Mayor de San Marcos, Lima, Peru John Starling III Garth Garrison University of Tennessee Health Science INTERNAL MEDICINE University of Utah School of Medicine Jason Morda Center College of Medicine University of Virginia Zahra Afshari Natasha (Ghazi) Bagdasarian David Stephenson University of Illinois at Chicago College of Wayne State University School of Guy Mulligan Oregon Health Sciences University Medicine Medicine Medical College of Ohio School of Medicine ➤

Medicine at Michigan 51 INCOMING RESIDENTS 2005

Internal Medicine continued Rebecca Margulies Fauziyah Hassan PSYCHIATRY University of Washington Nalanda Medical College, India Sara Bobak Jennifer (Svoboda) Vredeveld Katie Toft David Jeong Wayne State University School of Medicine Medical College of Ohio University of Minnesota Carver College of Medicine Sara Dumas Christine Veenstra Shefali Karkare George Washington University School of Wayne State University School of LTM Medical College, India Medicine and Health Sciences Medicine OPHTHALMOLOGY Deborah Chong Katherine Kormanik Kalyani Gavini Terrence Welch University of Wisconsin University of Selesia, Poland Washington University School of Harvard University Medicine Paul Conrad Katrina Kotlyarevsky Bardia Gholami Case Western Reserve University Dnepropetrovsk State Medical Academy, Tehran University of Medical Sciences Madhuri Yagalla Ukraine Michigan State University Jared Parker Victor Hong University of Utah Amanda Long Loma Linda University School of Justin Yax Wayne State University Medicine Kirksville College of Osteopathic Garrett Scott Medicine University of Southern California Jeffrey Magee Sohail Makhdoom Washington University Dow Medical College Esther Yu Roslyn Stahl Medical College of Wisconsin State University of New York May Ling Mah Christina Mueller University of North Carolina University of Cincinnati College of Yevgeny Zolotarevsky Alexander Taich Medicine Wayne State University School of Medicine Case Western Reserve University School Anjali Pawar of Medicine Karnataka Medical College, India J. Richard Navarre Donna Zulman University of North Carolina The David Geffen School of Medicine at Kerri Randall Michigan State University Ahsan Nazeer UCLA PATHOLOGY Meredith Riebschleger Rawalpindi Medical College, Pakistan Bryan Coffing Drexel University Amit Patel NEUROLOGY Dartmouth Medical School Fozia Saleem-Rasheed Philadelphia College of Osteopathic Olga Bogdanova Jonathan Cutlan University of South Carolina Medicine Nizhny Novgorod State Medical Academy, Medical College of Wisconsin Vasilis Pozios Russia Sandhya Sasi Farnaz Hasteh Syracuse College of Medicine Tufts University School of Medicine Tiffany Braley Iran University of Medical Sciences Divy Ravindranath Wayne State University Kristin Schultz Julie Jorns-Grandzielwski Medical College of Wisconsin University of California - San Francisco Maureen Ceresney Medical College of Wisconsin School of Medicine University of British Columbia, Canada David Selewski Cohra Mankey Rush University Medical College Chandra Sripada Lisa Cook University of Texas Southwestern Medical University of Texas University of Illinois School at Dallas Christine Stahle Loyola University Chicago Stritch School Mustafa Warsi Mark Garwood Julianne Purdy of Medicine Baqai Medical College, Karachi, Pakistan Loyola University of Chicago Stritch University of Cincinnati College of David Williams School of Medicine Medicine Michelle Villarta Michigan State University University of Alabama School of Medicine Tariq Irfan Tarek Rahmeh Anthony Wolf Dow Medical College, Karachi, Pakistan Damascus University School of Medicine, Scott Walters Michigan State University Dartmouth Medical School David Kuhlmann Syria Lubna Warsi Michael Yoo Kansas University Lindsay Schmidt Wayne State University School of Medical College of Wisconsin Baqai Medical & Dental College, Karachi, Raj Kumar Pakistan Medicine Government Medical College, Jammu, India PEDIATRICS RADIOLOGY Purvi Saraiy Sana Ahmed PHYSICAL MEDICINE & B.J. Medical College, Ahmedabad, India Medical College of Ohio REHABILITATION Sameer Ahmad Ansari Jeremy Adler Zachary Abbott Jefferson Medical College of Thomas Mihai Teodorescu Jefferson University Carol Davila University, Bucharest, University of South Florida Touro University College of Osteopathic Romania Drew Ammons Medicine Jefferson Balin Rush Medical College Jackie Whitesell Emory University School of Medicine Rishi Bakshi Indiana University Brian Benneyworth Des Moines University Ryan Dvorak University of Tennessee Tony Boggess Creighton University School of Medicine OBSTETRICS – GYNECOLOGY Win Boon Chicago College of Osteopathic Medicine Leandro Espinosa Courtney Barr Wake Forest University School of Sarah Carter Stanford University School of Medicine University of Missouri Medicine University of Minnesota Aaron Friedkin Mitchell Berger Aghiad Chamdin Timothy Lavis Case Western Reserve University School University of Pennsylvania Damascus University School of Medicine, University of Texas, Southwestern of Medicine Shah Divya Syria Katerina Radkevich Carrie Hoff Columbia University Chad Connor Albert Einstein College of Medicine - Mayo Medical School Yeshiva University Aimee Eyvazzadeh Harvard University Tausha Hope University of California - Los Angeles James Galas Balaji Singaracharlu University of Utah School of Medicine Michigan State University Ryan Longman State University of New York Sadashiv Kamath Jefferson Medical College of Thomas Byron Garn Timothy Yoon Bangalore Medical College Jefferson University Medical College of Wisconsin Wayne State University

52 Spring/Summer 2005 INCOMING RESIDENTS 2005

David Lambert Anthony Charles Mark Lorenz Matthew Romano Boston University School of Medicine University of Lagos, Nigeria Ohio State University Loma Linda University Jacob Livermore Daniel DeUgarte Raymond Lynch Apurva Shah Wayne State University School of Medicine University of California - Los Angeles Yale University Columbia University College of Physicians Prakash Manoharan Arnold Etame Paul Maggio and Surgeons University of Bristol Carver College of Medicine University of New York at Buffalo Sean Skinner Tahir Mohamed Eric Ferguson Nicholas Makhoul Ross University, West Indies University of Khartoum, Sudan Medical College of Wisconsin McGill University Giselle Tan Waleska Pabon-Ramos Thomas Gernon Amit Mather University of Illinois Boston University School of Medicine University of Washington University of Florida Thomas Varghese Jr. James Shirley Amir Ghaferi Bret Mettler University of Kerala, India Wayne State University School of Johns Hopkins University School of University of South Dakota Wheat Jeffery Medicine Medicine Nicholas Osborne University of California - Los Angeles Levi Sokol Jeremiah Hayanga Dartmouth University Kevin Wilson Columbia University College of Physicians Royal College of Surgeons, Ireland Christopher Pannucci Washington University and Surgeons Kyros Ipaktchi Washington University Troy Wolter Justus Leibig Universitaet, Giessen, Walter Parker University of Minnesota SURGERY Germany University of Rochester John Ziewacz David Ashburn Benjamin Levi James Phillips Johns Hopkins University School of East Tennessee State University Northwestern University University of Oklahoma Medicine Michael Birman James Lindner Mary-Anne Purtill Baylor College of Medicine University of Pittsburgh University of California - Los Angeles

Members of the class of 2005 and their families gathered at the Four Points Sheraton in Ann Arbor to learn of their residency match fate.

See more photos from Match Day at www.medicineatmichigan.org/magazine.

Medicine at Michigan 53 FOCUS ONPHILANTHROPY

Diabetes’ Elusive Cure BILL AND DEE BREHM’S LANDMARK $44 MILLION GIFT WILL “ACCELERATE THE PACE”

hen will type 1 diabetes be cured?

For more than 80 years, Photo: D.C.Goings Wregular injections of insulin have made it possible for type 1 patients to cope with the disease. A few, like Dee Brehm of McLean, Virginia, have lived into their 70s with type 1 diabetes (formerly “juve- nile diabetes”) without developing the complications usually expected. How- ever, that’s very rare. Moreover, multiple insulin injections every day present the constant peril of unpredictable plum- meting of blood sugar level that can pro- duce dangerous insulin shock. While science and industry have introduced better tools to help patients control their blood sugar more comfortably, insulin is still the only therapy for type 1 diabetes. Science still does not know how to pre- vent or cure type 1 and its potentially devastating complications. Type 1 dia- betes thus remains a serious chronic dis- ease that challenges both the patient and every member of the patient’s family. Diabetes’ grim scenario has been for many decades the impetus for the search for prevention and cure, involving dedi- cated researchers around the world. Now, Dee Brehm and her husband, Bill, want to strengthen the work of those Bill and Dee Brehm researchers. Their $44 million gift to the University of Michigan Medical School to create a new center for type 1 research and analysis is aimed at accelerating the pace of type 1 diabetes research. Their “Start with the universe; connect the apparently gift is the largest in the school’s history unrelated facts; defy the conventional wisdom; and the second largest for the university. become curious,naive and courageous; Bill Brehm, a scientist himself, knows foster unity of thought,purpose and spirit.” full well that no one can schedule dis- covery. He also knows that the research —Bill Brehm pathways to a cure will have many branches and loops. However, it is clear

54 Spring/Summer 2005 that the search is also an administrative together to develop and discuss ways of to help inform and enhance the creative and business process that includes much accelerating the pace of the search for work of the researchers dedicated to this more than research, and Brehm is con- type 1 diabetes prevention and cure. mission. vinced that better understanding of that More than 90 participants from across Brehm also admonished the charrette process will reveal ways to quicken the the country gathered in Ann Arbor participants to approach their task with pace and lead to earlier translation of March 23-25 to generate and distill open minds: “Start with the universe; research results into effective and avail- guiding ideas. The meeting, held in a connect the apparently unrelated facts; able therapies. “charrette” interactive format, included defy the conventional wisdom; be curi- several of the nation’s top diabetes Born in Dearborn, Bill Brehm received ous, naive and courageous; and foster researchers as well as leaders from indus- his bachelor’s and master’s degrees from unity of thought, purpose and spirit. We try, information science, engineering, pri- the U-M, concentrating in math and must not allow this moment to be lost to vate and government funding entities, physics. In 1952 he began a career in the conventional wisdom.” patients, and the U-M faculty and senior advanced systems development in the management team. Together this group For Dee Brehm, an Ypsilanti native who California aerospace industry. In 1964 he represented the thousands of players in has lived with diabetes since 1949, the moved into defense-related government the complex search and decision process. small victories of beating diabetes one day service, eventually serving three presi- Brehm told the participants that he at a time have been a part of her life for 55 dents (Johnson, Nixon, and Ford). In believes that an essential first step in the years. But she dreams of a larger victory of 1978, convinced of the huge potential of University’s initiative is to develop a far protecting all people, young and old, from information science and systems analysis better understanding of the roles of these the discomfort, fear, and devastating expe- to solve major management problems, he players — and how those roles interact rience of type 1 diabetes, now and in the helped found SRA International in and fit together. To facilitate that kind of future — a dream she would love to see Fairfax, Virginia. SRA serves government inquiry he emphasized that the new cen- fulfilled in her lifetime. clients by providing complete solutions to ter will incorporate modern systems complex system problems. Brehm now analysis and robust medical informatics serves SRA as chairman emeritus, and devotes a major portion of his time to the non-profit world. As Dee Brehm tells the story, their deter- mined search began one evening five The Michigan Difference years ago. She was in the kitchen prepar- ing dinner when her husband appeared A Campaign for Medicine at Michigan and asked in his quiet way, “What may I The Difference Made to Date*: $322 million (64%) do to help you?” “I don’t know where it came from,” she says as she recalls that defining moment, “but I looked at him Campaign Goal: $500 million and said, ‘You can find a cure.’ He paused for a moment, and then replied simply, ‘Okay...’” 0 $100 $200 $300 $400 $500 For Bill Brehm, whose career spans engi- neering systems development, defense Student Support: Building the Next Generation of Leading Physicians preparedness, crisis management, and the and Medical Scientists To date: $38 million of $50 million goal (76%) for new scholarships entrepreneurial challenge of building a Faculty Support: Investing in Creative Teaching and Superior Learning company in the highly competitive infor- To date: $48 million of $80 million goal (60%) for new professorships mation technology business arena, his Facilities Support: Building the Infrastructure To date: $66 million of $135 million goal (49%) wife’s challenge was not one he took for construction of a new children’s hospital, a depression center, a cardiovascular research center, and an addition to Kellogg Eye Center lightly. Together, the Brehms began an Research Support: Launching New Program and Research Initiatives To date: $170 million odyssey to discover more about diabetes of $235 million goal (72%) for a variety of thematic initiatives such as aging, women’s health, research and to develop a personal plan of bioinformatics, nanotechnology and many others throughout the U-M Health System involvement. Four years of persistent inquiry went into their development of a Bequest Intentions Goal: $50 million concept proposal. Their journey ulti- mately led them to Michigan. The univer- sity responded with an ambitious plan that amounts to a frontal assault on the 0 $50 disease. Estate Gifts: Future Support for the Health System To date: $41 million of $50 million goal (82%) The Brehms’ involvement will not stop with their $44 million gift. As an exam- ple, Bill Brehm suggested that the univer- * as of May 27, 2005 sity begin by bringing an eclectic group

Medicine at Michigan 55 CLASS NOTES

Alumni: Update your classmates! Send class notes to: Class Notes, Medicine at Michigan, 301 E. Liberty St., Suite 400, Ann Arbor, MI 48104- 2251, [email protected], or submit online at www.medicineatmichigan.org/classnotes.

1940s Ray C. Anderson, M.D., Ph.D. (Residency 1947), wrote a number of papers in the field of human genetics and, in March of 1951, became the first pediatric house officer at the heart hospital that was opened that year adjacent to the main University of Minne- sota Hospital. Upon completion of his residency, Anderson was appointed assistant professor and devoted himself to pediatric cardiology. He became associated with the Lillehei-Varco surgical team Save the Dates: Reunion Weekend that is now viewed as the founder of open-heart surgery. The 50th anniversary of the first operation is October 7-8, 2005! (on a patient of Anderson’s) was celebrated with a two-day symposium at the University of Minnesota Invited to this year’s reunion are all those who received their medical degrees from the last November, to which he was invited to return as University of Michigan in any years ending in “0” and “5,”all those who earned their med- a speaker. Anderson retired in 1980 as professor ical degrees in any year prior to 1955, and all those who, in any year, completed their res- emeritus of pediatrics (cardiology) and now resides idencies, fellowships or doctorates within the University of Michigan Health System. in Sun City, Arizona. The weekend’s activities — which include a bus tour of the medical campus and new con- 1960s struction, an awards luncheon, and class dinners — will culminate in the Big House on Glenn W. Geelhoed (M.D. Saturday as the Wolverines take on the Minnesota Gophers. 1968), professor of surgery, international medical edu- You may register online at www.medicineatmichigan.org/alumni. Deadline for registration cation, and microbiology and purchase of football tickets is August 31. Confirmation packets will be mailed in and tropical medicine at September. Football tickets will be available for pick-up throughout Reunion Weekend. George Washington Univer- sity Medical Center in Questions? Contact B.J. Bess, director of Alumni Relations, at [email protected] or (734) Washington, D.C., was 998-6044. unanimously elected as a 2005 recipient of the See you in Ann Arbor! Medical Mission Hall of Fame Award. The award was given on behalf of Geelhoed’s “exceptional, exemplary, and significant contributions to med- ical mission activities throughout the world.” Geelhoed and a group of students he recruits spend several months each year on international trips to places like Southeast Asia, Sudan and White Coat Ceremony on the Web Haiti to provide medical services to people who would otherwise have no access to health care. View a videotape of the August 7 White Coat Ceremony for the Class of 2009 on the Web at: www.medicineatmichigan.org

56 Spring/Summer 2005 1970s past president of the Long Montreal and, after his residency at Michigan, Edward B. Feinberg, M.D. Beach Surgical Society and served as a surgeon in the military with the U.S. (Residency 1977, Fellow- a former chief of staff at St. Public Health Service Center for Disease Control ship 1978), has been Mary’s Medical Center in at Fort Collins, Colorado, from 1975-77. He com- appointed professor and Long Beach. After his retire- pleted a fellowship in nephrology at the University chair of the Department ment in 1994, Benedict of Texas Health Science Center. Brinker was an of Ophthalmology at the concentrated on his hobby, avid outdoorsman who loved dry fly-fishing, Boston University School of painting, and in 1995 enjoyed hockey, and coached youth baseball. Medicine and chief of oph- enrolled at California State thalmology at Boston Med- University-Long Beach to Homer C. Brown (M.D. ical Center where he has study art. He completed a Bachelor of Fine Arts 1948), 81, died on practiced since 1999. After degree in 1999 and a Master of Fine Arts in December 25, 2004, at his completing his fellowship training at the U-M, he 2002. He was a life member of the American home in Defiance, Ohio, practiced retina surgery as a member of the fac- Physicians Art Association and served as editor of after a long illness. Brown ulty at the University of Tennessee College of its newsletter for 24 years. He also belonged to graduated from Ohio State Medicine. He spent 1997-98 at the Harvard the San Pedro Art Association and was a life University with a bachelor’s School of Public Health and 1998-99 at member of the Long Beach Arts. degree in 1944, received Massachusetts Eye and Ear Infirmary and Harvard his M.D. from the U-M Medical School. Karl R. Brinker, M.D. Medical School, performed (Residency 1975), a kid- an internship at Mt. Carmel Mercy Hospital in Thomas E. Price (M.D. ney transplant specialist in Detroit, and did his residency in surgery and 1979), an orthopaedic sur- Dallas, died on January 22 obstetrics at St. Francis Hospital in Hamtramck, geon from Roswell, Georgia, when the plane in which he Michigan. He also served with the U.S. Army was elected in November was a passenger crashed Medical Corps, U.S. Army Reserves, and was hon- 2004 to the U.S. House near Brownwood, Texas. He orably discharged with the rank of captain in of Representatives from was 58. His friend and col- 1962. He held various positions during his long Georgia’s 6th Congressional league Paulose Mathai, career at Defiance Hospital, including chief of District. Price, originally from M.D., 50, a lung transplant staff, and was honored by the Ohio State Medical Lansing, served in the specialist who was piloting the plane, was also Association in 2000 for his 50 years of medical Georgia State Senate from killed. Brinker was clinical associate professor practice. A dedicated Wolverine with, in the words 1996-2004. After complet- with the University of Texas Southwestern Medical of his daughter Rebecca, “a burning passion for ing his residency at Emory University, Price started Center for more than 20 years and also held posi- all things Michigan,” Brown made frequent trips an orthopaedic surgery practice in Roswell, a sub- tions at Methodist Medical Center in Dallas. He back to Ann Arbor to attend U-M football games. urb north of Atlanta, in the 1980s. By the mid- served as director of dialysis with Dallas Gifts in Brown’s memory may be made to the 1990s, his practice was the largest private Nephrology Associates and was a founding mem- University of Michigan C.S. Mott Children’s orthopaedic practice in the United States. Price’s ber of the Texas Transplant Society. Brinker earned Hospital Building Fund, 301 E. Liberty, Suite 400, Congressional Web site can be found at his medical degree from McGill University in Ann Arbor, Michigan, 48104-2251. ➤ www.house.gov/tomprice.

1990s Jamie Stalker, M.D. (Residency 1991), was appointed medical director at Argonne National Laboratory in Illinois on November 1, 2004. Stalker has been working as an occupational health physician and internist at Argonne since 2001, and prior to that was a clinician and instructor at Rush Medical Center and Northwestern Memorial Hospital in Chicago. She E-news to keep alumni informed! was recertified in internal medicine in 2003 and became certified as a medical review officer in In May, the Medical Center Alumni Society launched the first issue of its bimonthly 2004. Stalker lives in Lemont, Illinois, with her e-newsletter, MPulse. husband, Joel Whitehouse, an attorney and pri- Intended to keep alumni up-to-date on news of other alumni, special events, awards, vate investigator, and their children, Justin and reunion activities, volunteer opportunities and more, MPulse is distributed to all U-M Eliana. She can be reached at [email protected]. Health System alumni (former medical, graduate and doctoral students, as well as former residents and fellows) for whom the Medical School has working e-mail addresses. Alumni are encouraged to go to the Alumni Directory at www.medicineat- LIVES LIVED michigan.org/alumni to add or update their e-mail addresses, or to contact Chris Anne McCartney in the Office of Medical Development and Alumni Relations at James S. Benedict (M.D. 1954), 75, died October [email protected] or (734) 998-7584. 27, 2004. After completing his residencies at Iowa Methodist Hospital and Henry Ford Hospital Alumni with ideas for future issues of MPulse should contact McCartney with their in Detroit, he and his family settled in San Pedro, suggestions. California, in 1963. A thoracic surgeon for 31 years, Benedict served several hospitals and was

Medicine at Michigan 57 CLASS NOTES

Charles W. Butler (M.D. 1955), age 75, died on January 15 in Atlanta, Georgia. Remembering George Morley Leroy O. Carlson (M.D. 1943) died on March 29, George W. Morley (M.D. 1949, Residency 1954), 81, professor emeritus of obstetrics 2004, at the age of 85. and gynecology, founding member of the gynecologic oncology subspecialty, and After receiving his medical beloved teacher and mentor to hundreds of U-M students and residents, died on degree from the U-M, he February 20 after a brief illness. moved to Portland where he completed his intern- Morley’s history with the U-M and the Medical School is a long and illustrious one. In ship and residency at the addition to earning his medical degree and completing his residency here, he also University of Oregon Medi- received his bachelor’s degree (1944) and Master of Science (1955) at the U-M. His cal School and also met University Hospital career spanned more than five decades and included the titles of his future wife, Marian Cobb, whom he married in chief of the Gynecologic Oncology Service, director of the Gynecologic Oncology 1946. In 1947 Carlson became the first practic- Fellowship, and the Norman F. Miller Professor of Gynecology. He also served as pres- ing pediatrician in the southeastern Washington ident of the American College of Obstetricians and Gynecologists, the Society of Pelvic and northeastern Oregon area. He was a member Surgeons, the Society of Gynecologic Oncologists, the Central Association of of the Walla Walla, Washington, school board. Obstetricians and Gynecologists, the Society of Gynecologic Surgeons, and the Norman From 1954-56 he served as a major in the U.S. F. Miller Gynecological Society. Army where he was chief of pediatrics at Fort Bragg Hospital. In 1961 he returned to Portland Morley was a true Michigan man. In a written statement to the University community and accepted a position in the Pediatrics following Morley’s death, Medical School Dean Allen Lichter said,“In 2002 I presented Department of Oregon Health Sciences University, the Distinguished Alumni Service Award to Dr. Morley, and I can’t think of anyone more where he helped in the establishment of the Child deserving. [He] exemplified the very best in Michigan traditions.” Development and Rehabilitation Center. Carlson’s many awards and accolades include the Oregon John O.L. DeLancey, M.D., the Norman F.Miller Professor of Gynecology, in his words of Developmental Disabilities Council Award for remembrance at the memorial service, said of Morley, “His enthusiasm for surgery was Compassionate Leadership and Educator of the infectious, and many of us were infected for life. Throughout this country and around Year for the Association for Retarded Citizens from the world, his trainees take better care of their patients because of what they learned 1983-84. from his teaching wisdom. So many surgical careers were launched by his unique com- bination of surgical mastery, stimulating excitement and personal support. His influ- Milton Goldrath (M.D. ence will be felt for generations because of the young people he encouraged and 1951), 77, died from a stimulated to pursue careers of surgical excellence.” stroke on February 16 in Delray Beach, Florida. Visit the George Morley Memorial Web site at www.med.umich.edu/obgyn/morley.htm. To During his career, Goldrath read a profile of Morley in the fall 2003 issue of Medicine at Michigan, go to www.medi- served as chairman of the cineatmichigan.org/magazine/2003/fall/history. Gifts in Morley’s memory may be sent to Obstetrics and Gynecology the Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Department at Sinai Hos- Center Dr., L4000 Women’s Hospital, Ann Arbor, MI 48109-0276. Please write “George pital and as associate pro- Morley Fund” on the memo line. fessor at the Wayne State University School of Medicine, both in Detroit. He developed a hydro-ablation system that is now used worldwide, and he was a pioneer in the laser endometrial ablation technique and hysteroscopy. He was a member of Temple Israel and served on the board of the Jewish Federation of Metropolitan Detroit, the Allied Jewish Campaign and ORT, a non-governmental education and training organi- zation. Contributions may be sent to the Milton H. Goldrath, M.D., Resident Scholarship Fund, 301 E. Liberty St., Suite 400, Ann Arbor, MI 48104- 2251.

Herbert Humphrey (M.D. 1956) died on September 26, 2004. He was 76. Humphrey Morley attended the Medical School Reunion in October 2004 where he visited with friends at graduated from Marshall High School in Marshall, the tailgate party (left) and received his emeritus medallion from Dean Allen Lichter at the Emeritus Dinner (right). Michigan, in 1944 at age 16 and then attended

58 Spring/Summer 2005 CLASS NOTES

Albion College, but his education was interrupted ued to teach at the U-M and treat patients at the Lugg and his wife returned to the U.S. in 1991 in 1946 when he entered the Army. He served in North Outpatient Allergy Clinic, and also entered and moved to Silverdale, Washington, to be closer the Medical Services Unit in Germany until 1948. into private practice as an allergist at St. Joseph to their daughter, Lois Jane. While stationed in Munich he met Ingeborg G. Mercy Hospital in 1959. Lovell held consulting Dinse, and they were married on November 27, positions at the Veterans Administration Hospital Harold Proctor McGinnes (M.D. 1945) died on 1948. The couple returned to Michigan where in Ann Arbor (now the VA Ann Arbor Healthcare June 29, 2004, at McLean County Nursing Home Humphrey resumed his college career, but he was System), Wayne County General Hospital in in Normal, Illinois. He was 84. McGinnes was born called back to Army duty during the Korean War Eloise, Michigan, and served on President and raised in Charlotte, Michigan, where he grad- from 1950-51. In 1952, Humphrey completed his Eisenhower’s Commission on Veterans Pensions. uated from high school in 1938. He graduated degree at Albion and went on to pursue an M.D. He retired from private practice in 1990. His med- from Michigan State University in 1942 and from from the U-M. After completing an internship in ical affiliations included membership in the the U-M Medical School in 1945. He was a fellow Flint and at Butterworth Hospital in Grand Rapids, Michigan Allergy Society, which he served as pres- of the American College of Surgeons and founding Humphrey returned to Marshall and entered into ident in 1960. He achieved the rank of major dur- member of its Downstate Illinois Chapter, as well practice with his father. He was a physician and ing his service in the U.S.Air Force from 1955-56. as a founding member of the Illinois Surgical staff member at Oaklawn Hospital and held staff He was a founding member of the John M. Association. During his career he served on the privileges at both Leila Hospital and Community Sheldon Society, and his extensive community staffs of Brokaw Hospital, Mennonite Hospital and Hospital in Battle Creek until his retirement in service included volunteering for the American St. Joseph Medical Center, all in Illinois. 1991. He also served for many years as a Red Cross, YM-YWCA, the Ann Arbor Parks and Calhoun County deputy medical examiner. Recreation Department, Friends of the Library, Robert F. Schugmann (M.D. 1941), 87, a former and as University High School team physician. In Navy captain, died in Fort Bragg, California, on John R. Lewis (Ph.D. 1949), 88, died on August 1970, Lovell fulfilled a lifelong dream by teaching November 3, 2003, after a brief illness. 10, 2004, in Pittsfield, Massachusetts. Lewis was himself to play the great Highland Bagpipe and a 1937 graduate of Ottawa University,received his was certified as a senior instructor in 1978 by the Merlin C. Townley (M.D. master’s degree in biochemistry from Michigan Scottish College of Piping in Edinburough, 1952), 77, of Plymouth, State University in 1940, and his Ph.D. in phar- Scotland.Widely known as an Ann Arbor bagpiper, Michigan, died on Decem- macology from the U-M. Throughout his career he he appeared at many special events and occa- ber 16, 2004, after battling held positions at Michigan State University, sions in the area and taught piping lessons in his pancreatic cancer. Townley Fredrick Stearns & Co., and Stearling-Winthrop home until early 2004. He was also an avid grew up in Jackson, where Research before holding various positions with stamp collector and gardener whose gardens pro- he attended a one-room the Department of Drugs at the American Medical duced many award-winning roses over the years. country school and worked Association in Chicago. He retired from the AMA in on the family farm in the 1981 but continued to serve the organization as Robert M. Lugg (M.D. summers, then went on to a consultant for two more years. Lewis belonged 1952, Residency 1955) graduate as co-valedictorian from Jackson High to several pharmacological and scientific soci- died on November 3, School in 1945. He was active in a variety of stu- eties and authored or co-authored 33 articles 2004, at the age of 80, of dent organizations while attending the U-M, both published in scientific journals. complications from respira- as an undergrad (he received his bachelor’s tory problems. He enlisted degree in 1949) and as a medical student. He Robert G. Lovell (M.D. in the Navy Hospital Corps completed an internship at Wayne County General 1944, Residency 1950) during World War II at the Hospital in 1953 and was a resident in psychia- died in his home on age of 18, and received the try there from 1953-54. From 1954-56 he served December 31, 2004, after Silver Star and Purple Heart in the U.S. Air Force as director of the psychiatric a long battle with cancer. during his service. After that experience, he was service of a 400-bed hospital in Nagoya, Japan. He was 84. After complet- driven to pursue medicine. He met Margaret Townley then returned to Wayne County General ing his medical degree, Shannon while attending Purdue University and as a psychiatrist and was director of the female Lovell was diagnosed with they were married in 1949. The couple moved to service of the psychiatric division until the hospi- tuberculosis, and his first Ann Arbor where Lugg attended the U-M Medical tal closed in 1977. He became a fellow of the published book, Taking the School and did his residency, and then settled in American Psychiatric Association in 1967, a life Cure, described his experiences as a tuberculosis Port Huron where he maintained a private practice fellow in 1991, and a distinguished life fellow in patient during World War II. Following his recovery, for 29 years. A pediatrician, Lugg was an active 2003. He was active on the staff of Ardmore he began his career at University Hospital as a supporter of children’s mental health services Psychiatric Hospital, provided consultation serv- research assistant in the Division of Allergy in and, in 1983, was named Public Citizen of the ices at the Veterans Hospital in Allen Park, and 1948, and completed his residency in internal Year by the National Association of Social Workers saw patients privately at his practice in Wayne and medicine here. He was named assistant dean of for his contributions to social service organiza- Plymouth. He married Serena Louise Pittman in the Medical School in 1957 and served in that tions in St. Clair County. In 1985, he closed his 1968 and they had three children. He retired in capacity until 1959. He held the position of clini- practice and accepted a position with the U.S. 1995 and purchased the farm on which he grew cal professor of internal medicine at the time of Army as a developmental pediatrician assessing up, where he spent much of his free time garden- his retirement in 1985, when he was named pro- the needs of developmentally handicapped chil- ing. He also enjoyed traveling, visiting more than fessor emeritus of internal medicine. He contin- dren of military families in Stuttgart, Germany. 70 different countries in his lifetime.

Medicine at Michigan 59 CLASS NOTES

PLAY BALL! U-M MEDICAL SCHOOL ALUMNI ROBERT MURRAY AND DANIEL GOODMAN HELP MAKE SURE THE GAME GOES ON FOR THE SAN FRANCISCO GIANTS by Gary Libman Photo: David Paul Morris

Robert Murray and Daniel Goodman at SBC Park,home of the San Francisco Giants

uring a game a few years ago in San radiology team to perform a magnetic reso- In recent years Murray supervised ace pitcher DFrancisco,Giants first baseman J.T.Snow nance imaging (MRI) test.An ambulance sped Jason Schmidt’s treatment for rotator cuff ten- whipped a throw that second baseman Jeff Martinez to the hospital,where doctors diag- donitis,first baseman J.T.Snow’s arthroscopic Kent deflected before it banged shortstop nosed a concussion and called Murray with knee surgery and former closer Robb Nen’s Ramon Martinez in the head. the information.Murray relayed the news to the four shoulder operations.In every situation,he Giants within hours of the injury. says,it’s crucial to begin treatment quickly. The stunned Martinez left the night game at SBC Park and the Giants immediately reached Kent now plays for Los Angeles and Martinez “We’re very proactive,”says Murray,who also the team’s head physician,Robert E.Murray for Detroit,but Murray’s job remains the same. maintains a full practice as a general, vascular (M.D.1962),at home around 10 p.m.Murray In his seventh year as the Giants’head physi- and thoracic surgeon.“If we suspect anything quickly called St.Francis Memorial Hospital in cian,he coordinates treatment of players,their is wrong,we’ll get an MRI or treat the condition San Francisco,alerting the staff to call in a families,team executives and administrators.

60 Spring/Summer 2005 CLASS NOTES

immediately.We try not to allow any delay The team medical staff is necessary because Murray reacted quickly because he grew up a between a perceived injury and the treatment. “although these men are all under the age of baseball fan in Muskegon,Michigan,and 41,the wear and tear of a 162-game season rooted for the Detroit Tigers.“We just mowed “That’s important because the faster the player carries a price,”Murray says.“They all sooner or down a field across from our house and built starts rehabilitation,the quicker he will heal. later start breaking down a little.” our own playing field for the summer,”he says. Also,if someone goes down with an injury we “Playing was one of our major enjoyments. have to move players from the AAA team to the Because he deals with healthy young men, Money was tight and it occupied our time.”He majors,and we try not to create any delay in Murray says,“we are just treating colds,aller- also played American Legion,high school and that process.”In addition to players,Murray’s gies and gastrointestinal disorders.… Several semi-pro baseball. patients with the Giants include baseball Hall guys have had acute appendicitis,but most of of Fame members Willie Mays,Willie McCovey the major problems are dealt with by the Murray’s father was a mechanical engineer but and Orlando Cepeda,who work for the team. orthopaedists.”The staff’s treatment of these his mother,a housewife,influenced his career problems has helped the Giants register “one choice.“My uncle was a doctor,”he says,“and Murray’s work with the Giants extends far of the lowest number of disability days in major my mother was a strong influence that I be a beyond the 162-game season.It can involve league baseball,”Murray says.“That’s been doctor.… I was not bothered by career 11 months of the year.“We go from December consistent over the last six years.” choices.”He completed undergraduate and 1 through the end of October if we’re in play- medical school at Michigan in seven years. offs,”he says.“If not,our work ends October 1. To ensure that the Giants get proper care, Truly,the only time off is in November.”The work Murray spends weekends in spring training in “I had a wonderful time,”he says.“We had starts again in December with a training camp Scottsdale,Arizona,and attends about 50 of about 18,000 students and one campus,but for players and winter meetings for executives the team’s 81 home games.He arrives about it didn’t feel like you were at a large school. that doctors attend for continuing medical an hour before the first pitch and heads for the Everything was within walking distance.You got education. training room in the clubhouse to see players. around on a bike or you walked.” Doctors helping Murray on the Giants staff When the game starts he watches from his After medical school he chose a surgery spe- include orthopaedists and an internist,podia- seats behind home plate.After the game he cialty,and baseball factored into the decision. trist and ophthalmologist. waits in the trainers’room,in case he’s “Surgery required a certain The ophthalmologist,Daniel eye-hand coordination and Goodman (M.D.1980), it fascinated me,”he says. also received his medical The medical staff’s treatment has helped the Giants “It probably goes back to degree from Michigan,and register “one of the lowest number of disability days in when I played sports.And was a Phi Beta Kappa the second fascination was Wolverine undergraduate. major league baseball,”head physician Robert Murray the ability to make a differ- Team owner Peter A. says.“That’s been consistent over the last six years.” ence in the health of Magowan invited Goodman patients in a short period of to join the staff after time.” becoming Goodman’s patient. needed,until the players leave.Murray also Murray interned in San Francisco,completed a Goodman specializes in corneal transplant, traveled with the Giants to the 2002 playoffs residency at St.Louis University,served two cataract and lens implant surgeries and laser and World Series,where San Francisco lost to years in the Army and,in 1970,returned to vision correction.The former Chicago high Anaheim in seven games.Being at the World San Francisco to join a practice.He immedi- school third baseman sees fewer games than Series tops his baseball thrills.“It’s extremely ately became a Giants fan,and today delights Murray,and most players needing treatment exciting,”he says.“You’re on the inside and you in taking his grandchildren to games. come to his office. know everything that’s happening. “One of the biggest joys of having this job is In recent years,Goodman has performed “You are at another level of competition,so that during game time I will bring in one or two LASIK (laser vision correction) surgery to cor- your day-to-day activities with the team are friends’kids,or my grandchildren,to tour the rect contact lens problems for former Giants greatly accelerated.In a real sense you are liv- locker room,”he says.“They’ll usually bring shortstop Rich Aurilia,who signed a minor ing in the moment.You are not thinking about their dad along and take a picture by one of league contract with Cincinnati during the off- tomorrow or the next day because everything is the lockers and look at the weight room,and I season,and Robb Nen,now retired.Nen “had so much more intense.” try to give them each a baseball so they usu- extremely high near-sightedness and was hav- ally get an autograph. Events like the Series make him appreciate the ing difficulty with contact lenses,especially at job.When he became director of the Catholic “It leaves a lasting impression.They just light night — to the point where he was having a Healthcare West Sports Medicine Team,the up and,according to their parents,talk about hard time seeing the catcher’s signals,” organization asked if he’d also direct health it at home for days.” Goodman says.Each player’s vision was better services for the Giants.“I jumped at the job,” than 20-20 after surgery. Murray says.

Medicine at Michigan 61 IN THELIMELIGHT

James Albers (M.D. 1972), Andrew J. Haig, M.D., asso- John F. Greden, M.D., Rachel Ph.D., professor in the ciate professor of physical Upjohn Professor of Psych- departments of Neurology, medicine and rehabilitation iatry and Clinical Neuro- Physical Medicine and and of orthopaedic surgery, sciences and chair of the Rehabilitation, and Psych- has been elected North Department of Psychiatry, iatry, was appointed assis- American vice president of received the University of tant dean for instructional the International Society for Minnesota Medical Foun- faculty in December 2004. Physical and Rehabilitation dation’s 2005 Distinguished As assistant dean, Albers Medicine for a two-year term Alumni Award. The award focuses on policies and pro- ending in 2006. Haig was recognizes University of cedures related to the instructional track, the also re-elected president of the International Minnesota Medical School graduates who have appointment and promotion processes, as well as Rehabilitation section of the American Academy realized extraordinary achievement in their med- conducting third-year reviews and exit interviews. of Physical Medicine and Rehabilitation for a term ical careers and contributed outstanding service ending this November. to their communities. James R. Baker Jr., M.D., was recently elected director Maya Hammoud (M.D. Robert P.Kelch (M.D. 1967, of the American Board of 1996), assistant professor of Residency 1970), professor Allergy and Immunology, a obstetrics and gynecology, of pediatrics and communi- conjoint board of the was appointed assistant cable diseases, chief execu- American Board of Internal dean for student programs in tive officer of the U-M Health Medicine and the American February. Hammoud has System, and U-M executive Board of Pediatrics. As direc- served as director of vice president for medical tor, Baker will work to fulfill Michigan’s M3 clerkship pro- affairs, received the Joseph the board’s mission, includ- gram in obstetrics and gyne- W. St. Geme Jr. Leadership ing establishing qualifications and examining cology; she is also active Award at the annual meeting physician candidates for certification as nationally in medical education. Hammoud’s of the Pediatric Academic Societies in May in allergy/immunology specialists; establishing and responsibilities as assistant dean include medical Washington, D.C. The award honors individuals improving standards for teaching and practice of student career development, individual student whose broad and significant contributions are allergy/immunology; and establishing standards counseling and medical student wellness. considered to be “creating the future” of the field for training programs in allergy/immunology. of pediatrics. Baker begins his six-year term as director in Rodney Hayward, M.D., professor of internal med- January 2006. icine and director, VA Ann Arbor Healthcare Ormond A. MacDougald, System Center for Practice Management and Ph.D., associate professor of Darrell “Skip” Campbell, Outcomes Research, is the recipient of the 2005 molecular and integrative M.D. (Residency 1978), chief Under Secretary’s Award for Outstanding physiology, was selected to of clinical affairs and profes- Achievement in Health Services Research. The present the prestigious Henry sor of internal medicine, has award recognizes a VA researcher whose work has Pickering Bowditch Award been selected chair of the led to major improvements in the quality of veter- Lecture at the annual meet- executive committee of the ans’ health care, made significant contributions to ing of the American Physio- American College of Sur- the future of health services research and devel- logical Society this spring. geons’ National Surgical opment through training and mentorship, and The lectureship is awarded Quality Improvement Pro- enhanced the visibility and reputation of VA for original and outstanding accomplishments in gram, a national, validated, research through national leadership. the field of physiology. Founded in 1887, the outcomes-based, risk-adjusted program for the American Physiological Society fosters education, measurement and enhancement of surgical care. Steven Goldstein, Ph.D., scientific research, and dissemination of informa- The Veterans Health Administration created the associate chair for research tion in the physiological sciences, and has more program 11 years ago, resulting in surgical mor- in Orthopaedic Surgery and than 10,500 members. tality decreasing by 27 percent and morbidity by the Henry Ruppenthal Family 45 percent in 128 participating VA hospitals. Professor of Orthopaedic Ron Maio, D.O., professor of Surgery and Bioengineering, emergency medicine, was has been elected to the named assistant dean for National Academy of Engin- research regulatory affairs in eering, one of the National November 2004. Maio’s Academies of Science. responsibilities include pro- Goldstein was recognized for his contributions to viding leadership, expertise the understanding of bone micro-mechanical and and advice on regulatory remodeling behaviors and their translation into issues that affect human ➤ gene therapies and fracture fixations.

62 Spring/Summer 2005 New Leadership for Human Genetics and Neurosurgery THE UNIVERSITY OF MICHIGAN MEDICAL SCHOOL RECENTLY NAMED NEW CHAIRS FOR TWO KEY DEPARTMENTS

Sally Camper, Ph.D., professor of human Also on January 1, Karin Muraszko, M.D., genetics and internal medicine and a highly professor of neurosurgery, pediatrics and respected and nationally recognized geneti- communicable diseases, and of plastic sur- cist, became chair of the Department of gery, became chair of the Department of Human Genetics and the James V. Neel Neurosurgery. She received a bachelor’s Professor of Human Genetics on January 1. degree from Yale University and a medical Using genetically engineered mice, Camper degree from Columbia College of Physicians has identified and elucidated the genes and Surgeons. After residency in neuro- involved in inherited pituitary hormone defi- surgery at Columbia’s New York ciency diseases, deafness and skeletal Neurological Institute, she spent two years defects. Her work has led to important at the National Institute of Neurological advances in clinical research, as well as in Disorders and Stroke. basic science. Muraszko came to Michigan in 1990 and After a bachelor’s degree from the maintains an active clinical practice, along University of Delaware and a doctorate in with research interests in pediatric brain biochemistry from Michigan State tumors, Chiari malformations, developmen- University, Camper undertook postdoctoral tal anomalies of the spine (particularly training at Case Western Reserve University spina bifida), and craniofacial anomalies. Sally Camper in the Department of Molecular Biology Muraszko became chief of pediatric neuro- and Microbiology, at the Institute for surgery in 1995 and vice chair for educa- Cancer Research in Philadelphia, and at tion for the Department of Neurosurgery in Princeton University in the lab of Shirley 2001. In addition to her clinical, research Tilghman, a world-renowned scholar and and educational commitments, she has leader in the field of molecular biology and served on important U-M committees

Photo: Lin Goings Princeton University’s 19th president. including a term on the Advisory Committee Camper joined the Michigan Department of on Appointments, Promotions and Tenure, Human Genetics in 1988 and, in 2001, which she served as chair, and the Medical accepted a secondary appointment in the School Executive Committee. Muraszko Department of Internal Medicine. She is also holds leadership positions in multiple associate director of the Program in national neurosurgical organizations, Biomedical Sciences, a member of the including membership on the executive Organogenesis Steering Committee, and committee of the Congress of Neurological founding director of the U-M’s highly Surgeons, the public relations committee of regarded Transgenic Animal Model Core. the American Association of Neurological Camper is active in a variety of other inter- Surgeons, the board of directors of Women departmental programs, including the in Neurological Surgery, the health care Medical Scientist Training Program, policy steering committee of the American Genome Sciences Training, and Systems College of Surgeons, and the publication and Integrative Training. Her lab received a committee of the American Society of National Institutes of Health MERIT Award Pediatric Neurosurgery. Karin Muraszko in 2002 and serves as the training locus for many promising graduate and post-doctoral scientists and physician-scientists. She is the author of more than 125 publications in scientific journals.

Medicine at Michigan 63 IN THELIMELIGHT subjects and animal research in the U-M Health System. He also co-chairs the Institutional Review Board Leadership Committee. Dean Lichter to Receive Steven Pipe, M.D. (Resi- dency 1996), assistant pro- ASTRO Gold Medal fessor in the Division of

Hematology/Oncology, is Vloet Martin Photo: president-elect of the Mid- U-M Medical School Dean Allen S. Lichter, M.D., west Society for Pediatric has been chosen by the American Society for Research; his term begins in Therapeutic Radiology and Oncology to receive 2006. The society provides a the society’s 2005 Gold Medal. constructive forum for pedi- “The Gold Medal designation, the highest honor atric scientists, developmen- ASTRO awards, recognizes distinguished accom- tal biologists, and junior faculty and trainees at plishments and contributions in the field of radi- various levels to present their work, and is open to ation oncology,” says Theodore Lawrence, M.D., active full-time faculty in academic pediatrics at Ph.D., ASTRO chair, and chair of the U-M teaching institutions throughout the Midwest and Department of Radiation Oncology. portions of Canada. Lichter was recognized for his dedication to Ameed Raoof, M.D., Ph.D., teaching the next generation of radiation oncolo- lecturer in the departments of gists and for his development, along with other Cell Biology and Medical colleagues, of three-dimensional conformal radi- Education, is a member of ation therapy. He will receive the award in October the International Advisory during ASTRO’s 47th annual meeting in Denver. Board of Editors for Gray’s Anatomy for Students, which was published in October 2004. The textbook is con- Pohl, Ph.D., associate profes- sidered a major asset to sor of nursing, of the anatomy education and “firmly relates the study of Ginsberg Center for anatomy to the clinical practice of medicine,” Community Service and according to its publisher, Elsevier/Churchill Social Action’s Outstanding Michigan’s Livingstone. Faculty Member Award. The Continuing Medical award is given to university Yehoash Raphael, Ph.D., faculty members who have Education Program associate professor of oto- demonstrated excellence in laryngology and director of providing, developing or sus- the Otopathology Laboratory taining opportunities for engaging students in Internal medicine … care of the at the U-M Kresge Hearing community service, social action and learning. elderly … venous disease … sports Research Institute, has Williams and Pohl received the award for their medicine … these are but a few received the 2005 Research work with the Shelter Association of Washtenaw of the upcoming topics in U-M’s Award from the Deafness County Health Clinics. Continuing Medical Education Research Foundation for his work using gene therapy to regenerate auditory program. hair cells in the inner ear. Founded in 1958, the Deafness Research Foundation is the leading For information on course content, source of private funding for basic and clinical Corrections dates and locations, visit Medical research in hearing science. The Fall 2004 issue of Medicine at Education’s Web site at Michigan, in “Out of Africa” (pages 50-51), www.med.umich.edu/meded, call Albert Rocchini, M.D., professor of pediatrics and misspelled the name of one of Margaret (734) 763-1400, (800) 800-0666, communicable diseases and director of the Grigsby’s professors; the correct spelling is or e-mail [email protected]. Division of Pediatric Cardiology, has been elected Ruth Wanstrom. In the same piece, we to serve as vice chair of the Faculty Group Practice placed the Westminster Dog Show in Board of Directors. Rocchini began his three-year England. The competition, in which one of term in July 2004. Grigsby’s dogs won a blue ribbon, is held in New York City. Our apologies. Brent C. Williams, M.D., associate professor of internal medicine, is a co-recipient with Joanne M.

64 Spring/Summer 2005 INPRINT BOOKS AND JOURNALS WRITTEN OR EDITED BY MEDICAL SCHOOL FACULTY

Edited by Alon Y.Avidan,M.D.,clinical assis- A.Mark Fendrick ,M.D.,professor of internal tant professor of neurology; and Karen L. medicine; and Michael E.Chernew , Ph.D., Roos, M.D.: Seminars in Neurology — associate professor of internal medicine,edi- Introduction to Sleep and Its Disorders, vol- tors-in-chief: The American Journal of Managed ume 24,number 3.Thieme,September 2004. Care.Medical World Communications. By J.Sybil Biermann ,M.D.,associate profes- Edited by Carmen R.Green , M.D. (Residency sor of orthopaedic surgery,et al.: National 1992),associate professor of anesthesiology; Comprehensive Cancer Network Bone Rollin M.Gallagher,M.D.; Michael A.Ashburn, Cancer Clinical Guidelines. Jones & Bartlett, M.D.; Gary Bennett,Ph.D.; Daniel Carr,M.D.; 2005.Edited by J.Sybil Biermann ,et al.: David Fishbain,M.D.; Robert D.Kerns,Ph.D.; Journal of the National Comprehensive and Patrick McGrath,Ph.D.: Pain Medicine, Cancer Network,volume 3,number 2.Jones volume 6,number 1.Blackwell Publishing, and Bartlett,March 2005. 2005. By Richard E.Burney ,M.D.,professor of sur- Edited by Larry Junck (M.D.1976); Richard gery,et al.: Guideline for the Management of S.J.Frackowiak,M.D.,D.Sc.; and Anne B.Young, Cancer Pain in Adults and Children.American M.D., Ph.D.: Current Opinion in Neurology — Pain Society,2005. Neoplasms,volume 17,number 6.Lippincott Williams and Wilkins,December 2004. Edited by Kenneth R.Cooke , M.D., assistant professor of pediatrics and communicable Edited by Paul R.Kileny , M.D., Ph.D., profes- diseases; James L.M.Ferrara , M.D., profes- sor of otolaryngology and of pediatrics and sor of pediatrics and communicable dis- communicable diseases: International Journal eases; and H.Joachim Deeg,M.D.: of Audiology,volume 43,supplement 1.B.C. Graft-vs.-Host Disease,third edition.Marcell Decker Inc.,December 2004. Dekker, 2005. Edited by Harry L.T.Mobley , Ph.D., professor Edited by David R.Engelke , Ph.D., professor and chair,Department of Microbiology and of biological chemistry; and John J.Rossi, Immunology; James P.Nataro,M.D.,Ph.D.; M.D., Ph.D.: Methods in Enzymology, volume Paul S.Cohen,Ph.D.; and Jeffrey N.Weiser, 392.Elsevier Academic Press,2005.Also M.D.: Colonization of Mucosal Surfaces. ASM edited by David R.Engelke : RNA Press, 2005. Interference.DNA Press LLC,2003. By Sayoko E.Moroi (M.D. 1995), Ph.D., asso- By Eva L.Feldman (Ph.D. 1979, M.D. 1983), ciate professor of ophthalmology and visual Russell N.DeJong Professor of Neurology; sciences; R.Rand Allingham,M.D.; Karim James W.Russell ,associate professor of Damji,M.D.; Sharon Freedman,M.D.; and neurology; Wolfgang Grisold,M.D.; and Udo George Shafranov,M.D.: Shields’Textbook of A. Zifko, M.D.: Atlas of Neuromuscular Glaucoma,fifth edition.Lippincott Williams Diseases. SpringerWien, 2005. and Wilkins,2005.

Medicine at Michigan 65 IN THELIMELIGHT Three Faculty Members Honored with Newly Established Professorships The University of Michigan Medical School recently inaugurated three endowed professorships and installed the first holders of each in ceremonies in Ann Arbor.

The Frederick G.L. Huetwell and William D. Robinson, M.D., Professorship in Rheumatology Photo: Martin Vloet On October 28, 2004, Alisa Erika Koch, M.D., was installed as the first Frederick G.L. Huetwell and William D. Robinson, M.D., Professor of Rheumatology. Koch received her medical degree from Northwestern University in 1980. She com- pleted her residency in internal medicine at Loyola University and a fellowship at Northwestern. She was appointed assistant pro- fessor of medicine at Northwestern in 1986 and achieved the rank of professor in 1995. Since Marc Lippman, M.D., chair of the Department of Internal Medicine; Peter Polverini, Dean of the U-M Dental 1997, she had been the Gallagher Professor of School; Allen Lichter; Alisa Koch; Giles Bole (M.D. 1953, Residency 1956), former dean of the U-M Medical Arthritis Research at Northwestern and has School; David Fox, M.D., chief of Rheumatology; attorney Jon Gandelot; Robert Kelch served as chief of the Section of Rheumatology at the Veterans Affairs Chicago Health Care System since 1991. establishment of endowments in the Medical Montreal and her medical degree from School. McMaster University in Hamilton, Ontario. She Koch is widely recognized as a leader in the field completed a fellowship in pediatric hematol- William D. Robinson was responsible for the cre- of rheumatology. She has defined cytokine and ogy/oncology at the University of Michigan in ation of the Division of Rheumatology in the chemokine pathways in inflammatory synovitis. 1990 and joined the U-M faculty the same year. She has established a key role for macrophages Department of Internal Medicine. He practiced and their secretory products to the development medicine, trained medical students, and Castle’s primary research focus is neuroblas- of rheumatoid arthritis and the angiogenesis that expanded the horizons of biomedical knowledge toma, a pediatric solid tumor. She is specifically contributes to this disease. Her bibliography in a career that spanned 54 years. When interested in mechanisms of chemotherapy and reflects more than 130 peer-reviewed articles, Robinson died in 1988, his department col- radiation resistance and studies the control of one book and 21 book chapters. leagues joined forces to contribute a gift in his neuroblastoma invasion and metastases. Her name. laboratory is funded by the National Cancer The Frederick G.L. Huetwell and William D. Institute and several foundation grants. Her Robinson, M.D., Professorship in Rheumatology The Ravitz Foundation research interests in neuroblastoma are com- honors two men who made extraordinary contri- Professorship in Pediatrics plemented by her clinical expertise; Castle is butions to the growth of the University of and Communicable Diseases widely regarded as one of the world’s foremost Michigan Medical School. specialists in the treatment of this devastating Huetwell was a great friend to the U-M and to On November 19, 2004, the U-M Medical disease. She holds leadership positions in a the Medical School, and one of the University’s School inaugurated the Ravitz Foundation number of professional organizations, including leading benefactors. Despite physical difficulties Professorship in Pediatrics and Communicable the Society for Pediatric Research, the American related to cerebral palsy, Huetwell earned a Diseases. Valerie Castle, M.D., a professor of Society of Pediatric Hematology/Oncology, the degree in history from the College of Literature, pediatrics and communicable diseases and American Pediatric Society and the American Science, and the Arts in 1938, and went on to chair of the Department of Pediatrics at the Association for Cancer Research. become an active and devoted alumnus. University of Michigan, was installed as the first Ravitz Foundation Professor. Edward Ravitz was born in Detroit in 1918 and Huetwell died in 1994. A year later, his bequest grew up in the midst of the Great Depression. of nearly $17 million came to the University, A native of Toronto, Canada, Castle received her Although he was a brilliant young man, the eco- with more than $9 million dedicated to the bachelor’s degree from McGill University in

66 Spring/Summer 2005 IN THELIMELIGHT Photo: Martin Vloet Photo: Martin Vloet

Robert Kelch and Valerie Castle Steve Goldstein, Ph.D., Henry Ruppenthal Family Professor of Orthopaedic Surgery and Bioengineering; Larry S. Matthews, M.D., professor emeritus and former section head of Orthopaedic Surgery; Jim Carpenter; Robert Hensinger (M.D. 1964) professor in the Department of Orthopaedic Surgery nomic devastation of the times precluded edu- The Harold W. and Helen L. Since 1993, Carpenter has also taught in the cation beyond Central High School, so he U-M Biomedical Engineering Program. He was worked with his father, a carpenter. He entered Gehring Professorship in named chair of the Department of Orthopaedic the army in World War II and was soon in officer Orthopaedic Surgery Surgery in 2003. candidate school, where he was commissioned December 8, 2004 marked the inauguration Helping others and giving back to the commu- a second lieutenant. Upon graduation, he was of the Harold W. and Helen L. Gehring nity were principals that guided Harold W. assigned to combat in the Pacific where his Professorship in Orthopaedic Surgery. James E. Gehring (M.D. 1936, Residency 1941) and his leadership and courage earned him the Bronze Carpenter (M.D. 1984), chair of the Depart- wife, Helen, throughout their lives. During World Star Medal for Valor and promotion to captain. ment of Orthopaedic Surgery, was named as the War II, when medical services as well many other In 1963, Ravitz was hired by Edward Rose and first Gehring Professor. American endeavors were limited by heavy con- Sons, a large building company, and sent to A third-generation graduate of the University of scription to military service overseas, the establish their Kalamazoo office which, through Michigan Medical School, Carpenter received Gehrings provided free medical care to Native his leadership, grew to more than 600 employ- his training in orthopaedic surgery at Harvard, Americans in Lapeer County as their own form of ees, who built more than 15,000 single-family where he held a research fellowship in service to an American society under siege. homes and apartment units in Michigan and orthopaedic biomechanics, and at Massachusetts Harold Gehring specialized in orthopaedics; more than 12,000 in other states. General Hospital in Boston. He has been a Helen Gehring had earned bachelor’s and mas- ter’s degrees in bacteriology from the U-M in Ravitz became interested in high-risk medical member of the Section of Orthopaedics and an 1935 and 1938, respectively, and also held a research, children and child development. Not integral part of the U-M Sports Medicine research fellowship from 1935 to 1941. long before his death in 1999, he established Program since 1990. Carpenter is active in Subsequently, Harold Gehring practiced at the Edward Ravitz Foundation. The foundation’s research, has presented at scientific meetings Beaumont and Grace hospitals in Detroit. gift of a professorship for the chair of the nationally and internationally, and is the author Department of Pediatrics and Communicable of numerous scientific articles and book chap- Harold Gehring died in 1984. Helen Gehring Diseases at the University of Michigan follows ters. His areas of interest and expertise are in later established the Harold W. and Helen L. on earlier gifts to support construction of shoulder, knee and arthroscopic surgery as well Gehring Professorship in Orthopaedic Surgery to the new children’s hospital and research on as sports medicine.As a team physician for ath- help train future physicians at the institution that neuroblastoma. letes, Carpenter provides orthopaedic care for had provided both of them with so many oppor- the Michigan Wolverines. tunities and the ability to make a difference in the world. —WH

Medicine at Michigan 67 Message from the Executive Vice President for Medical Affairs

The global impact of medicine at Michigan is disease. The Brehms’ faith in us is a great testa- impressive and undeniable, and the pride we all ment to the caliber of research at Michigan, can derive from the world-wide volunteer efforts research that is at once commonplace and of our students, physicians, nurses and staff is incredible, research that comprises the daily enormous and gratifying. We congratulate and work of medical professionals as well as the commend everyone within the Health System extraordinary moments when a human life is who is involved in these global initiatives. Our saved. We salute the Brehms’ generosity, dedi- positive effects on developing nations would not cation and steadfast vision, and we are grateful be possible, however, without the spectacular for their partnership at this remarkable time in biomedical achievements happening right here in biomedical research. Ann Arbor every day. We are also grateful for the continuing partner- Providing the best environment and culture to ship of the C.S. Mott Foundation, whose $25 enable those achievements is an ongoing respon- million gift toward construction of a new chil- sibility of the Medical School and the Health dren’s and women’s hospital furthers a relation- System of which it is part. Facilities and equip- ship going back 40 years when the foundation’s “Our ability to ment must keep pace with advances in technol- support helped build the existing, and now out- ogy for optimal progress in research, education dated, C.S. Mott Children’s Hospital. The Mott remain a leader in and clinical care. Researchers, in particular, Foundation gift, as well as that of Bill and Dee biomedical research need to be able to pursue new directions at any Brehm and indeed so many others at so many time, as today’s newly discovered knowledge levels, illustrates perfectly the power and and health care charts tomorrow’s course of scientific inquiry. progress that can be realized when those of like minds and like visions work together to accom- delivery comes Our ability to remain a leader in biomedical plish a common goal. The Michigan Difference research and health care delivery — and, corre- from a variety of campaign for medicine at Michigan will forge spondingly, in the education of future more of these partnerships, and help provide the strengths, not the researchers and physicians — comes from a foundation upon which our work and progress variety of strengths, not the least of which is least of which is will continue. public and private support of our institution. public and private Though state appropriations have decreased in Our vision of the medical campus is revolution- support of our recent years, they still form a substantial portion izing how we do research and deliver clinical institution.” of the funding that supports the University of care, while providing a top education to some of Michigan and its Health System. As a public the nation’s brightest students. The Biomedical institution, we owe much to the state that has Sciences Research Building, the Cardiovascular supported us for so many years. Funding from Center, the Depression Center, the new chil- the National Institutes of Health helps provide a dren’s and women’s hospital — all in some stage vital foundation for our research efforts, with- of construction or planning — will have pro- out which many of the remarkable scientific found benefits to future science, education and pursuits taking place throughout the Health health care delivery at Michigan. And, as we’ve System today simply would not be possible. seen in this issue of Medicine at Michigan, those profound benefits will reach well beyond the Private philanthropy forms another crucial ele- Health System and the state of Michigan, help- ment of our support, as illustrated by the his- ing to improve lives around the world. toric gift made by Bill and Dee Brehm (see page 54) to hasten the pace of discovery of a cure for type 1 diabetes. The Brehms made their gift out of an unwavering conviction that the University of Michigan holds the greatest promise for medical breakthroughs, that the scientific rigor and collaboration inherent in Michigan research Robert P. Kelch (M.D. 1967, Residency 1970) is the most likely source of a cure to this U-M Executive Vice President for Medical baffling, often debilitating, sometimes deadly Affairs and CEO, U-M Health System

68 Spring/Summer 2005 “I Want to Help the Next ‘Me’ Out There …”

“I grew up in rural Michigan, in Menominee. My dad died after my first semester of medical school, and I

Photo: Darrell Hoemann had no money. I made it through on loans — I didn’t qualify for scholar- ships. I told myself at the time that when I could, I wanted to help the next ‘me’ out there, and make it a little bit easier. “My loans are paid off now, and I’ve begun to fund a $5,000 named scholarship. I named it after my father, Kenneth James Sobeski, who was a foundry worker. I think he’d like that.”

James Sobeski, M.D., a 1993 gradu- ate of the University of Michigan Medical School, is an orthopaedic surgeon in Champaign, Illinois, where he lives with his wife, Paddy, and their three children, Ellen, Sophia and Jimmy.

To learn more about how your gifts, current and future, can benefit medical students, residents and fellows at the University of Michigan, please call Jim Thomas at (800) 468-3482 or e-mail him at [email protected]. To obtain a DVD or VHS copy of “Lifting the Burden … Realizing the Dream,” (winner of the 2004 Association of American Medical Colleges Group on Institutional Advancement Award of Excellence) a 12-minute film describing the difference your support will make, please e-mail Karin Roberts at [email protected].