SUMMER/FALL 2020

EINSTEINTHE MAGAZINE FOR ALUMNI AND FRIENDS OF ALBERT EINSTEIN COLLEGE OF MEDICINE

CONFRONTING THE COVID-19 CRISIS Einstein and Montefiore spearhead research and guide patients through a pandemic SUMMER/FALL 2020

EINSTEIN A Message from the Dean Science at the Heart of Medicine Summer/Fall 2020 IN THIS ISSUE The magazine for alumni, faculty, hen the COVID-19 students, friends, and supporters of pandemic struck the Albert Einstein College of Medicine COVER STORY and Montefiore Bronx last spring, it 22 CONFRONTING COVID-19 disrupted our lives in Published by Four physicians and researchers organize for the onslaught Wways we had never experienced before The Philip and Rita Rosen Department of the pandemic, guide patient care during the crisis, and of Communications and Public Affairs develop potential lifesaving therapies and for a time it threatened to over- Gordon Earle, Associate Dean whelm us. But as Albert Einstein once Office of Development FEATURES said, “In the middle of difficulty lies Rachelle M. Sanders, Vice President and opportunity.” Chief Development Officer 12 EINSTEIN STUDENTS TAKE ACTION The pandemic summons many Einstein fourth-years to Evidence of that can be seen in how Director, Science and Research Content Larry Katzenstein graduate early and work at Bronx hospitals, while graduate 22 different parts of the Einstein commu- students pivot to create an antibody test nity have rallied to confront a virus that Senior Director, Strategic Communications and External Relations was rapidly filling hospitals with new Deirdre Branley 18 EXAMINING RACISM AND SOCIAL JUSTICE patients daily. Our cover story (page 22) Einstein’s two deans for diversity share their thoughts on Managing Editor focuses on four Einstein and Montefiore Susan Byrne how to help stop institutional racism physicians and researchers and how Director, Creative Services 38 WOMEN IN UROLOGY they have organized for the onslaught of the solution (page 18). Marie L. Kurtz Female role models at Einstein and Montefiore are inspiring of patients, dealt with the crisis while Finally, despite COVID-19, our Senior Director of External Relations, women to consider this specialty in the eye of the storm, and developed research continues. Type 1 diabetes is Development Rachel Eddey 42 TYPE 1: THE OTHER DIABETES potential therapies to save lives. increasing at an alarming rate. Einstein As the autoimmune disease increases at an alarming rate, Our students and staff have risen and Montefiore scientists are working Associate Director of External Relations, Development Einstein and Montefiore physicians and researchers are to the challenge as well. Many fourth- to address this autoimmune disease on a Sean McMahon 18 addressing it on a number of fronts year medical students took the oppor- number of fronts (page 42). Art Director tunity to graduate several weeks early I’m extremely proud of what Lorene Tapellini 60 SPOTLIGHT: IN FLEISCHER’S FOOTSTEPS New diabetes institute builds on a legacy of research and and join the battle against COVID-19 we’ve accomplished at Einstein and Associate Art Director in Montefiore hospitals (page 12), and Montefiore over the past several months. Jeneffer Lee interdisciplinary care some of our graduate students changed Despite the difficulties that are sure to Illustrations DEPARTMENTS the focus of their research to come up lie ahead, it’s clear that we are taking the Tatyana Starikova Harris with an urgently needed coronavirus opportunity to make many good things Digital Imaging 2 Campus News Donna Bruno antibody test (page 16). Our essential happen here. 6 Research Notes staff members have been keeping our Photography 8 Lab Chat: Jonathan Ross, M.D. jtorresphoto.com campus running (page 2) during this 52 Passionate Pursuits tremendously challenging period so that Multimedia Communications 54 Crossword: Albert’s Puzzler Sunita Reed, Director 42 crucial experiments can continue. 55 Motivations: The Front Line of Philanthropy Over the past several months we Address correspondence to: 57 Continued Connection: Emanuel Phillips, M.D. ’59 Editor, Einstein Magazine 64 Your Impact: Justice Felice K. Shea have also seen nationwide protests Jack and Pearl Resnick Campus against the systemic racism and police 1300 Morris Park Avenue, Belfer 905 68 Class Notes violence that have damaged the lives Bronx, NY 10461 73 A Look Back GORDON F. TOMASELLI, M.D. of Black Americans and other people Email: [email protected] Visit magazine.einstein.yu.edu The Marilyn and Stanley M. Katz Dean Website: www.einstein.yu.edu or scan code of color for far too long. Einstein’s two Albert Einstein College of Medicine deans for diversity share their thoughts Copyright © 2020 Executive Vice President, Chief Academic Officer Albert Einstein College of Medicine ON THE COVER: Illustration by Tristan Eaton (b. 1978) on how our community can be a part Montefiore Medicine All rights reserved Artwork commissioned by Montefiore | Einstein, 2020

MAGAZINE.EINSTEIN.YU.EDU 1 CAMPUS NEWS

Einstein Meets the COVID-19 Challenge

everal Einstein teams stepped up to keep vital services running on campus last spring, when many people Swere asked to work from home because of the pan- demic. These frontline workers have allowed the College of Medicine to continue essential operations around the clock. “A lot goes on behind the scenes,” says Neil Kaplan, chief of security and transportation. “The research here never stops.” There are research animals to be cared for, IT support to provide, lab orders to process, mail to deliver, buildings to secure, staff to feed, rooms to sanitize, and heating and cool- ing to maintain. “Some people took on additional respon- sibilities last spring and helped out in other departments as well,” says Joe Ben-Ari, director of design and construc- tion. “They are proud to be a part of it all, to make sure our experiments can go on. They are truly selfless.”

THIS PAGE, at top: Wearing full personal protective equipment to ensure both human and animal safety, staff members Lindann Depesa, left, and Alexis Castanon check on the research mice in the Institute for Animal Studies. Below, chef Dan Lopez wears a face mask as he prepares vegetables for one of the menu options available in the Forchheimer Building’s Main Street Café.

OPPOSITE PAGE, clockwise from top left: Multimedia systems engi- neer Elvis Cruz sets up the technology for a remote learning video- conference broadcast from Robbins Auditorium; Richie Resto of the receiving department makes sure that supplies are delivered to labs; Sonia Torres of the housekeeping department disinfects a hallway; the security team of Gary Francis, left, Marie Bailey, and Amaury Pena screen a visitor at the Michael F. Price Center for Genetic and Translational Medicine/Harold and Muriel Block Research Pavilion; Freddy Vasquez sorts the never-ending stream of Einstein mail for delivery; and engineer Dario Vazquez of facilities management provides maintenance on the central boiler, which provides heating, air conditioning, hot water, and other steam-related services such as autoclaving and cage washing.

VIEW MORE Find additional photos, including of members of the environmental health & safety team:

magazine.einstein.yu.edu/challenge20 Photos by Jason Torres

2 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 3 CAMPUS NEWS

Dr. Edward Chu to Lead New Roles for Einstein Faculty Cancer Center Dr. Gong Picked to Dr. Tagoe Named Dr. Chambers to Direct Dr. Cassese Named Edward Chu, M.D., novel agents and treatment Lead Pulmonary Medicine Chief of Rheumatology Family Medicine Research Education Associate Dean M.M.S., has been named approaches. His research has the director of the National focused on the molecular Michelle Ng Clement Tagoe, Earle Todd Cassese, Cancer Institute (NCI)– mechanisms underlying drug Gong, M.D., M.D., Ph.D., has Chambers, M.D., has been designated Albert Einstein resistance. Additionally, he M.S., has been been named chief Ph.D., M.P.H., named associate Cancer Center (AECC), has studied Chinese herbal named chief of the division has been dean for medical the vice president for cancer medicine and its integration of the division of rheumatology appointed direc- education at medicine at Montefiore with standard care, with the of pulmonary in the depart- tor of the division Einstein. Dr. Medicine, and a professor goal of improving outcomes medicine in the ment of medicine of research in the Cassese, an asso- of medicine and of molecu- and reducing the toxic side department of medicine at Einstein at Einstein and Montefiore. Dr. Tagoe department of family and social medi- ciate professor of medicine at Einstein lar pharmacology at Einstein, where he effects of chemotherapy. and Montefiore. Dr. Gong will also joined Einstein and Montefiore in 2004 cine at Einstein and Montefiore. and a hospitalist at Montefiore, came will hold the Carol and Roger Einiger The AECC was one of the first three continue her roles as chief of the and previously served as a professor of Dr. Chambers is an associate profes- to Einstein in July 2018 as the inaugu- Professorship of Cancer Medicine. academic cancer research centers to division of critical care medicine and medicine and director of clinical opera- sor of family and social medicine and of ral assistant dean for clinical sciences Dr. Chu, who started his new roles receive an NCI designation, which it leader of the unified Jay B. Langer tions in the division. epidemiology & population health and education. on Oct. 1, will unite Einstein’s and has held since 1972. Under more than Critical Care Network. Dr. Tagoe’s research focuses on a member of the leadership team for the A recognized thought leader in med- Montefiore’s cancer programs into two decades of leadership by I. David Dr. Gong completed a combined autoimmune thyroid disease, which New York Regional Center for Diabetes ical education with particular strengths an integrated research and clinical Goldman, M.D., researchers have made fellowship in her two specialties at affects about 5% of the population. Translation Research at Einstein. in assessment, basic and clinical science enterprise. fundamental discoveries revealing how Harvard Medical School and is board He is also the site principal investigator “As a department, we continue to integration, gender equality, and curric- cancers form, grow, and spread. The certified in both. Prior to joining for the Consortium of Rheumatology place health equity front and center, ular innovations, Dr. Cassese helped lead CLINICIAN AND RESEARCHER AECC works with the Montefiore Montefiore and Einstein, she worked Researchers of North America for rheu- and it’s my goal to have our research the task force that restructured students’ Most recently, Dr. Chu was the deputy Einstein Center for Cancer Care to con- in the pulmonary and critical care matoid arthritis and psoriatic arthritis. agenda reflect that,” says Dr. Chambers, clinical experiences in the wake of the director of the University of Pittsburgh duct hundreds of clinical trials a year. divisions at Massachusetts General A native of Ghana, Dr. Tagoe earned who began his career at Einstein and COVID-19 pandemic and streamlined Medical Center’s Hillman Cancer Approximately 80% of its clinical-trial Hospital and at Mount Sinai in New his medical degree from the University Montefiore in 2007. He says he wants to the preclerkship and clerkship curricula. Center (HCC), the co-leader of the participants are racial or ethnic minori- York. of Ghana Medical School. He com- develop a health equity research lab to Among the positions he has held are: HCC Cancer Therapeutics Program, ties, and it is one of only 14 minority/ As chief of critical care medicine, pleted his Ph.D. in biochemistry at provide dedicated resources at Einstein returning scholar in the Harvard Macy the director of the HCC Phase 1 underserved clinical sites designated Dr. Gong expanded staffing and the University of Leeds in the United to support interdisciplinary studies of Institute Program, Strategic Educators Program, the associate director of the by the NCI Community Oncology supervision while increasing revenue Kingdom. In 1993, he came to the the social determinants of health and the Enhancement Fund fellow with the University of Pittsburgh Drug Discovery Research Program. and cutting expenses and was instru- United States for his internal medicine inequities that result in harmful out- National Board of Medical Examiners, Institute, and the chief of the division of mental in opening the Neuroscience residency at New York Hospital Medical comes for some people. He also would former president of the Directors of hematology-oncology. EAST COAST ROOTS Progressive Care Unit to support the Center in Queens, where he was chief like to help build a diverse pipeline of Clinical Skills Courses, and member of the Dr. Chu is a National Institutes of Dr. Chu is a native New Englander. He Comprehensive Stroke Center. resident. Dr. Tagoe completed his investigators, including medical students, Northeast Group on Educational Affairs Health–funded basic, translational, and received his undergraduate, master’s, As director of critical care research, rheumatology fellowship and postdoc- residents, and fellows. Steering Committee of the Association of clinical investigator and a clinical oncol- and medical degrees from the Brown Dr. Gong built a research program toral fellowship at New York University Dr. Chambers earned his bachelor’s in American Medical Colleges. ogist with a history of developing and University Program in Liberal Medical that generated more than $21 million (NYU), where he became an attending biology from Duke University, his mas- Dr. Cassese earned his medical leading phase 1 and phase 2 clinical tri- Education and stayed on at Brown to do in funding. She is co-leader of the rheumatologist in its Hospital for Joint ter’s in public health from the University degree at the University of Chicago, als, particularly for colorectal and other his internal medicine residency. Health Research Implementation and Disorders. of Illinois at Chicago School of Public where he continued his postgraduate gastroenterology cancers. He has received numerous academic Informatics Core in the Harold and Prior to his clinical career, he was a Health, and his Ph.D. in epidemiology training. He was an assistant professor With his expertise in cancer pharma- honors, has authored more than 200 Muriel Block Institute for Clinical and research associate at NYU and a senior with a concentration on chronic dis- at Yale University before being recruited cology and drug development, he has research papers, and holds a patent on a Translational Research at Einstein and research associate at Scripps Research ease from the University of Pittsburgh to Quinnipiac University as director of been active in designing and developing novel siRNA therapeutic molecule. Montefiore. Institute in La Jolla, California. Graduate School of Public Health. its doctoring course.

4 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 5 RESEARCH NOTES Vaccine Protection Against Herpes Pandemic Dramatically Increases Cardiac Arrests n effective vaccine against herpes against HSV-2 infection viral infections caused by either in mice already infected and Deaths in New York City A HSV-1 or HSV-2 remains elu- with HSV-1. When a sive. Genital herpes (primarily caused by different vaccine candidate HSV-2) is notorious for promoting HIV was used on mice infected he COVID-19 pandemic in infection, and vaccinating against HSV-2 with HSV-1, it provided New York City caused a surge RESUSCITATIONS BY PERIOD could have a major effect on HIV trans- no significant protection T in out-of-hospital cardiac mission. An ideal herpes vaccine would against HSV-2 superin- arrests and deaths, according to a study not only protect against both HSV-1 and fection. By contrast, the co-authored by researchers at Einstein, HSV-2 but also protect people already ΔgD-2 vaccine completely Montefiore, and the Fire Department of infected with HSV-1 (more commonly protected the HSV-1- the City of New York (FDNY). associated with oral disease and highly infected mice from HSV-2 The study, published in June in prevalent worldwide) from becoming superinfection. Herpes simplex type 1 virus (HSV-1). JAMA Cardiology, found a threefold infected by HSV-2. Dr. Herold is a pro- increase in out-of-hospital nontraumatic In a study published in May in npj fessor of pediatrics, of microbiology Block Chair in Pediatrics at Einstein cardiac-arrest cases in March and April Vaccines, Betsy Herold, M.D., and col- & immunology, and of obstetrics & and is chief of the division of pediat- 2020 compared with the same period leagues showed that their experimental gynecology and women’s health. She ric infectious diseases at Einstein and in 2019. On the worst day—April 6— HSV-2 vaccine, called ΔgD-2, protects also holds the Harold and Muriel Montefiore. cardiac arrests peaked at 305, a nearly tenfold increase compared with April 6 one year earlier. The mortality rate for cardiac-arrest cases also rose, from 75% in 2019 to more than 90% during the Mobilizing Blood-Forming Stem Cells

same period in 2020. ©2020 Lai PH et al. JAMA Cardiology Source: “The dramatic increase in cardiac This graph plots the number of daily out-of-hospital cardiac-arrest resuscitations ematopoietic stem cells (HSCs) living mice for several hours. HSCs were arrests compared with the same period performed over the same 56-day period in 2019 (orange) and 2020 (dark blue). reside in the bone marrow and thought to remain stationary within the in 2019 strongly indicates that the pan- H produce all of the body’s blood bone marrow, but the researchers found demic was directly or indirectly respon- 2020 (when EMS call volume had patients were: cells. Clinicians can stimulate HSCs to that the survival of HSCs requires that sible for that surge in cardiac arrests and receded to pre-COVID-19 levels). For • Older (average age of 72 vs. 68 for the enter the bloodstream, where they can they move around constantly. In addi- deaths,” says the study’s senior author, comparison, cardiac-arrest data were 2019 cardiac-arrest patients) be harvested and used for bone-marrow tion, Dr. Fooksman and his team showed David Prezant, M.D., professor of also analyzed for the same time period • Less likely to be white (20% white vs. transplantation to treat cancers and that blocking a receptor on HSCs, called medicine at Einstein, a clinical pul- during 2019. 33%) other conditions. But just where HSCs CXCR4, halts their movement within monologist at Montefiore, and the chief Between March 1 and April 25, • More likely to have hypertension actually “live” in the bone marrow has the bone marrow and causes them to medical officer at the FDNY. 2020, 3,989 patients underwent EMS (54% vs. 46%) been highly controversial, and the mech- enter the bloodstream. The findings The study used data from the New resuscitation attempts for out-of- • More likely to have diabetes (36% vs. anisms involved in mobilizing HSCs to reveal the unexpectedly dynamic nature York City emergency medical services hospital cardiac arrests, compared with 26%) leave the bone marrow have not been of HSCs while in the bone marrow and system. Data were analyzed for patients 1,336 patients who were treated during • More likely to have physical limita- well understood. may lead to strategies for making more 18 years or older with out-of-hospital that period in 2019. tions (57% vs. 48%) In a study published online on June HSCs available in the blood for use in cardiac arrest who received EMS resus- Compared with cardiac arrests in “Our findings show that it’s clearly 25 in Cell Stem Cell, David Fooksman, bone-marrow transplants. citation from March 1, 2020 (when the 2019, cardiac arrests occurring during important to intervene early in the Ph.D., and colleagues used two-photon- Dr. Fooksman is an associate profes- The study’s findings may lead to strategies first case of COVID-19 was diagnosed the pandemic were associated with sev- course of COVID-19 infection, before for making more stem cells available in the laser-scanning microscopy to observe sor of pathology and of microbiology & in New York City), through April 25, eral risk factors. On average, the 2020 cardiac arrests occur,” Dr. Prezant says. blood for use in bone-marrow transplants. labeled HSCs in the bone marrow of immunology at Einstein.

6 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 7 RESEARCH NOTES MAJOR NIH RESEARCH AWARDS Lab Chat $111 Million NCI Grant for Preventing and Treating HIV-Associated Cancers onathan Ross, M.D., is a primary-care physician who focuses on HIV/ AIDS. He works to improve access to HIV care in Rwanda and in immi- J grant communities in the United States. Dr. Ross was born in Israel and he widespread use of antiretro- raised in Westchester County, New York. After studying medicine at Weill viral therapy has helped people Cornell Medical College, he completed a residency in primary care and social Twith HIV live healthier, longer medicine at Montefiore. He joined the Einstein faculty in 2017, where he is lives—but it also means an increased an assistant professor of medicine. Dr. Ross recently completed a master’s risk for developing cancer. For 25 years, degree through Einstein’s Clinical Research Training Program (CRTP). the AIDS Malignancy Consortium (AMC) has led efforts to improve and treat HIV-related cancers. Now What sparked your interest in CRTP, so I modeled it after the research Montefiore and Einstein have received a global health? of my mentor, Kathy Anastos, M.D., five-year, $111 million National Cancer After college, I served as a Peace Corps who works on HIV in Central Africa. Institute (NCI) grant to lead this inter- volunteer in Mozambique, where I My proposal was to study ways to national research consortium. taught high school biology. Living in ensure that people with HIV in Rwanda “People living with HIV shoulder another society and witnessing its enor- initiate and remain on antiretroviral an enormous burden of cancer,” says mous health challenges inspired me to therapy under the country’s HIV treat- Joseph Sparano, M.D., associate chair consider a career in public health. ment guidelines. The NIH [National for clinical research in the department Institutes of Health] funded my pro- of oncology at Montefiore, associate Why did you choose medicine over posal in 2017. director for clinical research at the other possible options? Dr. Jonathan Ross recently wrote a NCI-designated Albert Einstein Cancer Joseph Sparano, M.D., leads the AIDS Malignancy Consortium. After returning from the Peace Corps, You coauthored a “Viewpoint” JAMA article about COVID-19’s impact Center, and principal investigator on on immigrant communities. I worked in community and public article in JAMA on the heavy the grant. “Montefiore and Einstein are “AMC is the only organization Einstein-Rockefeller-CUNY Center for health research in New York City. But burden of COVID-19 on Bronx perfectly positioned to lead this organi- worldwide solely dedicated to the study, AIDS Research (CFAR) and professor of I worried that a purely public health immigrants. Were you surprised at via telemedicine, but I worked on a zation and steer research advances.” treatment, and prevention of cancer in pediatrics and of microbiology & immu- career would limit my involvement “on the toll on this community? COVID-19 ward for a few weeks. The this group of people,” Dr. Sparano says. nology at Einstein, Dr. Sparano has the ground.” I was advised that medical How quickly the pandemic took hold initial uncertainty about how best to ENGAGING THE COMMUNITY The AMC oversees a network of 42 established a scientific working group school would open doors for all sorts of was a surprise—but its impact on immi- care for these patients was a tremen- Approximately 38 million people are clinical trial sites in the United States, focused on cancer and HIV that will clinical work as well as research. grant communities was not, given the dous challenge, to say the least—and infected with HIV, including 1.2 mil- Africa, and Latin America, as well as guide the direction of future collabora- numerous barriers they face in accessing worrying about getting infected and lion in the United States. People living translational scientists who support tive research at the CFAR and the AMC. What attracted you to Einstein and care, such as lack of insurance and fear infecting my family was scary. with HIV have an increased risk of its clinical trials. It also runs a career The group will be co-chaired by Dr. Montefiore? of immigration enforcement. It didn’t developing cancer compared with the enhancement program to cultivate Sparano and Howard Strickler, M.D., I did a fourth-year medical school elec- help that the federal government’s new Do you have any hobbies? general population and are more likely the next generation of leaders. Luca professor and chief of epidemiology tive at Einstein called “Research-Based “Public Charge” rule—under which I love biking. When I can, I bike to die of cancer, interrupting otherwise Paoluzzi, M.D., director of the HIV in the department of epidemiology Health Activism,” which really reso- immigrants who obtain public bene- to work at Montefiore’s Wakefield healthy lives. This is due to a variety of Oncology Service at Montefiore and & population health at Einstein and nated with me. After that, I decided that fits can be denied green cards or visa Ambulatory Care Center. I also love causes, including long-term inflamma- assistant professor of medicine at Montefiore. Montefiore’s social medicine residency extensions—went into effect just as the playing guitar but haven’t played much tion and an overtaxed immune system. Einstein, will act as the AMC’s principal would be a great fit for my career goals. pandemic hit. in recent months with all the extra In addition, HIV infections are con- investigator at Montefiore and Einstein. challenges of the pandemic. centrated in marginalized communities WATCH THE VIDEO How did your work circle back to Has your clinical role changed in the United States, primarily among PARTNERSHIP WITH CFAR See Dr. Sparano discuss his plans for Africa? during the pandemic? people of color, who make up approxi- In collaboration with Harris the future of the AMC: I needed to write a mock grant for the I’ve mostly been practicing primary care Photo by Jason Torres mately 70% of new infections. Goldstein, M.D., director of the magazine.einstein.yu.edu/Sparano20

8 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 9 RESEARCH NOTESNOTES: MAJOR NIH RESEARCH AWARDS

Probing Predementia Predicting the Spread Understanding ‘Chemo Brain’ Understanding the Causes Seeking the Roots Insights Into and Alzheimer’s of Breast Cancer in Children of TB Latency of Adolescent Depression TB Drug Resistance Joe Verghese, M.B.B.S., M.S., received Einstein researchers have received a Chemotherapy usually cures children Many people who are infected with Vilma Gabbay, M.D., and colleagues at The antituberculosis drug bedaquiline, two five-year National Institutes of five-year, $5.1 million grant from the diagnosed with acute lymphoblastic Mycobacterium tuberculosis (Mtb), the Einstein and Montefiore have received a combined with at least four other Health (NIH) grants totaling $13.8 NIH to further develop their novel tests leukemia, but it may affect key cognitive bacterial pathogen that causes tuberculo- five-year, $4 million NIH grant to iden- drugs, has transformed the treatment million to study predementia and for predicting whether primary breast functions, including memory and atten- sis (TB), harbor latent bacteria that later tify biological and behavioral factors of multidrug- and extensively drug- Alzheimer’s disease. Dr. Verghese is tumors are likely to spread. The prin- tion. Elyse Sussman, Ph.D., professor in in life reactivate to cause active disease. predicting the duration and severity of resistant (M/XDR) TB. However, a professor and the chief of the uni- cipal investigators are Thomas Rohan, the Dominick P. Purpura Department Determining the mechanisms that regu- depression in adolescents. Dr. Gabbay due to serious side effects, up to one- fied divisions of geriatrics and of M.B.B.S., Ph.D., D.H.Sc., professor of Neuroscience and of otorhinolaryn- late Mtb latency is important for under- is an associate professor of psychia- fourth of patients stop treatment cognitive & motor aging at Einstein and chair of epidemiology & popula- gology-head and neck surgery, along standing how the bacteria inflicts its try and behavioral sciences and in the early. Bedaquiline has a much longer and Montefiore, the Murray D. tion health, and John Condeelis, Ph.D., with colleagues at the Rutgers Cancer damage. Research by John Chan, M.D., Dominick P. Purpura Department of half-life than the drugs it is combined Gross Memorial Faculty Scholar in professor and co-chair of anatomy & Institute of New Jersey, has received a suggests that the Mtb gene Rv2623 may Neuroscience at Einstein and director with, so a halt in treatment means that Gerontology, and the director of structural biology. The test for predict- five-year, $4.6 million NIH grant to play an important role in regulating Mtb of the Psychiatry Research Institute at bedaquiline persists in the bloodstream the Resnick Gerontology Center at ing tumor spread was developed by determine how chemotherapy exerts latency. The NIH has awarded Dr. Chan Montefiore Einstein (PRIME). Her for many months, allowing TB bacteria Einstein. The first grant, for $7.6 mil- Dr. Condeelis and his colleagues in the its damaging effects on the brain. They a five-year, $4.5 million grant to study team hypothesizes that inflammation to become resistant to it in the absence lion, funds a study of the predementia Gruss Lipper Biophotonics Center and will investigate how chemotherapy dis- how Rv2623—the protein encoded by leads to dysregulation of reward cir- of other drugs to combat them. James condition called motoric cognitive risk its Integrated Imaging Program, both of rupts sensory processing, memory, and the Rv2623 gene—regulates the growth cuitry (brain areas involved in feeling Brust, M.D., was awarded a five-year, (MCR). The study, involving 11,000 which he co-directs. They had observed attention in children; where damage of Mtb in an infected host. The find- pleasure) and, eventually, to depression $3.6 million grant from the NIH older adults in six countries, will look that breast cancer spreads elsewhere in is occurring in the brain; and whether ings from this research may reveal how in adolescents. Previous research has to investigate the development of for biomarkers for MCR. The second the body when three specific cell types a biomarker can be found to identify Mtb evades the host’s immune response shown that increased inflammation of resistance to bedaquiline after therapy is grant, for $6.2 million, funds research are in direct contact, forming a “door- those most vulnerable. Their long-term to persist in a dormant state in infected the brain is associated with the inability interrupted. The study involves patients on at-home use of transcranial direct way” (referred to as a tumor microenvi- objective is to develop protective inter- people, and may suggest novel therapies to feel pleasure. During three sessions in South Africa with M/XDR TB and current stimulation (tDCS), delivered ronment of metastasis, or TMEM) that ventions that can prevent permanent for treating Mtb infection. Dr. Chan is over two years, 120 adolescents with will address fundamental questions through a head covering. The study allows tumor cells to enter blood vessels. harm. The new study will include 240 a professor of medicine and of micro- depressive symptoms will receive evalu- about bedaquiline pharmacology and will evaluate whether six-month use of The greater the number of TMEMs children between the ages of 5 and 12 at biology & immunology at Einstein and ations for psychiatric illness, functional resistance. Dr. Brust is an associate tDCS can improve cognition in 100 observed in tumors, the more likely the Children’s Hospital at Montefiore and an attending physician in infectious MRI of reward circuitry, and blood tests professor of medicine at Einstein and an Alzheimer’s patients. tumor will metastasize. the Rutgers Cancer Institute. diseases at Montefiore. for inflammation. attending physician at Montefiore.

10 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 11 s thousands of COVID-19 patients were pouring into Bronx hospitals last spring, dozens of fourth- A year med students opted to accept Einstein’s offer to let them graduate early to help battle the pandemic. There would be no restaurant celebrations or nights out with friends. Instead, many pivoted to help stressed healthcare workers cope with the increasing need for patient care at Montefiore. Here are three of their stories.

BENJAMIN LIU, M.D. doing compressions. “Moses, Weiler, Emergency Medicine Wakefield, and CHAM [Children’s For early Einstein graduate Benjamin Hospital at Montefiore] were treating Liu, the most sobering moment was the more than 900 COVID-19 cases at that first time he signed “M.D.” after his time, and Weiler had about a third of name on a death certificate. “It was a them,” he says. “I made the most out of jarring experience,” he says. a horrible situation.” Dr. Liu started working on the car- He visited patients every morning, At left, new Einstein graduate Benjamin Liu, diac telemetry floor of Weiler Hospital making sure they had the oxygen they M.D., inside Weiler Hospital last spring. Above, just three days after his April 17 grad- needed or turning them over so that their he takes a break outside the hospital. uation. He thought he’d already seen lungs could work better. “The sad part is his fair share of death: eight patients he that there was nothing much you could wanted if they could speak for them- had helped care for during nearly two do to change their prognosis,” he says. selves. Some families felt if they moved years of rotations. The telemetry floor Dr. Liu hopes the pandemic will help to palliative care, that would be like took care of COVID-19 patients with Americans realize the importance of dis- killing their loved one. But my response GRADUATING EARLY TO heart conditions. The team on that floor cussing end-of-life care. “What bothers to that was ‘You’re not killing them. The recorded 12 deaths over the next month, me isn’t that people die—that is always virus is.’ and he had personally followed six of sad—but how people die and how we “As physicians with modern technol- them. “Those were very tough weeks,” can make it better,” he says. ogy we can keep people alive for quite a BATTLE COVID-19 the 27-year-old says. “It felt like the sky Since family members were not long time—we artificially sustain them,” was falling down.” allowed to visit, Dr. Liu’s responsibilities Dr. Liu says. “But is that a life worth included phoning family members daily living? We don’t always ask ourselves, RELIEF FOR THE FRONT LINES to tell them how patients were doing. ‘When is it appropriate to stop?’” The coronavirus crisis summons many Einstein Dr. Liu decided to graduate early “I tried to make it clear to families fourth-years to work at Bronx hospitals because “I felt like I had something to what was happening, to give them the NO REGRETS offer,” he says. “The hospital staff was patient’s realistic chances of recovery,” Dr. Liu’s experience with COVID-19 overwhelmed, and I wanted to relieve he says. By the time patients arrived at prompted him to get a healthcare proxy BY SUE BYRNE the front lines.” Weiler, “they often were pretty sick and that he asked his sister to sign. “It was His emergency medicine training couldn’t make decisions on their own,” a weird thing to do,” he says. “Getting helped, and he had experience putting Dr. Liu says. “So part of my job was ask- sick myself was definitely on my mind:

Photos courtesy of Benjamin Liu, M.D. in intravenous lines, drawing blood, and ing families what the patient would have Will I be one of those people who do

12 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 13 STUDENT COVID-19 RESPONSE

Hospital on the Einstein campus, part of As Dr. Morales Allende now she knew she was witnessing history and “Neither death was unexpected—they a team consisting of one intern (radiol- immerses herself in her Montefiore wanted to be a part of it. were extremely ill and we knew what ogy), one resident (anesthesiology), and surgery residency, she reflects on the the outcome was likely to be. They just one attending (medicine). She worked as past several months. “Everybody is still EXPECTED LOSSES happened sooner than the team was a subintern, making rounds every morn- struggling,” she says. “But as much as In March Dr. Yeung had been complet- prepared for.” ing, checking notes and labs to see how you want to complain, it’s hard to do. At ing her medicine subinternship at Jacobi Then came Einstein’s offer allowing patients did overnight, examining them, least you have your health, you know?” Hospital before Einstein’s clinical educa- fourth-years to graduate early, and she and reporting back. tion was suspended because of the pan- signed up to work as a new physician “Montefiore gave us a daily recap, demic. A couple of weeks later she fell ill on COVID-19 floors at Montefiore’s explaining the latest protocols, what ALYSSA YEUNG, M.D. with a mild case of the virus herself. Wakefield and Moses campuses.

we were doing well, and what needed Photos courtesy of Ana Paula Morales Allende, M.D. Obstetrics and Gynecology When she recovered, Dr. Yeung to change,” she recalls. “They told us Getting sick from COVID-19 last spring returned to Jacobi as a volunteer sub- EVOLVING PROTOCOLS things like, ‘This many patients were made Dr. Alyssa Yeung all the more itern on COVID-19 units. Physicians Dr. Yeung says she felt “more responsi- extubated today’ or ‘Tomorrow we determined to battle the pandemic once from many different specialties were bility, and it seemed more real” when are going to start giving steroids.’ It she got better. coming together to help deal with the she went into the hospital after graduat- was a stimulating and ever-changing For one thing, she hoped her hard- flood of patients. “I was on a team with ing. She needed to adapt to a constantly environment.” won antibodies might protect her from a pediatrician and an obstetrician- evolving situation when it came to reinfection. “That’s still to be deter- gynecologist,” she says. “The internal diagnosing and treating patients. “Loss Ana Paula Morales Allende, M.D., in medical scrubs, at left, and wearing a face BONDING WITH PATIENTS mined, but I did feel more comfortable medicine residents were very experi- of taste and smell was something that we shield over a face mask on a COVID-19 floor at Weiler Hospital last spring. Dr. Morales Allende especially remem- with the situation because I’d already enced and great at helping everyone out. were hearing about early on, and then bers a patient she worked with for three gotten sick, and I wanted to help in “In my first couple of days, two of those losses became official symptoms well, or not? I heard about young people newly minted Einstein graduate—born weeks: a woman in her mid-60s with whatever way possible,” she says. And my patients passed away,” she says. to look for,” Dr. Yeung says. “And the who were intubated and didn’t make it.” in Argentina, raised in Queens—felt COVID-19 complicated by chronic drug hydroxychloroquine, touted early Dr. Liu is now involved in his emer- compelled to be there. obstructive pulmonary disease. The Alyssa Yeung, M.D., recovered from a case of COVID-19 last spring and quickly on as a game-changer, turned out to be gency medicine rotations at Montefiore “We have a large immigrant and patient did well when first hospitalized, signed up to graduate early to work at Montefiore hospitals. ineffective.” and Jacobi Hospitals. As he braces for minority population in the Bronx,” but later kept needing more and more Working with COVID-19 patients, the pandemic’s possible second wave, she says. “I feel a great connection to oxygen. Since no visitors were allowed on says Dr. Yeung, helped her learn about he is glad to have helped stem the first them—I speak their language, I under- COVID-19 floors, Dr. Morales Allende workflow and other nonclinical aspects one. “I didn’t want to look back 10 years stand their culture, and I knew that brought in an iPad so that the patient of medicine that she hadn’t focused on could communicate with her family. from now and say I didn’t do everything people of color were being dispropor- Photo by Jason Torres directly as a medical student. “I saw the I could,” he says. tionately affected by COVID-19. I “We were buddies, and I got to know additional steps involved in taking care wanted to advocate for them.” her whole family after speaking to them of a patient—calling family members every day,” Dr. Morales Allende says. “It to update them, working with consult ANA PAULA RISKY BUSINESS was just so sad when I had to tell her, teams, arranging for discharge,” she says. MORALES ALLENDE, M.D. Dr. Morales Allende completed a ‘We need to intubate you because you “We get a taste of those things during Vascular Surgery rotation in ambulatory medicine in are getting worse.’ medical school, but we don’t fully appre- Before starting her first shift as a physi- mid-March, just as the pandemic “I rolled in the iPad so she could tell ciate their importance until afterward.” cian last April, Dr. Morales Allende was began hitting the Bronx. She learned her family what was going on. I wanted Now beginning her residency in terrified. COVID-19 was a mysterious that Einstein was considering allowing to stay hopeful and tell her she’d see her obstetrics and gynecology at Montefiore, illness that kept filling intensive care fourth-years the chance to graduate family later,” she says. “But the truth she says these past months have been beds in the Bronx. early. After talking to friends, family, about intubation was that mortality rates “one of the best learning experiences a “I knew I was taking a risk,’” she and professors about the risks and bene- were high. I knew she might be saying person could possibly get. I’m fortunate says. “It was pretty scary. Some health- fits, she decided to take the plunge. goodbye forever.” The patient was trans- to have been a part of it. Medicine is care workers had gotten sick, and I Dr. Morales Allende quickly found ferred to the intensive care unit and died changing right in front of our eyes.” didn’t know what to expect.” But the herself on a COVID-19 floor at Weiler a little more than a week later.

14 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 15 EINSTEIN STUDENTS STUDENT COVID-19 RESPONSE VOLUNTEER

When the COVID-19 crisis hit New Virology at Einstein. “Our labs have a lot Chandran. “But as a result, Montefiore York City in mid-March, Einstein of tools that we can use to study different was able to give us a plentiful supply of medical and graduate students viruses,” says Ms. Wirchnianski, a sixth- the sera we needed to validate the test.” mobilized to help the Bronx cope. year Ph.D. candidate. “If we could apply Mr. Malonis, with others in the Lai More than 100 fourth-year med-

Photo by Jason Torres them to this new virus, and we could lab, produced large quantities of spike ical students opted to graduate make some small difference in combating protein by inserting a gene into cells early; more than one-third of them this pandemic, we wanted to try.” grown in tissue culture. As soon as he signed up to work in clinical Robert Bortz, a sixth-year M.D./ could isolate and purify a batch, he settings. Ph.D. candidate and Ms. Wirchnianski’s would deliver it to Ms. Wirchnianski Nearly 400 volunteers colleague in the Chandran lab, agrees and Mr. Bortz, who would use it to test contributed more than with her. “Kartik asked who was avail- hundreds of patient-serum samples. 10,000 total hours ... * able and willing to come in to build “As a small academic lab, this was this diagnostic test, given that we had a something we were not used to,” Mr. limited number of people who could be Malonis continues. “What was exciting Helping at hospitals in the lab, to maintain social distancing,” is that it felt like we were part of a large he says. “As someone deeply interested in effort at Einstein, one of many labs that Answering Occupational virology research, I was eager to help.” were focused and determined. It was Health Services calls something unique that I had never expe- A TEAM EFFORT rienced before in my training.” Testing COVID-19 Members of the Lai and Chandran labs samples first determined how best to coordinate USEFUL RESEARCH their efforts to develop the antibody Mr. Bortz agrees. “This has been an amaz- Caring for children, Ph.D. candidate Ariel Wirchnianski, center, works in the lab with M.D./Ph.D. students Ryan Malonis, left, and Robert Bortz. The three test. “It was, ‘We’ll do this, we’ll hand it ing learning experience, finding out what helping with homework, students, all sixth-years immersed in virology research, processed samples of donated blood from recovered COVID-19 patients. off to you, and then you will do that,’” it takes to mobilize such a huge effort, to and pet sitting Mr. Malonis says. His own role involved shut everything down and then build a making large quantities of the coronavi- test for detecting antibodies against a virus Delivering groceries, EINSTEIN GRADUATE STUDENTS JOIN FORCES rus’s spike protein, which the coronavi- we’re not familiar with,” he says. meals, prescriptions, rus uses to infect human cells; antibodies The successfully validated test is and medical supplies TO CREATE CORONAVIRUS ANTIBODY TEST that do the best job of protecting against now being used in Montefiore’s clinical infection are those our immune systems pathology lab. “That’s not something we Constructing face masks make against these proteins. Dr. Lai always think about on the research side,” and face shields wo of them had been study- COVID-19, the disease caused by the was working in the Michael F. Price explains: “Our test would use the spike Mr. Bortz says. “It has given us a differ- ing Ebola infection. Another coronavirus (page 35). Center for Genetic and Translational protein like bait, to detect those antibod- ent perspective on the types of experi- Finding and distributing Twas working on mosquito- and Ryan Malonis, a sixth-year M.D./ Medicine/Harold and Muriel Block ies from a patient’s serum.” ments we do in our day-to-day work, donations of face masks, tick-borne diseases. But last March, all Ph.D. candidate, hit the ground run- Research Pavilion in the lab of Jonathan Both of the labs processed sam- and makes me wonder how we can com- face shields, gloves, gowns, three Einstein graduate students quickly ning: His work on chikungunya virus, Lai, Ph.D., professor of biochemistry at ples of donated blood from recovered mit to being more clinically relevant or scrub sets, and goggles switched gears to tackle a different bug. which is transmitted by mosquitoes, uses Einstein. COVID-19 patients—which came in useful during a pandemic situation.” Within weeks they were playing key some of the same technology needed to Across Morris Park Avenue in the at all hours—to separate out the serum, Ms. Wirchnianski says that her work Assembling and roles in creating an antibody test for the develop a coronavirus antibody test. Samuel H. and Rachel Golding Building, the part of the blood that contains on the coronavirus antibody test has distributing infant novel coronavirus. “This brand-new coronavirus was Ariel Wirchnianski was developing antibodies. helped people understand why virus survival kits The antibody test was crucial for devastating the community around us, antibody therapies against the Ebola The three students had one big advan- research is important. “My family used to determining whether people had been and very little was known about how it virus in the labs of Dr. Lai and Kartik tage in developing the test: “Montefiore ask, ‘What do you do in the lab all day?’ Performing telemedicine previously infected and for evaluating worked,” he says. “As infectious-disease Chandran, Ph.D., professor of microbi- Health System unfortunately was at the Now that the coronavirus is mainstream wellness checks whether serum from recovered patients researchers, we felt a sense of duty to ology & immunology and the Harold epicenter of the epicenter of the pan- news they say, ‘OK, I get it. What you do could effectively treat patients ill with be a part of this effort.” Mr. Malonis and Muriel Block Faculty Scholar in demic in the United States,” says Dr. is actually useful,’” she says with a laugh. *March through May 2020

16 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 17 n the wake of nationwide protests against police Examining Racism violence and systemic racism, we reached out to two IEinstein leaders to get their take on these major events. Here, Nerys Benfield, M.D., M.P.H., senior associate dean and Social Justice for diversity and inclusion, and Irene Blanco, M.D. ’04, Q&A With Drs. Nerys Benfield M.S., associate dean for diversity enhancement, share their thoughts on how we at Einstein and Montefiore can help and Irene Blanco stop institutional racism.

How do you feel about the I am heartened by the discussions we events surrounding George are having on campus. I just hope we Floyd’s death and the resulting can keep moving forward and use this social-justice movement? energy to effect positive change. Dr. Benfield: My overriding feeling is of being energized. It feels like there Public opinion has shifted in a finally is momentum on many levels. very short time: Most Americans The work within one institution is now believe that systemic racism valuable, but structural racism needs a is a real problem in this country breadth of effort to make real change. and needs to be addressed. Have I’m also incredibly saddened that it you seen a corresponding change took something this dramatic to push at Einstein? the conversation back into the national Dr. Benfield: I think what has changed space. We were here in 2014 with is the sense of urgency. Einstein devel- Michael Brown. And we were here with oped a diversity and inclusion strategic Rodney King [1991] and with Amadou plan years ago. It was understood as Diallo [1999]. But I’m optimistic that important and valuable to the Einstein there is real momentum for change. And community. But now a large group hopefully we can sustain this. is finally saying “Oh, right, it is a Dr. Blanco: I agree that it is incredibly structural issue.” But we’re still on the energizing to see all these millions of upslope of the curve. people who have taken to the streets, Dr. Blanco: Especially when we’re amplifying these voices and bringing talking about an incredibly difficult light to police brutality and systemic rac- subject fraught with so much emotion. ism. But at the same time, it is frustrat- Making changes is not simply like Nerys Benfield, M.D., addresses ing because we’ve been talking about this introducing a new test for hepatitis B. those assembled on the lawn during for a very long time—and in my own You run the test, you do the numbers, it Einstein’s moment of solidarity, held career for decades. Do we really have looks like a great test, you capture more June 5 in the wake of the killing of George Floyd. At right, Irene Blanco, to watch someone’s televised murder to patients, you implement it. This is not

M.D., holds a sign. Photo by Lori Adams galvanize people around this issue? But that. We are talking about changing

18 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 19 EXAMINING RACISM AND SOCIAL JUSTICE

things that are ingrained and structural no qualms about putting the spotlight of mistreatment compared with and touch every aspect of the institu- on what needs to change, while we white medical students. Is that tion. It’s naïve to think there will be were so scared—were we going to lose also true at Einstein? If so, how quick solutions. our scholarships? Were we going to has Einstein addressed this sort of get kicked out of school? Our students discrimination? While Einstein’s faculty is more today are saying “Enough is enough.” Dr. Blanco: If we look at our diversity diverse than that of many insti- Seeing how much the students have engagement and climate survey, we tutions, can more be done to accomplished now is mind-boggling, know that certain populations definitely improve diversity in hiring and but their job is to be trained and then do not feel included, particularly our Einstein students hold posters during the moment of solidarity assembly in June. promotion? potentially leave Einstein. The onus is Black associates and students, as well Dr. Benfield: If we think about the hir- on us to stay and take up the flag. I hope as our LGBTQ associates and students. STUDENTS SEEK IMMEDIATE STEPS “We have to make ing process, we should think about each we can move a little faster now, because And it’s a work in progress. We need to AGAINST SYSTEMIC RACISM step and how we can intervene. How there’s a lot of continued, persistent address everything that these students Prompted by national events over the past several months, Einstein’s sure our candidates can we ensure that our network is broad work that needs to be done. This is not are facing. Let’s say that we made the chapter of White Coats for Black Lives, in conjunction with the Student understand that diversity and focused on diverse candidates? a sprint—it’s a marathon. most-inclusive environment in terms of Collective for Action on Diversity, sent a letter in July to Einstein’s Whether we are working with a search the faculty and all the administrators. If leaders indicating their concerns about systemic racism, which they and inclusion are central firm or doing it ourselves, we need How does our curriculum address students go out to an affiliate hospital stressed require meaningful and immediate action. values for us.” to use an expanded network list. We social justice, which Einstein views and they are faced with microaggres- “In order to put an end to the cyclic violence against Black Amer- also have to make sure our candidates as one of its core missions? sions, that’s not an inclusive environ- icans, we must now act to fundamentally transform the ways our — DR. NERYS BENFIELD understand that diversity and inclusion Dr. Blanco: How do we take things ment. When you see people addressing society and institutions function,” their letter stated. The two student are central values for us. And we need that are part of the elective curriculum patients in disparaging ways and you’re groups listed specific areas for action; the letter was signed by more to support junior investigators of color and make them compulsory? All medical from that community, you take it to than 200 medical and graduate students, faculty, staff, residents, and once they arrive, whether it be through students must take at least an introduc- heart, right? That faculty member is alumni. It addressed 12 major categories for change, from antiracist funding, mentorships, or opportunities tion to implicit-bias mitigation training actually talking about you. That resident training to increasing recruitment and retention of underrepresented for program participation. And how during orientation. How do we make is talking about you. Our climate survey groups among the students and faculty. can we hold leaders accountable for the this more continuous? We do discuss shows that we need to do more and we diversity that they foster—or don’t—in the social determinants of health as they need to do better, because there are still FACULTY, STAFF, AND ALUMNI ISSUE real ways within their departments? affect populations with certain diseases, a lot of areas where we have to make A CALL TO ACTION but how do we think about and discuss everyone feel included. If you ask our In support of the Black community at Einstein and Montefiore, a letter What are some things Einstein is that more broadly? And not only the students what their opinion is about signed by more than 300 faculty, staff, alumni, and students was sent doing to change how faculty medical school curriculum—how do we this, they’re going to give it to you. to leaders at the two institutions in August, asking for an investment of members are recruited and teach our M.D./Ph.D. and Ph.D. stu- They are not going to hold back. resources to “uproot the weeds of white supremacy from medicine.” retained? Are there any success dents to think about these issues in the A lot of them have done community- The letter further stated: “The communities that we jointly serve and “We need to start stories to share? context of their research? We are very organizing and social-activism work. the communities that many of us belong to are being hit hard by two Dr. Blanco: The creation of Nerys much a translational school in terms of They are adults and they have lived life crises—COVID-19 and police violence—with the common roots of thinking about how [Benfield]’s position was an enormous our research, right? So we need to start and they have perspective. When they structural racism and systemic inequality.” our research affects success story. She has accomplished thinking about how our research affects see something that is not true to their The letter outlined a series of steps to take “in order to create truly quite a bit since she started in the fall of the community and how we teach our values that they know we can do better, benevolent institutions in which all students and residents can learn the community and how 2019. I have the long-term perspective future scientists to advocate for those they’re going to tell us. and thrive.” we teach our future of having seen diversity and inclusion communities. Added one anonymous signer: “Real investment in an antiracist efforts at Einstein since I was a medical healthcare system is long overdue and necessary.” FIND MORE ONLINE scientists to advocate A recent Yale study published student 20 years ago. Things picked up Read more of this Q&A and for those communities.” speed when students were reacting to in JAMA Internal Medicine watch video from Einstein’s READ MORE national events like Eric Garner’s death reported that multiracial medi- moment of solidarity: Find the letters and the administration’s response: — DR. IRENE BLANCO [2014]. Students today have absolutely cal students report higher rates magazine.einstein.yu.edu/justice20 magazine.einstein.yu.edu/letters20

20 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 21 CONFRONTING THE COVID-19 CRISIS Four physicians and scientists at Einstein and Montefiore spearhead coronavirus research and guide patients through a pandemic

BY GARY GOLDENBERG

Tristan Eaton (b. 1978) Artwork commissioned by Montefiore | Einstein, 2020

MAGAZINE.EINSTEIN.YU.EDU 23 CONFRONTING THE COVID-19 CRISIS

my own bathroom. But we live in an IN THE EYE OF THE apartment, and everyone got sick.” (She, her husband, and her two teenage sons have since recovered.) Fortified with acetaminophen and STORM ibuprofen, Dr. Gong set up shop Michelle Ng Gong, M.D., M.S. at home, remotely orchestrating Montefiore’s efforts to scale up its ICU and consulting with clinical colleagues n mid-March, just two weeks after on the front lines. Her tasks included the first COVID-19 case was detected building a central command center I in New York State, patients began where her staff could monitor and direct flooding into Montefiore Medical care for hundreds of critically ill patients Center’s intensive care unit (ICU), trig- on three different campuses. gering anxiety throughout the hospital. “Given the limited size of our No one had seen anything like this, not critcal-care staff, there was no other way even at the height of the AIDS epidemic to manage it all,” she says. Ten days later, a generation earlier. the center—with links to every ICU “We started doing projections about bedside and nursing station—was up and what to expect in the days ahead,” says running in the Binswanger Auditorium Michelle Ng Gong, M.D., M.S., chief on Montefiore’s ground floor. “It didn’t of the divisions of pulmonary medicine matter that I was sick,” says Dr. Gong, and of critical care at Montefiore and whose fever persisted for 10 days. Einstein and professor of medicine and “Patients were rolling in nonstop. If we of epidemiology & population health didn’t set up the command center, many at Einstein. “The worst-case scenario more patients were going to die.” was that we had to prepare for 600 ICU patients at once—six times our normal WE’RE ALL CRITICAL-CARE capacity. Basically, we would have to DOCTORS NOW turn the entire hospital into an ICU.” Meanwhile, Dr. Gong recruited “every- With the administration’s support, body under the sun” to take care of Dr. Gong began planning for a super- patients: anesthesiologists, pediatric sized ICU. And then things went from neurologists, cardiologists, otolaryngolo- bad to worse. A week after treating her gists, endocrinologists, rheumatologists, first coronavirus patient, Dr. Gong gastroenterologists, and psychiatrists. came down with a fever, body Anyone who wasn’t well versed in aches, and fatigue. She didn’t critical care soon would be. Dr. Gong need a nasal-swab test to returned to Montefiore after 13 days know the diagnosis. away, just as the hospital’s COVID-19 “My biggest worry was caseload was peaking. about infecting my fam- Somehow, she and her staff found ily,” Dr. Gong says. “I had time to initiate clinical trials to evaluate already kicked my hus- band out of our bedroom Michelle Gong, M.D., en route to care for

by that time, and I had a COVID-19 patient at Montefiore. Photos by Jason Torres

24 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 25 CONFRONTING THE COVID-19 CRISIS

toll, as days blurred into weeks and says. “It’s so life-affirming, their dedi- “I hope by the more and more staff members fell ill cation and selflessness. There were so with the very virus they were trying to many heartwarming stories, like the end of this quell. In late April, the pandemic’s emo- one of the husband and wife who were pandemic we’ll tional price was brought to the fore by hospitalized with COVID-19 at the news that a NewYork-Presbyterian emer- same time, and the nurse who arranged know a lot more gency room physician had killed herself. for them to share a room. Simple, little “It hurt to the core,” Dr. Gong says. things like that really meant a lot.” about how to To counter the gloom and doom, To Dr. Gong, the biggest heroes handle the next members of the department of psychi- were her critical-care and pulmonary atry were invited to join staff meetings medicine fellows. “These folks are still one.” and lend support. Staffers who were in training, yet they were so skilled in ­— DR. MICHELLE GONG sickened by COVID-19 but had recu- responding to emergencies,” she says. perated and rejoined the battle were “They functioned like full attending awarded “purple pins” decorated with physicians and never lost their cool.” an image of the coronavirus and the Asked to sum up what was learned word “recovered.” Nurses called out from the crisis, Dr. Gong says: “I think “happy codes” over the intercoms to we’ve learned a lot. We’ve learned how celebrate patients weaned from ventila- to mobilize a large system. We’ve learned tors—an antidote to the relentless “rapid how difficult it is to communicate across response” codes alerting the staff to a large hospital—that’s something we patients in distress. need to improve on. I hope that by the A recovered COVID-19 patient is The number of patients in the ICU end of this pandemic we’ll know a lot cheered on by Montefiore health- at the Moses campus finally crested at more about how to handle the next one.” care workers as he is wheeled 300 in late April, a welcome relief to down the hallway. Montefiore’s beleaguered staff. “We were very challenged, but we were never From left are respiratory therapist Sakar Alvarez Brown, Rishi Malhotra, M.D., Michelle Gong, M.D., and Phylis Lorusso, R.N. overwhelmed,” Dr. Gong says. “At every stage, we were able to escalate our “We were very three promising coronavirus medica- early March she’d gone to Washington, resources to meet the needs of patients.” tions. “Doing research is very challeng- D.C., for an international meeting of challenged, but ing when patients are so critically ill,” critical-care physicians. A hot topic of BRAVERY AND HOPE we were never she says. “But we needed to find better conversation: how to conduct research In May Dr. Gong and her team were the treatments, not just for our patients but in the midst of a pandemic. subject of an hour-long CBS News spe- overwhelmed.” also for those in states and countries Practicing medicine in an entirely cial documentary, “Bravery and Hope: where the pandemic was just emerging. new environment posed challenges. Seven Days on the Front Line.” In June ­— DR. MICHELLE GONG Not to have learned anything from all “We got used to the physical inconve- she was given the Museum of the City the lives lost in this city would be an niences—the facial rashes and headaches of New York’s Gotham Icon Award for even bigger tragedy.” from constantly wearing masks,” says her “heroism, selflessness, and amazing Dr. Gong drew on her decades of Dr. Gong. “What was worse was having leadership” during the pandemic. experience participating in and lead- to keep patients’ loved ones away. Many Dr. Gong doesn’t want to be por- ing clinical trials, several focused on of our care decisions depend on fam- trayed as the hero in this story. “I can’t preventing acute respiratory distress, ily meetings, and those had to be done give enough credit to everybody who the death knell for many COVID-19 using apps like FaceTime.” stepped up during this crisis: the admin- patients. In a case of perfect timing, in The intensity of the work took its istrators, the doctors, the nurses,” she

26 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 27 THE CORONAVIRUS AND ITS IMPACT ON THE BODY

COVID-19 can affect virtually the entire body. Einstein and Montefiore researchers are involved in efforts to combat the illness and the novel coronavirus that causes it. Heart Attacks VIRUS–FOCUSED RESEARCH The COVID-19 pandemic in New York Cytokine Storm City caused a surge in out-of-hospital GALIDESIVIR cardiac arrests and deaths during March An antiviral compound discovered at Einstein is Montefiore and Einstein participated and April 2020. (David Prezant, M.D.) being evaluated as a treatment for COVID-19 in two FDA-approved trials evaluating leronlimab, an anti-inflammatory patients in a randomized, double-blind clinical trial drug that showed promise in quelling in Brazil. (Vern Schramm, Ph.D.) “cytokine storms” that can overwhelm C-Reactive COVID-19 patients’ lungs. REMDESIVIR (Harish Seethamraju, M.D.) Protein (CRP) Montefiore participated in two multicenter, A common blood test, for the randomized, double-blind clinical trials evaluating inflammatory biomarker CRP, identifies the antiviral drug remdesivir: (1) remdesivir vs. Convalescent Plasma which COVID-19 patients will benefit or be harmed by steroid treatment. placebo; (2) remdesivir plus the anti-inflammatory Einstein and Montefiore are participating (Marla Keller, M.D., Shitij Arora, M.B.B.S., and drug baricitinib vs. placebo. (Barry Zingman, M.D.) in a randomized clinical trial evaluating WIlliam Southern, M.D.) blood plasma from recovered COVID-19 patients as a treatment for patients with ANTIBODY TEST the disease. (Liise-anne Pirofski, M.D.) Einstein and Montefiore scientists developed an Gut Microbiome antibody test showing whether someone was exposed to the coronavirus. An ongoing study of 16,000 Hispanics/ (Kartik Chandran, Ph.D., Jonathan Lai, Ph.D., Amy Fox, M.D., Cancer Latinos is investigating whether the COVID-19 patients with cancer are much gut microbiome influences the body’s M.S., and Michael Prystowsky, M.D., Ph.D.) more likely to die than those without response to the novel coronavirus. cancer; blood-cancer patients have the (Carmen R. Isasi, M.D., Ph.D., and Robert C. A ‘SAFE’ CORONAVIRUS FOR STUDY highest mortality rate. (Balazs Halmos, M.D., Kaplan, Ph.D.) M.S., and Amit Verma, M.B.B.S.) Einstein scientists transferred the gene for the coronavirus’ spike proteins into the relatively harmless vesicular stomatitis virus (VSV), causing Diabetes ACE2 Receptors spikes to sprout from VSV’s surface. Men have more trouble clearing the (Kartik Chandran, Ph.D., and Rohit Jangra, Ph.D.) COVID-19 patients with diabetes and coronavirus and have worse outcomes who are obese and use insulin are at than women, perhaps because ACE2 greater risk of dying compared with receptors to which the virus binds are other COVID-19 patients with diabetes. highly expressed in the testes. (Shivani Agarwal, M.D., and Yaron Tomer, M.D.) (Aditi Shastri, M.B.B.S.)

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ORGANIZING FOR THE and hospital administrators. In addition, the department’s treatment protocols were disseminated through an online folder and a smartphone app. “Those ONSLAUGHT tools were constantly updated with the Yaron Tomer, M.D. latest guidelines, and this improved out- comes,” Dr. Tomer says. he past few months have been and working remotely during this cru- Collaboration involved the entire a bit of a blur for Yaron Tomer, cial week—far from ideal for a hospital medical center. “COVID-19 is a med- T M.D., but one date in particu- facing the largest crisis in its 138-year ical disease, but we couldn’t double the lar stands out: March 24, 2020. “That history. Fortunately, before the pan- size of our medical service and triple the day, our population health experts demic reached the Bronx, Dr. Tomer size of our intensive-care units without informed us that, at current admission had devised and implemented a “Three help from departments throughout the rates, our health system would soon be C Teamwork” plan for handling the cri- hospital,” he says. “We did not do any- overwhelmed with COVID-19 cases, sis: coordination, communication, and thing alone.” Yaron Tomer, M.D., who recovered from COVID-19, prepares to donate plasma. and we wouldn’t have enough doctors, collaboration. nurses, ventilators, or protective equip- In a nutshell, his approach aimed FLATTENING THE CURVE ment to properly care for every patient to ensure that his thousand-member Montefiore’s frontline workers were of the virus, we learned that we could “This virus directly with the disease,” recalls Dr. Tomer, department of medicine (DOM), by anxious about becoming infected and save lives by taking care of the compli- who is the chair of medicine at Einstein far the hospital’s largest, coordinated bringing the virus home to family mem- cations and giving the immune system harms almost and Montefiore and a professor of medi- its COVID-19 efforts, that leadership bers, and rightly so—nearly one in five time to clear the virus.” every system in cine and of microbiology & immunol- communicated with frontline staff, and residents tested positive for COVID-19. Montefiore physicians were directly ogy and the Anita and Jack Saltz Chair that the department collaborated with But they had an even bigger concern. responsible for several COVID-19 clini- the body.” in Diabetes Research at Einstein. other parts of the health system. “As I met with the hospital’s doctors and cal advances. One example was the use of Adding to his concern, March 24 was To achieve the first C—coordina- nurses,” Dr. Tomer says, “their number steroids to quell the often-fatal inflam- ­— DR. YARON TOMER also when Dr. Tomer was diagnosed with tion—Dr. Tomer assembled a depart- one worry was that we’d have to ration mation caused by the immune system’s COVID-19. “My wife, son, and daugh- mental COVID-19 task force, consisting healthcare, as had happened in Europe. overzealous response to infection. ter also tested positive,” he says. “We all of 18 representatives from all arms of the They were asking, ‘Will we have to “The Centers for Disease Control came down with a mild fever and back DOM. The task force convened every decide who gets admitted to the hospi- and Prevention and two medical soci- pain and temporarily lost our sense of morning via conference call for weeks. tal, or who will get a ventilator? Will we eties had warned against using steroids smell. But given what I’ve seen in the Communication was achieved have to make such decisions?’” in COVID-19 patients, based on their hospital, we were extremely lucky.” through a daily electronic newsletter—a It didn’t come to that, thanks to harmful effects in SARS patients,” Dr. potpourri of news and information New York City’s lockdown and social- Tomer says, referring to the coronavirus THE THREE C’S about COVID-19 treatment proto- distancing measures, which gradually that plagued China in the early 2000s. In the last week of March, more cols and clinical trials, links to salient flattened the curve of the pandemic, “But one of our attendings, Shitij Arora, than 650 COVID-19 patients papers, useful resources such as housing and because Montefiore’s clinicians got M.B.B.S., had a patient who was doing were admitted to Montefiore and parking information, and statis- better at managing patients. very poorly, and he gave her steroids Health System, and the numbers tics on how the hospital was handling “COVID-19 is not like any disease as a last resort. The patient recovered. were increasing exponentially. the pandemic. “My motto was that we have seen before,” Dr. Tomer says. Dr. Arora subsequently tried it on To make things worse, criti- whatever I know about COVID-19 at “This is not just a serious viral pneu- four other critically ill patients, and all cal-care director Michelle Gong, Montefiore, everybody should know,” monia that sometimes affects other responded.” M.D., was already sickened by Dr. Tomer says. organ systems. This virus directly harms Dr. Tomer and his team concluded COVID-19 (page 24). That More than 7,000 staff members and almost every system in the body, includ- that steroids such as prednisone were meant that two of Montefiore’s alumni received the newsletter, as did ing the lungs, the heart, the brain, and beneficial for COVID-19 patients with top physicians were quarantined a sizable number of outside clinicians the intestines. While we couldn’t get rid low oxygen levels and signs of severe

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inflammation. So in early April they Hospitalization and Death Rates Hospitalizations Deaths issued a new steroid-treatment protocol, SPIKING THE which was communicated throughout 800 Montefiore and to other institutions. “We now know from a large clinical 600 CORONAVIRUS trial in the United Kingdom that we did Kartik Chandran, Ph.D. the right thing,” Dr. Tomer says. “That trial found that dexamethasone, another 400 steroid drug, reduces mortality by 20% to 30% in patients.” Montefiore’s own artik Chandran, Ph.D., feared community spread came to light, “People were study during the pandemic found that 200 this day would come. “After he and his wife began to socially steroids reduce mortality by nearly 80% K the SARS, MERS, and H1N1 distance from neighbors and immunologically in COVID-19 patients with the highest virus-caused outbreaks, it seemed only friends and to stockpile supplies naïve and had no level of inflammation. a matter of time until we had a global for a lengthy stay in their Brooklyn Bronx Brooklyn Manhattan Queens Staten Island Montefiore physicians also devised viral pandemic,” he says. “The only home. They withdrew their son real protection.” and disseminated COVID-19 protocols During the time in early 2020 when New York City was nearly overwhelmed by the questions were what agent would cause from his private school and helped COVID-19 pandemic, the Bronx was the most heavily affected borough with respect to for the treatment of potentially deadly it and under what circumstances.” persuade its administrators to shut ­— DR. KARTIK CHANDRAN both hospitalizations and deaths, expressed in this graph as rates per 100,000 residents. blood clots and for ketoacidosis, a severe Source: New York City Department of Health During his years of doctoral and it down before it had a single case, complication of diabetes seen frequently postdoctoral training, Dr. Chandran weeks before public schools in the in COVID-19 patients (page 51). eliminate the health disparities that have can be expected every 10 or 20 years, had mastered the skills for succeeding city did the same. existed for decades, if not centuries.” and we need to plan accordingly.” in academic research, from designing “For my lab, the signal moment DIFFERENT OUTCOMES FOR In addition, many survivors of experiments to writing grants to pub- was the third week of February, DIFFERENT RACES PRESCRIPTION FOR THE FUTURE COVID-19 will still need help. “We lishing papers. Now he needed to learn when several of us were supposed to COVID-19 has highlighted certain Now that this pandemic seems to be have to address the challenges faced by how to run a lab from home—in the go to a conference in San Diego,” strengths of the healthcare system—its easing, at least in New York, Dr. Tomer thousands of patients who’ve recovered middle of a pandemic he had known he continues. “I cancelled our ability to adapt quickly when con- is already thinking about and prepar- from COVID-19 but are still suffer- was inevitable. travel plans. A week later, I told my fronted by a new and catastrophic ing for the next one. “The main lesson ing from complications,” Dr. Tomer For Dr. Chandran, professor of staff that I would be working from disease, for example—but also revealed from COVID-19 is to let the scientists, says. “So we’ve created our COVID- microbiology & immunology and home and that they could do so as glaring weaknesses, such as racial dispar- not the politicians, lead the response to 19 Recovery Clinic, where they can be the Harold and Muriel Block Faculty well.” ities in health outcomes. epidemics,” he says. “Public health and cared for by a multidisciplinary team of Scholar in Virology at Einstein, the Socially distanced but electroni- “I think the level of care that people individual health should take prece- experts.” connection to COVID-19 began cally connected, Dr. Chandran got here in the Bronx wasn’t any differ- dence over everything else.” Dr. Tomer has also been thinking in late January, when the first cases began collaborating on ent than in other regions,” Dr. Tomer A second lesson is the need to plan about the future of postpandemic medi- of COVID-19 were reported in the a variety of COVID- says. “If anything, it was superior. But ahead, just as we do for nuclear disasters cal education. “Since physician training United States. “At the time, government 19 studies. “Most of the Bronx was hit particularly hard by and earthquakes. “For pandemics,” Dr. is taught at the bedside, it will probably leaders and public health officials were the work was done the pandemic, with Blacks and Latinx Tomer says, “I would recommend a plan change less than other aspects of health- giving mixed messages about COVID- by my ‘COVID hospitalized at nearly twice the rate of for storing and distributing personal pro- care,” he says. “There will certainly be 19, saying it was similar to the flu,” he Crew’—the stu- whites. One reason is the inadequate tective equipment, and for developing more remote and virtual learning, but recalls. But as a virologist who works dents in my lab who access to care for chronic diseases such capabilities for creating test kits that can mastering the key aspects of care— with some of nature’s most notorious went in to work on as diabetes, hypertension, and kidney be mass-produced quickly. We also need speaking to patients, examining and pathogens, he wasn’t persuaded. all the COVID- disease—major risk factors for becoming to establish the infrastructure needed diagnosing them—cannot be simulated “People were immunologically naïve 19 projects,” Dr. severely ill or dying from COVID-19. for rapidly manufacturing vaccines by any program or machine. That’s why to the virus responsible for COVID- Chandran says. (See “If there’s anything good that can against known and emerging pathogens. I and so many others became doctors in 19 and therefore had no real protec- “Einstein Graduate come from this,” he adds, “I hope the Pandemics are no longer a once-every- the first place, for those human interac- tion against infection,” he notes. In Students Join pandemic emphasizes the urgent need to hundred-years phenomenon, but instead tions. That’s the beauty of medicine.” late February, when the first cases of Forces,” page 16.)

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TESTING ANTIBODIES the opposite: a “sheep in wolf’s cloth- us something about the epidemiology The first priority was an urgently ing” virus that behaves just as the novel of the disease.” Dr. Chandran’s team is OLD TREATMENT needed antibody test. Montefiore was coronavirus does but is much safer for analyzing the antibodies of dozens of TAKES ON A NEW using convalescent plasma (obtained scientists to study in the lab. recovered COVID-19 patients who will from patients who’d recovered from The coronavirus infects cells via its provide blood samples at regular inter- COVID-19) as a treatment for the surface spike proteins, which enable vals for up to a year. disease and needed a test to ensure that the virus to latch onto and enter cells. PANDEMIC donated plasma was rich in antibodies. Dr. Chandran and his colleague Rohit MAKING ANTIBODIES Liise-anne Pirofski, M.D. (See “Old Treatment Takes On a New Jangra, Ph.D., research assistant profes- In potentially his most consequential Pandemic,” facing page.) sor, transferred the coronavirus spike- COVID-19 project, Dr. Chandran Such a test would also allow protein gene into a relatively harmless is developing a monoclonal antibody arly in the pandemic, as doctors convalescent plasma could offer imme- “COVID-19 conjured Montefiore to determine whether staff virus called vesicular stomatitis virus (mAb) therapy for COVID-19 patients. scrambled to find some way to diate immunity by providing antibodies members exposed to the virus had (VSV), causing spikes to sprout from It’s a turbocharged version of convales- E treat patients infected by the novel that patients need to fight off microbial up thoughts of mounted an immune response and VSV’s surface. cent-plasma therapy. coronavirus, Liise-anne Pirofski, M.D., infections. might therefore safely be able to return By infecting cells in precisely the way Convalescent plasma contains many chief of infectious diseases at Einstein Dr. Pirofski collaborated on the antibodies, plagues, to work. And an in-house test would the coronavirus does, this safer, genet- different antibodies against the corona- and Montefiore, had a eureka moment. JCI article with her longtime Einstein and convalescent increase testing capacity and provide ically engineered version could help virus, some of which neutralize it much “For my entire medical career, I’ve colleague Arturo Casadevall, M.D., backup in case commercial antibody scientists develop drugs that block infec- better than others. Monoclonal anti- been interested in antibodies and how Ph.D., who now chairs the department plasma.” tests were found to have problems. tion and protect against disease. body therapy is much more focused: the they bolster the immune response,” of molecular microbiology and immu- ­— DR. LIISE-ANNE PIROFSKI The antibody test developed by Dr. result of screening plasma from hun- recalls Dr. Pirofski, who is also a pro- nology at Johns Hopkins. Their widely Chandran, Jonathan Lai, Ph.D., and SEQUENCING THE VIRUS dreds of recovered COVID-19 patients, fessor of medicine and of microbiology publicized article, published March their teams looks specifically for anti- “Other groups around the country have finding the one or two antibodies that & immunology and the Selma and Dr. 15, alerted the world to convalescent bodies against the virus’s spike proteins, sequenced the coronavirus, but not here do the best job of neutralizing the coro- Jacques Mitrani Chair in Biomedical plasma—an old and all-but-forgotten which protrude from the viral surface in the Bronx,” Dr. Chandran says. “The navirus, and then manufacturing those Research. therapy with the potential for saving and enable the virus to infect human genetics of SARS-CoV-2—the official antibodies in great quantities. “Studying art history in college, I lives today. cells. (Dr. Lai is a professor of biochem- name of the novel coronavirus—is con- As part of the Prometheus Consort- was particularly intrigued by medically “We recommend that institutions istry at Einstein.) stantly evolving, and it’s conceivable that ium—five institutions collaborating to related images, such as renditions of the consider the emergency use of convales- we could learn something new about it develop antibody-based therapies against dance of death and of people ravaged cent [plasma] and begin preparations as ‘DEFANGING’ A VIRUS from the strains circulating here. Our viruses—Dr. Chandran’s team has eval- by plague. COVID-19 conjured up soon as possible. Time is of the essence,” You’ve heard of a “wolf in sheep’s cloth- preliminary data suggest that uated hundreds of antibody candidates thoughts of antibodies, plagues, and Drs. Pirofski and Casadevall wrote in ing.” Dr. Chandran’s team created the virus arrived in the Bronx and identified several that powerfully convalescent plasma, which had shown JCI. “In the early 20th century, convales- from all over the world, not neutralize SARS-CoV-2. promise against pandemic plagues such cent [plasma] was used to stem outbreaks just from the West Coast as influenza and SARS. Historic uses of of viral diseases such as poliomyelitis, of the United States READ MORE convalescent plasma led to a Journal of measles, mumps, and influenza,” the or from China, Find out how the antibody test Clinical Investigation [JCI] article, which authors wrote, noting that the therapy which tells was created, and learn more helped kick everything off,” she says. fell out of favor with the advent of anti- about the surrogate coronavirus. Plasma, or sera, is what remains microbial therapy in the 1940s but magazine.einstein.yu.edu/ when red and white cells are removed never completely disappeared. It antibody20 from blood: a yellowish liquid con- recently showed promise against magazine.einstein.yu.edu/ taining water, salt, enzymes, and two other coronavirus-caused surrogate20 antibodies. Convalescent plasma is outbreaks (SARS1 in 2003 taken from people who have recovered and MERS in 2012), Members of Dr. Chandran’s lab at work, from from an infection and then transfused as well as the 2013 left: Catalina Florez, Ph.D., Eugenia Dieterle, Ph.D., and Robert Bortz, sixth-year M.D./ into patients suffering from the same West African Ebola Ph.D. student. infection. In contrast to vaccination, epidemic.

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“Although every viral disease and patients with COVID-19 who had in general—is especially urgent in the “What gives me epidemic is different, these experiences respiratory signs and symptoms, half Bronx, Dr. Pirofski says. “For far too provide important historical precedents to receive convalescent plasma and long, the health of poor communities hope is that we that are both reassuring and useful as the other half a placebo. But recently, has not received sufficient recognition or have the ability to humanity now confronts the COVID- recruitment has fallen off. Success in resources,” she says. “Here in the Bronx, 19 epidemic,” the researchers added. controlling the pandemic in the area we see how this has led to the pan- make things better has reduced the number of patients who demic’s devastating effect on Hispanics MAKING PLASMA ACCESSIBLE qualify. As of mid-August, 185 patients and African Americans, due mainly to for people.” underlying health conditions that have “The pandemic allowed me to study the had been enrolled in New York City and ­— DR. LIISE-ANNE PIROFSKI effectiveness of antibodies in people,” the Bronx. gone untreated. What gives me hope Dr. Pirofski says. But her first prior- It’s a national problem as well: other is that, as physicians and scientists, we ity was trying to make convalescent RCTs evaluating convalescent plasma in have the ability to make things better for plasma available to the many patients the United States have so far recruited people in these communities and allevi- for whom it might mean the difference fewer patients than expected as the pan- ate some of the suffering.” between life and death. demic has moved to new areas. By late March, a national conva- To gain insight into plasma’s pos- COMPARISONS WITH AN lescent plasma advisory group (led by sible effectiveness, Dr. Pirofski and EARLIER EPIDEMIC Dr. Casadevall and the Mayo Clinic’s colleagues conducted a meta-analysis For Dr. Pirofski, the COVID-19 pan- Michael Joyner, M.D., and including Johanna Daily, M.D., M.S., at right, and her team helped recruit hundreds of convalescent- on data pooled from 12 RCTs and demic has echoes of her experience Dr. Pirofski) had convinced the U.S. plasma donors. Dr. Daily is a professor of medicine and of microbiology & immunology at other studies from around the world, more than 30 years ago, as a young Einstein and an infectious-disease specialist at Montefiore. Food and Drug Administration to des- involving a total of 804 patients. Their resident on a Bellevue Hospital ward ignate convalescent plasma as an inves- study, posted as a preprint on July 30 where more than a quarter of the tigational new drug, allowing physicians now being reviewed for publication, of establishing its effectiveness against to medRxiv, found that convalescent patients were suffering from AIDS. to administer it to seriously ill COVID- found that convalescent plasma appeared COVID-19. Helpful though it may be, plasma reduced mortality rates for “Taking care of those patients was a 19 patients on a “compassionate use” helpful, especially for younger patients the expanded-access program lacked the patients treated with it by 57% com- devastating experience,” she recalls. basis outside clinical trials. treated early in the course of the dis- necessary control group. Dr. Pirofski pared with those for untreated patients. “There was the same helpless feeling of The resulting U.S. Convalescent ease—a confirmation of past experiences wanted to settle the matter. Meanwhile, in an approach described being overwhelmed, of patients with Plasma Expanded Access Program has with the therapy. On April 17, she helped launch a con- recently in JAMA, other researchers plan labored breathing withering away and proven extremely popular. As of late Other researchers recently published valescent-plasma RCT involving Einstein- to continuously pool and monitor data dying because we couldn’t change the August, the program had administered a “safety update” on the program’s Montefiore, NYU Langone Medical being generated by at least 10 incom- course of their disease. plasma to more than 70,000 patients first 20,000 patients treated under the Center, and the Yale University School plete and still-active RCTs. “It requires “But compared with AIDS back nationwide. In a call with governors expanded-access program. “That study of Medicine, a group that has recently some innovative statistical techniques, then,” she continues, “we’ve known on August 3, U.S. Health and Human showed that convalescent plasma is very been expanded to include the University but this project has the potential for about COVID-19 for a very short Services Secretary Alex M. Azar II said safe, with an incidence of serious adverse of Miami and the University of Texas– reaching scientifically valid conclusions time—only about eight months—and that demand for plasma was exceeding effects similar to standard plasma used in Houston. The Einstein-Montefiore study about plasma once enough data have yet we’ve learned much more about the supply. hospitals every day,” Dr. Pirofski says. was launched with a $300,000 gift from been collected,” Dr. Pirofski says. how COVID-19 occurs and how it’s Dr. Pirofski directed the expanded- the G. Harold and Leila Y. Mathers What will be the verdict? “Everything transmitted, and we’re taking better care access program at Montefiore along GOING FOR THE GOLD Foundation and $200,000 in emer- we’ve learned so far indicates that conva- of our patients.” with co-investigator Hyun Ah Yoon, Randomized controlled trials (RCTs) are gency funding from Montefiore Health lescent plasma is safe—certainly no risk- M.D., and was part of its national lead- medicine’s gold standard: the only way to System; Dr. Pirofski, along with Marla ier than a blood transfusion,” says Dr. ership group. They treated 103 severely conclusively show whether a therapy is Keller, M.D., later received a $4.3 million Pirofski. “As for effectiveness, we won’t MORE ONLINE Get up-to-date coverage of ill COVID-19 patients at Montefiore effective. Despite its more than 100 years National Institutes of Health grant to know for sure until the RCTs have spo- Einstein and Montefiore’s with convalescent plasma and compared of use, convalescent plasma for a pan- support the trial. ken—which I hope will happen soon.” response to COVID-19: their outcomes to those of patients in a demic disease has never been evaluated Plans for the Einstein-Montefiore The need for an effective COVID-19 magazine.einstein.yu.edu/ retrospective control group. The study, in large RCTs; hence the importance trial called for studying 300 hospitalized treatment—and for health improvements pandemic20

36 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 37 hen she was a medical tion where he worked before coming clinic patients. “Surgeons want to fix school student, Laena to the Bronx in 2014 “was essentially things, and I think most of us consider W Frechette, M.D., thought all male, and I can tell you the vibe was ourselves surgeons first,” she says. “But she had a pretty good idea of what urol- very different.” we’re also able to treat patients nonsur- ogists looked like (male) and what sorts Amanda C. North, M.D., associate gically.” of ailments their patients had (prostate professor of urology at Einstein and While Allison Grant, M.D., was problems and urination difficulties). a practicing urologist at Montefiore, doing her clerkship at Montefiore, Then, during her third year at Einstein, points out that women now make up she found this spectrum of treatment she started her surgery rotations at more than 50% of enrolled medical approaches appealing. “Say you go to Montefiore. She discovered that urology students nationwide, according to 2019 your internist, who says you have a high is not at all limited to treating older data from the Association of American cardiovascular risk score,” she says. “The men—instead, about 30% of all adult Medical Colleges. “If we want the very internist sends you to a cardiologist, patients nationwide are women. She best practitioners,” says Dr. North, “then who does evaluations, tests, and proce- also found that female mentorship we should strive for that percentage dures. And then separately there are car- matters. among urologists.” diac surgeons for those who need heart “I ended up meeting so many em- surgery. But in urology, you do it all.” pathetic female urologic surgeons here A SURGICAL SPECIALTY—PLUS Dr. Grant, who like her best friend that it made it easy to envision myself In her practice, Beth Drzewiecki, M.D., Dr. Frechette graduated from Einstein as a urologist,” she says. After gradu- associate professor of urology at Einstein in May, says her clerkship experience ating from Einstein this past May, Dr. and a clinical urologist at Montefiore, helped her decide to make urology her Frechette entered a urology residency spends about half her time in the oper- career. She entered a urologic residen- program at the University of Rochester ating room and the other half caring for cy program at NewYork-Presbyterian Medical Center—one of two women from Einstein’s Class of 2020 who chose the specialty. “I was used to seeing so many women on the faculty who were urologists that I thought it was normal,” she says. “I learned in my interview sea- son how rare that is. Something really WOMEN special is happening at Einstein and Montefiore.”

AHEAD OF THE CURVE IN UROLOGY Women make up just under 10% of practicing urologists nationwide, according to a 2019 report by the American Urological Association—but Female role models at Einstein and Montefiore at Einstein and Montefiore, they repre- sent more than 40% of urology depart- are inspiring women to consider this specialty ment physicians. “I’m incredibly proud of the fact that there’s greater gender balance in our BY NANCY METCALF department,” says Mark P. Schoenberg, OPPOSITE PAGE: Amanda North, M.D., works with a pediatric patient at Montefiore Medical Center in the Bronx. ABOVE: Einstein graduates Allison Grant, M.D., left, and M.D., professor and chair of urology at Laena Frechette, M.D., best friends since their undergrad days at Cornell University, take Einstein and Montefiore. The institu- a break on the last day of their urology residency interviews.

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UROLOGY AND CHILDREN on older children, many from the Accordingly, she works with a multi- Three of Einstein and Montefiore’s 17 Bronx’s large Bengali community. “In disciplinary team of endocrinologists, urologists specialize in pediatric urology Bangladeshi culture circumcision is geneticists, and psychologists. (two are women), and the demand is so done right before puberty,” Dr. North great that the medical school and health says, “so I end up doing many of them A CHALLENGE OVERCOME system are looking to hire a fourth. on children who are ages 8 to 10.” Surprisingly, Drs. Abraham, Drzewiecki, “Our obstetrics and gynecology Another practice area is the treatment and North say that they haven’t run into department has outreach clinics all over of babies born with various intersex much resistance from male patients. “I the Bronx and into Westchester County, conditions, a focus of Dr. Drzewiecki’s feel men end up being more comfort- and it funnels cases to us through mater- practice. “It is a very controversial able speaking about urology issues to a nal-fetal medicine,” says Dr. North, who subject right now—bodily autonomy woman,” Dr. Drzewiecki says. focuses on congenital disorders of the and performing operations on children All three spoke of their joy in being urinary tract. “I probably see one or two who have no say in them,” she says. able to “offer treatment that can be so “We have significantly “During my residency, “I’m incredibly proud prenatal cases a week.” “We have significantly increased our life-changing for people.” As Dr. North The most common condition she knowledge of how to approach patients. recalled: “The chairman who trained increased our whenever I had a female of the fact that there’s encounters is hydronephrosis, or fluid I would never, ever force surgery on me used to say, ‘There are no unhappy knowledge of how to patient, she’d say, ‘Oh, greater gender balance in the kidneys. The condition usually any family who wasn’t prepared for it urologists because we make people feel rights itself during fetal development, or didn’t understand the implications.” better.’” approach patients.” I’m so relieved to see a in our department.” “but the rest of the time babies need woman!’” more intervention, possibly surgery, — DR. BETH DRZEWIECKI — DR. MARK P. SCHOENBERG soon after birth.” — DR. NITYA ABRAHAM Other conditions that pediatric urol- TRENDING UPWARD: PERCENTAGE OF ogists commonly fix are hypospadias, WOMEN FEMALE PRACTICING UROLOGISTS IN THE WORKFORCE: in which the urethra comes out on the IN UROLOGY underside of a baby’s penis instead of at BY THE NUMBERS 9.9 Hospital’s Columbia campus this past pediatric urology. because “they thought it was just a part the tip, and orchiopexy, where unde- 9.2 8.8 % summer. Nitya Abraham, M.D., associate pro- of getting old. Men, on the other hand, scended testicles must be moved into 8.5 % 7.7 % Urology also stands out because it fessor of urology at Einstein and a urolo- wanted erectile dysfunction addressed the scrotum. % % encompasses diverse health issues. “A gist at Montefiore, specializes in female right away.” Among Dr. North’s most fulfilling small segment of problems in urology pelvic medicine and reconstructive sur- One patient, a 64-year-old Orthodox recent cases was that of a 5-year-old NEARLY is very male-specific—prostate cancer, gery. “During my residency, whenever I Jewish woman from Brooklyn, says she girl whose parents brought her to 2019 erectile dysfunction, testicular prob- had a female patient, she’d say, ‘Oh, I’m came to Dr. Abraham after a different Montefiore’s pediatric urology clinic 2017 2018 2015 2016 lems—and a lot of pediatric urology is so relieved to see a woman!’ I almost felt surgeon tried to repair her prolapsed because she was constantly wetting her 1 also male-dominated, because there are obligated to pursue this as a subspecialty vagina and bladder but failed. “I some- pants. “I saw that she was dripping urine IN more parts to go wrong for boys,” Dr. because it provided my female patients times couldn’t urinate and had to have a and knew exactly what was going on,” Drzewiecki notes. “But men and women so much comfort,” she says. catheter,” says the woman, who asked to Dr. North says. “A sonogram showed share many other urologic problems, Dr. Schoenberg noted that Dr. be identified only as “Mrs. A.” that the ureter from her right kidney 9 including bladder and kidney cancer, Abraham’s area of expertise “is the Dr. Abraham performed a success- was draining into her vagina instead of 3 IN fastest-growing specialty in urology” ful repair and made the patient feel kidney stones, and blood in their urine.” her bladder. We moved it where it be- UROLOGY Studies of urologic-practice pat- as women become more aware that completely at ease. “It makes a very big longed, and after her surgery she proud- PATIENTS IS FEMALE terns show that women perform more treatments exist for age-related prob- difference having a woman urologist,” ly showed me her new princess under- 10 female-specific procedures than men, lems such as pelvic organ prolapse and Mrs. A. says. “I’m religious, and it feels wear. That family was so grateful—they PRACTICING Source: American Urological Association, and men more male-specific procedures urinary incontinence. Dr. Abraham says more comfortable with a lady around. thought it was all in her head.” The State of the Urology Workforce and UROLOGISTS than women. In addition, women are that women had been reluctant in the She was very, very nice and calming. She Pediatric urologists also perform a Practice in the United States, 2019 ARE MALE more likely to subspecialize in female or past to get these problems addressed gave me a lot of support.” surprising number of circumcisions

40 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 41 The autoimmune disease is increasing at an TYPE 1: THE OTHER alarming rate. Einstein and Montefiore scientists DIABETES are addressing it on a number of fronts. BY GARY GOLDENBERG am (not his real name) was diagnosed with type 1 diabe- tes in his early teens. He struggled to follow the insulin Sregimen needed to control his blood-glucose level, even after experiencing diabetes-related complications that required hospitalizations. Finally, in his late 20s, Sam started handling self-management for his diabetes, but his effort came too late to prevent permanent disability.

All too many people with type 1 dia- COMING OF AGE WITH T1D betes (T1D)—especially adolescents As Sam’s story suggests, controlling and young adults—fail to reach tar- blood-glucose levels poses particular get blood-glucose levels. The elevated problems for young people with T1D. glucose forms toxic compounds that A key goal is keeping their A1C levels damage tissues, leading to potentially (the standard measure of long-term devastating consequences that occur in blood-glucose control) within cer- T1D as well as type 2 diabetes: diabetic tain parameters. Researchers, however, coma, blindness, heart disease, kidney estimate that between 85% and 90% failure, nerve damage, and amputations. of teens and young adults with T1D “People talk about the type 2 diabe- nationwide do not regularly meet their tes epidemic—and it is certainly a major target A1C levels—a red flag for com- public health issue,” says Yaron Tomer, plications to come. M.D., who is the chair of medicine at “Managing type 1 diabetes requires Einstein and Montefiore and a profes- constant vigilance—counting carbs, sor of medicine and of microbiology & testing your blood sugar, and inject- immunology and the Anita and Jack ing insulin at every meal,” says Shivani Saltz Chair in Diabetes Research at Agarwal, M.D., M.P.H., assistant Einstein. “But type 1 diabetes is much professor of medicine at Einstein and more common than people think. Since director of the Supporting Emerging World War II, the frequency of type 1 Adults with Diabetes (SEAD) program has doubled every 20 years in almost at Montefiore. “That’s difficult for every population group, and nobody everyone, but especially teens and young knows why” (page 47). adults. While some are ready to assume

42 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 43 TYPE 1: THE OTHER DIABETES

is the most important thing we can do. When they’re lost to the healthcare sys- tem is when things really go wrong.” One of Dr. Agarwal’s goals is to cre- ate a model of care that can be adopted by providers around the nation, even those with limited resources. “Second, we need to demonstrate that our approach makes sense financially to healthcare providers and payers,” she says. SEAD is a product of a larger proj- ect to reduce disparities in T1D care among young racial/ethnic minorities, funded by a five-year, $988,000 award from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The project aims to identify Young people with type 1 diabetes must be vigilant about controlling their modifiable factors that can reduce dis- blood-sugar levels, which requires the daily use of insulin. This girl is being taught parities and improve health outcomes, how to use a penlike syringe for injecting insulin. learn more about patient-provider relationships in these communities, and responsibility for their care, most need priority. By early adulthood, they may design and test interventions. guidance along the difficult journey to already have started experiencing signif- Sadly, SEAD came too late for Sam, adulthood.” icant complications. “But if we support who later in life became Dr. Agarwal’s Dr. Agarwal created the year-old these patients and push them toward patient. By his early 30s, he had gone SEAD program (a part of the Fleischer independence, we can change that tra- blind from T1D. “It was heartbreaking Institute for Diabetes and Metabolism) jectory,” Dr. Agarwal says. when he told me he wished he’d had to offer that guidance. It’s one of the SEAD is staffed by an endocrinolo- this program when he was younger,” Dr. first clinical services specifically designed gist (Dr. Agarwal); a nurse practitioner Agarwal says. “Let’s hope we can prevent for people with T1D on the cusp of with expertise in type 1 diabetes and others from developing such devastating adulthood (ages 18 to 25). advanced technologies such as insulin complications.” “Our philosophy at SEAD is to nur- pumps; a nurse specializing in social ture young adults so that they’re ready work and community care; and, nota- WHAT PATIENTS WANT to take over their care when they’re bly, a psychologist—a rare combination For patients with T1D, a key goal is transferred to adult services,” says Dr. in diabetes clinics. The team also offers maintaining healthy A1C levels to avoid Agarwal. “Imaging studies show that the peer-support groups and a yearly group complications and hospitalizations. But brain’s frontal lobe, which is responsible retreat where participants can discuss that’s not all they want. for executive functioning, doesn’t fully T1D-related psychosocial issues and “If you ask patients what’s import- develop until the mid-20s. That’s when learn about technologies for managing ant to them, they’ll say they want a we see our patients taking responsibility. their care, such as continuous glucose It’s like a switch is flipped.” monitors and insulin pumps. All too often, when left to their own “We’re not going to improve every- Shivani Agarwal, M.D., conducts devices, young adults with T1D neglect one’s glycemic control,” Dr. Agarwal a telemedicine visit with a patient

self-care or are unable to make it a admits. “But engaging patients in care via a mobile digital device. Photo by Jason Torres

44 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 45 TYPE 1: THE OTHER DIABETES TYPE 1 DIABETES “We’re not going to good A1C and a good quality of life,” diabetes distress. “This was an import- improve everyone’s says Jeffrey Gonzalez, Ph.D., professor ant step forward,” says Dr. Gonzalez, of medicine and of epidemiology & who contributed to the new treatment BY THE NUMBERS glycemic control. population health and co-director of the guidelines. “But we still have so much But engaging patients New York Regional Center for Diabetes to learn before we can adequately Translation Research. “For them, it’s not address the problem. For example, we in care is the most either/or—and it shouldn’t be for care- don’t really understand the relationship NEARLY important thing we givers, either. There’s a lot of evidence between stress and blood-glucose levels. 1.6 MILLION that stress is associated with poor treat- Does a day of high stress precede a day AMERICANS HAVE can do.” ment adherence and poor glucose con- of poorly controlled blood sugar? Or TYPE 1 By the year 2050, trol, so we would do well to emphasize is it the other way around, or perhaps TYPE 1 DIABETES, DIABETES 5 MILLION people in the — DR. SHIVANI AGARWAL the psychological as well as the physio- bidirectional?” including about accounts for United States are expected logical aspects of diabetes care.” Dr. Gonzalez hopes to answer these CHILDREN and 187,000 ADOLESCENTS. Dr. Gonzalez is in the vanguard of and other questions in a study using 5% to 10% to have type 1 diabetes, health professionals bringing much- smartphone apps and continuous glu- of all diagnosed including nearly 600,000 cose monitors (devices that are worn on needed attention to the psychosocial cases of diabetes. YOUNG PEOPLE. aspects of diabetes, with a particular the body that automatically and contin- focus on “diabetes distress”—where uously measure blood-sugar levels). patients experience feelings such as “We usually ask patients to fill out stress, guilt, or denial stemming from paper-and-pencil questionnaires about living with diabetes and the burden of their moods over a recent week and Among people self-management. relate these to a single measure of A1C age 19 and below, To the untrained eye, diabetes that may not overlap with that period,” distress can look a lot like depression, he explains. “But memory is often the annual rate of new which is also common among those imprecise and unreliable. With our Between cases of type 1 diabetes is with diabetes. But the two conditions app, we can query patients about their HIGHER FOR HISPANICS are different. Depression is characterized moods several times a day. Then we 2001 and 2009, by symptoms (such as persistent feelings can correlate that info with data from there was a (4.2%) than for of worthlessness or guilt, or lack of continuous glucose monitors. This will non-Hispanic whites interest in normal activities) that don’t give a better sense of how stress relates (1.2%). necessarily arise from a specific medical to blood glucose from moment to 21% condition. Diabetes distress, by contrast, moment. We’ll also determine whether INCREASE is an emotional response to having and hyperglycemia and hypoglycemia are managing the disease. associated with changes in patients’ cog- in the prevalence “It’s important to make this distinc- nitive function, as has been suspected. of type 1 diabetes One of four tion,” Dr. Gonzalez says. “An antide- “We need to look beyond A1C,” he in people under pressant may not help a patient who adds. “The long-term measure of blood Americans with FEWER THAN ONE-THIRD of age 20. is overwhelmed by diabetes. He or she sugar is important, but we also need to type 1 diabetes people with type 1 diabetes might be better served by diabetes- look at patients’ day-to-day experiences HAS RATIONED in the United States are specific interventions, such as teach- with diabetes, and at how those experi- ing skills for coping with anxiety or for ences can be improved.” INSULIN USE consistently achieving target managing one’s illness.” In the meantime, Dr. Gonzalez is due to cost. blood-glucose control levels. In 2016, the American Diabetes also investigating how to make T1D Association began recommending care more patient-friendly and more screening for both depression and accessible. Recent surveys show that Sources: Centers for Disease Control and Prevention, JDRF, The New England Journal of Medicine, 2018 T1 International Patient Survey

46 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 47 TYPE 1: THE OTHER DIABETES most adults with T1D are seen not by “Clearly, we need to endocrinologists but by primary care doctors, who are hard-pressed to give build a workforce adequate time to patients with complex that can deal with chronic diseases and may not be familiar with all the nuances of diabetes care. patients confronting the “Smartphone apps are one approach; psychosocial aspects of telehealth is another,” Dr. Gonzalez says. “Adding mental-health professionals diabetes care.” to diabetes clinics, as we’ve done at the — DR. JEFFREY GONZALEZ Fleischer Institute, would also be help- ful. Unfortunately, it’s not financially rewarding to deliver mental-health care in this setting, at least in the short term. That’s part of the reason why it’s so hard to access. Part of my job as a researcher is to demonstrate to payers that this is an investment worth making.” autoimmune diseases. But gene variants In sum, says Dr. Gonzalez, “clearly, aren’t sufficient, since fewer than 5% of we need to build a workforce that can people with HLA variants develop T1D. deal with patients confronting the psy- Additional factors—most likely envi- chosocial aspects of diabetes care. But ronmental exposures of some kind—are This illustration of an immunological synapse shows an antigen- bound by a T-cell receptor (green). This interaction activates the T cell it’s also clear that we have a long way to believed to trigger T1D in genetically presenting cell or APC (upper cell) interacting with a CD4+ T cell (low- to attack cells containing that peptide. In type 1 diabetes, the display go with that mission.” susceptible people. er cell). In the circular close-up of the synapse, an HLA protein (pink) of peptides belonging to insulin-producing cells in the pancreas “There’s a lot of debate about what on the APC’s surface is displaying a peptide (orange) that is being “miseducates” T cells to attack and destroy those pancreatic cells. AUTOIMMUNITY AND those environmental triggers might be,” DESTRUCTION Dr. Tomer says. “I believe they’re viral T1D and other autoimmune diseases infections, but they could be chemical occur when the immune system—nor- exposures or even changes in the gut peptides—bits of protein from invading mistakenly bind the body’s own pep- Using computer modeling to mally a bulwark against viruses and microbiome. Whatever the trigger, the bacteria, for example—to tell them what tides. T-cell receptors recognize these screen thousands of potential com- other microbial invaders—instead result is a T-cell attack on the pancreas to attack. Those immunity-arousing “self” peptides—prompting the T cells pounds, they found one highly prom- attacks a person’s own tissues. In the that stresses or kills insulin-making peptides are called antigens. to attack the body’s own cells and tissues ising pocket-blocking candidate that case of T1D, the pancreas is the target. cells.” Dr. Tomer is working to prevent T cells get their marching orders, and leading to autoimmune diseases. they are now modifying to boost its Immune cells known as T cells mount T1D caused by T cells known as CD4+ in the form of peptide antigens, from effectiveness. It’s called a retro-inverso the assault, causing inflammation that T cells, or “helper” T cells. He and his another type of immune cell called anti- THE SEARCH FOR POCKET peptide. destroys pancreatic beta cells—the colleagues are trying to short-circuit gen-presenting cells (APCs). Transferring PROTECTORS “We made a mirror image of the source of the insulin that enables the instructions directing CD4+ T cells to a peptide from an APC to a T cell resem- Most T1D cases occur when APCs original peptide and then reversed body’s tissues to use glucose as an energy target the pancreas. bles spoon-feeding. The APC’s “spoon” is bind insulin peptides, causing T cells to its amino acid sequence,” Dr. Tomer source. Over time, the destruction of present on its surface as a tangle of pro- attack insulin-rich beta cells of the pan- explains. “This configuration stabilizes insulin-producing beta cells leaves the THE ‘MISEDUCATION’ teins dictated by HLA genes. This spoon creas. To halt T1D, Dr. Tomer and his the peptide so it sits securely within body unable to control its blood-glucose OF T CELLS contains grooves, known as “pockets,” colleagues in the Einstein–Mount Sinai the APC’s pocket.” The experimental levels—the hallmark of T1D. T cells such as CD4+ T cells aren’t born which accommodate peptides that APCs Diabetes Research Center are pursuing peptide has shown encouraging results Variations in certain genes called knowing what to hunt for. Just as blood- then “feed” to T cells. a novel strategy: Find peptide drugs to in inactivating APCs in a T1D mouse HLA genes are associated with the hounds require a scent to track and However, some HLA gene vari- block the binding pockets of APCs sus- model and in cells taken from patients misdirected T-cell attacks that cause find a missing person, T cells rely on ants create APC spoons whose pockets ceptible to causing T1D. with T1D.

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protein is called a synTac, short for DIABETES AND COVID-19: A CONFUSING COMBINATION “artificial immunological synapse for T-cell activation.” The platform can also be tailored to fight other diseases, arly in the COVID-19 pandemic, doctors at including cancers and AIDS. Montefiore observed that about 40% of people The synTac concept was developed Ehospitalized with the disease also had type 1 or by Dr. Almo, professor and chair of type 2 diabetes. It was a striking observation but not a biochemistry, professor of physiology total surprise. People with diabetes are no more suscep- & biophysics, the Wollowick Family tible than others to viral infections, but they are more Foundation Chair in Multiple Sclerosis vulnerable to serious complications once infections and Immunology, and director of the occur. Factor in the high prevalence of diabetes in the Einstein Macromolecular Therapeutics Bronx, and the 40% figure makes sense. Developmental Facility. His synTac What didn’t make sense were other aspects of the work with Dr. DiLorenzo is supported coronavirus-diabetes connection. Some patients with by NIDDK. diabetes had well-controlled blood-glucose levels pre- The Einstein team is producing a COVID-19, but those levels became dangerously high variety of synTacs for T1D, designed and fluctuated wildly following infection. to target T cells known to interact Even stranger, COVID-19 may actually cause diabe- with the most-common insulin pep- tes. Patients with no history of diabetes were showing up tides. “We envision that this would be on the COVID-19 wards with ketoacidosis, a poten- a personalized medicine for T1D,” says tially deadly condition usually associated with type 1 people with diabetes who develop COVID-19. Dr. DiLorenzo, who is a professor of diabetes (T1D). Ketoacidosis (the buildup of acidic sub- One project is assessing how well continuous glucose microbiology & immunology and of stances called ketones) occurs when cells lack sufficient monitors (tiny devices that automatically measure glu- “We envision that this THE ARTIFICIAL SYNAPSE medicine and the Diane Belfer, Cypres glucose for energy and burn fat instead. cose levels) will work on hospitalized patients. “The monitors are approved for outpatients but not would be a personalized CD4+ T cells are not the only T cells & Endelson Families Faculty Scholar in “There are many interesting things about this virus— implicated in T1D. To prevent T1D, Diabetes Research. “We would test the some more interesting than we’d like,” says Jill Crandall, for the inpatient setting, where finger sticks are used,” medicine for T1D.” another Einstein team is focusing on patient’s blood for insulin peptides and M.D., professor of medicine, the Jacob A. and Jeanne E. Dr. Agarwal says. “But with nurses so busy and to re- CD8+ T cells, or “killer” T cells. The then choose the appropriate molecules Barkey Chair in Medicine, and chief of the division of duce use of personal protective equipment and exposure — DR. TERESA DILORENZO strategy of researchers Steven Almo, from a whole panel of synTac immuno- endocrinology at Einstein and Montefiore. to COVID-19, it would be better to automate this pro- Ph.D., and Teresa DiLorenzo, Ph.D., therapy molecules.” As yet, clinicians have no definitive guide for caring cess and not use up protective gear just to take a glucose is to intercept misguided CD8+ T cells SynTacs could overcome a major for COVID-19 patients who have diabetes, so they’re measurement. However, several factors could affect the before they can reach and damage the drawback of conventional immunother- learning by doing—and by sharing. Einstein and accuracy of these monitors in the inpatient setting, and pancreas. The researchers are testing a apies, which indiscriminately affect all T Montefiore’s endocrinologists are now contributing to so we need to rigorously test this approach.” novel double-barreled immunotherapy cells—not just the harmful ones—and a nationwide population health–surveillance study of A second project is evaluating whether subcutaneous that homes in on specific CD8+ T-cell therefore can cause serious and even fatal individuals with T1D who contract COVID-19. insulin injections can replace intravenous insulin drips populations and then inhibits their side effects. SynTacs, by contrast, should “We’re focusing this surveillance effort on type for managing patients with diabetic ketoacidosis. activity. have fewer unintended effects, since 1 diabetes, but we’re also interested in the effects of “Insulin drips allow for fine-tuning of insulin to The immunotherapy’s ammo is a they’re aimed only at those CD8+ T cells COVID-19 on type 2, the more-common form,” adds control blood sugar but are labor intensive since a lot of two-armed “fusion protein”: one arm with autoimmune potential. Dr. Crandall. She notes that patients will also be mon- monitoring is needed, including hourly finger sticks,” docks specifically to CD8+ T cells The search for some way to prevent itored after they return home, to see if COVID-19 has Dr. Agarwal says. “In this context, periodic insulin injec- genetically programmed to attack T1D has gone on for decades. Research caused long-term changes to their diabetes. tions may be the better alternative, especially because of insulin-producing cells in the pancreas; by Einstein scientists could potentially COVID-19. Our number one priority is to maintain the second arm puts the CD8+ T cells achieve that goal. For all the young IMPROVING PATIENT CARE patient safety and optimize clinical outcomes, but we out of action by stimulating receptors “Sams” of this world, that would be Meanwhile, Dr. Shivani Agarwal (page 43) is coordi- also need to reduce the burden on our nursing staff. We on their surfaces. The double-armed good news indeed. nating two pilot projects aimed at improving care for hope this approach will achieve both goals.”

50 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 51 PASSIONATE

PURSUITS “Snapping that picture wasn’t just about the photo. For me it was about stepping into a mother’s Taking a Walk on the Wild Side home and experiencing how she BY GINGER SKINNER feeds and cares for her young.”

efore the COVID-19 pandemic ­— JEREMY D’ARBEAU shut down much of New York B City last spring, one of photogra- pher Jeremy D’Arbeau’s favorite destina- competition called “I Shot It!” he would see things and capture people tions was the Bronx Zoo. He would sit In addition to photographing ani- walking by, that’s truly what motivated quietly on the sidelines, his gaze fixed on mals, Mr. D’Arbeau focuses on sports, me to take up photography,” he says. his animal subjects, as visitors wielding long-distance cycling in particular. Since “After that I began walking around and camera phones darted around him from 2015 he has taken photos of the annual creating various projects for myself.” one exhibit to the next. Gran Fondo New York race, often rid- His other influences include trailblazing “With wildlife you have to be very ing on the back of a motorcycle while 20th-century photographers Gordon patient,” he says. To capture a mother balancing two cameras. His pictures Parks and Paul Strand and filmmaker gorilla cradling her baby (page 53), he of bicyclists crossing the finish line Stanley Kubrick. waited nearly two hours for the right are featured in Gran Fondo magazine. moment. “Snapping that picture wasn’t “Capturing those intense moments, FLASHING FORWARD just about the photo,” says the 39-year- especially the winning moment—there’s The COVID-19 pandemic forced old Mr. D’Arbeau. “For me it was about nothing like it,” he says. Mr. D’Arbeau to shelter at home in stepping into a mother’s home and White Plains, New York. “In the way experiencing how she feeds and cares for HIS GRANDFATHER’S GIFT that writers experience writer’s block, her young.” Mr. D’Arbeau’s first camera was a toy I found myself experiencing photogra- A systems engineer in the department model his mother gave him when he was pher’s block,” he says. But the chance of information technology at Einstein, 7. Camera in hand, he would shadow to photograph a nearly empty Grand Mr. D’Arbeau took up wildlife photog- his grandfather, a New York City transit Central Terminal for his cousin’s college raphy six years ago as a hobby. “I love worker who toted Pentax and Leica cam- graduation reinvigorated him. “No one capturing subjects that are unaware of eras to work, seizing any opportunity to else was around, and it was midday on the photographer,” he says. “I like to photograph passersby. “My grandfather a Saturday in late spring,” he says. “No picture myself in the animal’s habitat, was the first person I ever saw using a crowds. No commuters. No disruptions. whether it’s eating, catching its prey, camera,” Mr. D’Arbeau says. “Today It was something I normally would Two photos Mr. D’Arbeau captured at the or caring for its young.” While taking you’d call it street photography; I call it never have been able to do.” Bronx Zoo: At top, a mother gorilla and her baby; above, a Nicobar pigeon, which photos at the zoo, he shuts off his flash photojournalism.” Mr. D’Arbeau looks forward to may be the closest living relative of the so he won’t startle the animals, and uses When Mr. D’Arbeau turned 18, resuming a project he started with a extinct dodo bird. natural light instead. his grandfather became very ill and his relative in late 2019: directing and vid- His photographs of apes, aquatic life, grandmother started giving away his eotaping a cooking show. He equates and birds are featured in the 2019 and belongings. Mr. D’Arbeau claimed his mapping out the show’s next phase with Jeremy D’Arbeau captured this image of 2020 issues of Ad Libitum, Einstein’s grandfather’s Pentax cameras and right preparing for his next photo session at VIEW MORE a jellyfish at the National Aquarium annual art and literary magazine, and he away began inspecting the decades-old the Bronx Zoo. “Both require a certain Denmark. The photo, called “Ocean’s Life,” Find additional photos by is featured in the 2020 issue of Einstein’s received a Mark of Excellence prize for film rolls, exploring New York City amount of patience,” he says, “but the Mr. D’Arbeau: Ad Libitum magazine. wildlife photography in an online photo through his grandfather’s eyes. “The way results are worth waiting for.” magazine.einstein.yu.edu/photos20

52 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 53 ALBERT’S 12 3456 7891011 PUZZLER 12 13 14 15 16 17 18 MOTIVATIONS BY DEIRDRE BRANLEY The Front Line of Philanthropy at Einstein and Montefiore 19 20 21 22

Of Plagues and Pandemics 23 24 25

Across 26 27 28 29 1 Yellow discoloration of the skin 30 31 32 5 Organ in the skull 7 Not off 33 34 35 36 37 9 Energetic enthusiasm 38 39 40 41 12 Grab 14 I think, therefore I _____

16 Procedure developed to help diphtheria 42 43 44 45 46 patients with blocked airways 17 Arranged in a straight line 47

18 Rare blood type 48 19 Atomic symbol for gold 49 50 20 To _____ or not to be 21 A type of inhibitor used to treat cancer, 51 52 53 and possibly COVID-19 54 23 Pandemic that came after WWI 26 Liquid unit of measure 55 56 57 58 59 27 As needed: Ad _____ 60 61 62 63 64 29 Viral cause of the AIDS pandemic 30 Suffix to denote inhabitants of a place 65 66 67

31 A practice to prevent infection used in 68 69 China beginning in the 11th century 33 U.S. state where the Spanish flu originated 36 Path between eardrum and outer ear Down 35 Second-century plague brought to the 37 Symbol for germanium 1 American virologist who developed the Roman Empire by returning soldiers 38 Type of scan used to detect severe first successful polio vaccine 39 Disease first described by German COVID-19 lung infection 2 Slang for uptight, or relating to the anus physician Friedrich Hoffmann 40 Thigh bone’s connected to the _____ bone 3 Leader of the medical school 41 Not well 42 Disease famously spread 4 Epinephrine injector: Epi_____ 42 Foot digit asymptomatically by Mary Mallon 5 Colloquialism for bubonic plague 44 Made up of two elements or parts 43 Epidemic spread by fleas in 14th century 6 Negatively charged ions 45 Although depictions of this disease date 47 Not out to prehistoric times, it is nearly eradicated 8 A sealed glass capsule containing a liquid 48 Artificial respirator with a steely name for injecting 46 Nucleotides within a chromosome 49 12 p.m. 9 Mosquito-borne virus declared an 49 A profession that cares for the sick 50 Animal whose eggs were used to grow emergency in 2016 50 Beginning in 1817, a series of seven the virus for the first flu vaccine 10 Attempt, or type of surgical incision pandemics of this disease swept the world IN THIS ISSUE 51 Epidemic in West Africa in 2014–16 11 Has killed more people than any other 52 Sled dog whose Central Park statue 53 An area of red, often itchy, skin infectious disease in history honors his help with Nome diphtheria 56 From the Chair, Board of Trustees outbreak 55 Diseases brought by Europeans to 13 Vaccine that protects against 2 viral types 54 Lose consciousness 57 Continued Connection: the Americas, devastating indigenous 15 Disease whose 2019 outbreak included populations 1,282 U.S. cases, 73% linked to New York 56 Encounter, or a type of sports competition Dr. Emanuel Phillips 58 Parasitic disease once endemic in every 19 Not before 57 A small opening in the skin or nucleus American state except Alaska 60 Spotlight: In Fleischer’s Footsteps 22 Name for H1N1 in 2009–10 58 Animal mouth 60 Latin abbreviation for “in other words” 24 Belonging to him 59 Restore someone to health 64 Your Impact: Social Justice 61 _____ and fro 25 Acid that is excreted 62 Busy time of sleep for your eyes 63 Short for infectious diseases 68 Class Notes 27 Place where the 1968 pandemic H3N2 64 Carrier of genetic information 65 Where the Anti-Vaccination League of was first reported 67 Department that runs the ER 72 In Memoriam America held its first meeting in 1882 28 Short for oculocutaneous albinism 66 Person credited for smallpox vaccine To learn more, please visit 29 Animal used for vaccine development See how well you did at: 68 Our dean’s initials montefiore.org/giving and 32 Symbol for sodium magazine.einstein.yu.edu/ 69 Domesticate einstein.yu.edu/giving 34 A description for continuous, dull pain puzzler20 Photo by Jason Torres

54 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 55 MOTIVATIONS MOTIVATIONS | CONTINUED CONNECTION A Message From the Chair of the Einstein Board of Trustees DR. EMANUEL PHILLIPS ROGER W. EINIGER Doctor of Humane Letters, Albert Einstein College of Medicine CLASS OF ’59 Member of Einstein’s first graduating class When my parents, Glory and Jack, made their first gift to a young, pays a kindness forward with $2 million groundbreaking medical school in the 1950s, they sought to make the world a better place—for their children, for aspiring doctors and endowed scholarship researchers from all cultures and backgrounds, and for the Bronx and BY TERESA CARR beyond. During their long history as philanthropists and founding lead- ers of Einstein, they helped build the medical school into the research manuel Phillips, M.D. ’59, is compassionate physicians. Here, he powerhouse, top-ranking academic destination, and force for social a member of Albert Einstein answers a few questions about his his- good that it is today. I am honored to continue their legacy. College of Medicine’s first tory—and future—at Einstein. Similar enduring commitments from countless supporters have E graduating class. He went on to propelled our mission from my parents’ time to now—and we’re seeing Iris Phillips and Emanuel Phillips, M.D. ’59 Roger W. Einiger serve in the U.S. Army as a med- What was it like to walk into a those investments pay off at never-before-seen speed. Discoveries that ical officer and then returned to brand-new medical school? scientists began to unearth years ago are informing current COVID-19 treatments. The previ- Einstein to teach internal medicine Back then, the school consisted of one heterogeneous. Our class was all white ous generation’s physicians are mentoring the newest interns. And we’re saving lives through and care for families in the Bronx building—Forchheimer—and it wasn’t and Jewish, and there were only three exceptional science. and surrounding communities for even totally finished. Some of the rooms women. Today it’s much more diverse Einstein students, alumni, researchers, and donors share the passion and foresight of those more than three decades. But his still contained scaffolding, and we saw and welcoming, which is a good thing. who came before us to work together toward a healthier, stronger tomorrow. The inspiring eminently successful medical career workmen all around. Some of the creaks When I started out, you couldn’t get individuals showcased in this issue of Motivations embody that purposeful spirit. nearly didn’t happen. didn’t come out until after the first few into some medical schools because you One striking example is Emanuel Phillips, M.D. ’59. Through a $2 million endowed schol- Dr. Phillips’s family fell on hard weeks, but that didn’t matter. We had a were Jewish. Those barriers based on arship, Dr. Phillips is paying forward the generosity of donors who made an investment in our times while he was in medical table for anatomy dissections and nice race, ethnicity, income, or other factors school, and only with financial sup- lecture halls. just shouldn’t exist. medical training program six decades ago (page 57). In a similar spirit, Montefiore Health port from Einstein was he able to And it was an exciting time! Even System trustee Justice Felice Shea has dedicated her life to shaping social-justice initiatives graduate. He has been returning the though it was a new school, it was How did you meet your wife, for all (page 64). And the lifelong work of Norman Fleischer, M.D., lives on through transfor- favor ever since. In his most recent strongly connected to the past. The Iris? mational contributions to the Fleischer Institute for Diabetes and Metabolism (page 60). act of generosity, Dr. Phillips and faculty brought in wonderful lecturers For many years, I was all wrapped up in What we accomplish today is in large part a product of caring partners throughout his wife, Iris, announced a $2 mil- from far and wide, some quite famous. my work and my parents, and I didn’t Einstein’s history. Our connections are strong and sustained—and will only grow with each lion endowed scholarship enabling I remember being impressed when the have much time to socialize. One of my new stride we take. talented students to pursue careers pediatrician Béla Schick, founder of medical colleagues wanted to introduce Together, our Montefiore and Einstein community drives action that will affect health for in science and medicine. His gift the Schick test, which helped eradi- me to Iris, but I had just been diagnosed generations to come. My parents looked toward the future with hope; I do the same, knowing will support aspiring physicians and cate diphtheria in this country, came with bladder cancer and wasn’t quite we can and will shape it for the better. Thank you for standing with me and with Einstein. researchers for generations to come. to talk. I felt like I was following in the ready. After six months, my treatment In reflecting on his connec- tradition of a long line of extraordinary had gone well, and I decided “Now’s Sincerely, tion to Einstein, Dr. Phillips says physicians. the time.” I met this lovely woman and a lot has changed since he first set thought “This is the one for me.” We foot on campus, but one thing in Aside from having grown, how went on our first date in December particular remains constant: the has Einstein changed? 1984 and were married by the following idea that everyone deserves quality Now, when I walk in, I notice May. So that’s been it for more than 35 Roger W. Einiger healthcare delivered by well-trained, right away that it’s much more wonderful years.

56 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 57 MOTIVATIONS | CONTINUED CONNECTION Help us go further —together.

In May 2020, the Price Family Foundation matched every gift to Einstein’s COVID-19 research initiatives, dollar for dollar, up to $1 million—doubling every donor’s impact by completion in June.

Members of Einstein’s first graduating class gather for a group photo on June 10, 1959, outside the Van Etten Building. Dr. Emauel Phillips is pictured in the top row, the 10th person from the left. Here’s how you can help: • Make a gift to any Einstein fund. Did undergoing treatment for was a personal touch that I think is self-perpetuating. My dream is that some- • Connect with your (and/or your We believe deeply in cancer change how you interact quite lacking in medicine today. day there’d be enough for every student to spouse’s) employer’s benefits with your own patients? go to school tuition-free. Then students Einstein’s mission, and the It sure did. There’s nothing like being What led you and Iris to estab- wouldn’t have financial pressure or debt; program to request a gift match. matching gift challenge was in the bed yourself to change your lish an endowed scholarship? they could practice humane rather than (Note that some organizations match gifts perspective. I remember feeling crazy In my fourth year of medical school— businesslike medicine. There’s this old from retirees as well.) Your employer may an opportunity for us to with worry, waiting for 10 days for the it’s still difficult for me to talk about— Yiddish expression I love: “The shrouds be able to contribute to your designated inspire philanthropy and pathology report to come back after I my father became very ill and our have no pockets,” which means “You can’t Einstein fund and double your impact! had a biopsy. After that, I tried to be as finances were strained. I didn’t know take it with you.” My wife and I have no deepen our partnership at a responsive to my patients as possible. I how I was going to get through it. I heirs. Our donation will help train the time when the Bronx, NYC, also became a better listener. went to my adviser crying because I felt next generation of physicians—that’s my and the world needed it most. the shame of being a 25-year-old man progeny, my DNA. Look for other opportunities to increase What do you value most from in need of financial support. An assis- your gift’s power through matching practicing medicine? tant dean got me the funds I needed to What is your advice to students? Looking back, what gave me warm complete my education. One of the most important things I gift challenges like the Price Family feelings were the connections I made I’ve never forgotten that. Einstein imparted was how to handle difficult Foundation’s initiative by subscribing — Michael F. Price, Trustee gave me my profession, my livelihood, aspects of being a physician, like telling a with my patients. I often took care of to fundraising communications at The Price Family Foundation multiple generations of the same family. my purpose, really—and I’m grateful. patient about a cancer diagnosis—how to Albert Einstein College of Medicine Some of the kids are now adults and My wife and I agreed that lack of funds be optimistic, but also help carry people einstein.yu.edu/giving. still call to check on me. I get holiday shouldn’t be a barrier to a good medical through a difficult time. I want students cards. When I practiced, you were more education. This is our way of helping to to understand that it’s not all peaches and socially connected to your patients. If equalize things, so that someone who’s cream in life. Compassion is what sees someone called because they were hurt talented and has a desire to practice you through. For more information on contributing or seriously ill, I’d say, “Meet me at the medicine can, and then pay it back by to Einstein, contact the office of emergency room and we’ll take care of serving the community. TO DONATE development and alumni relations at it.” I treated people in the hospital and By creating an endowed scholar- einstein.yu.edu/giving/ 718.430.2411 or made house calls when I could. There ship, we hope that the funds will be SupportScholarships [email protected].

58 EINSTEIN : SUMMER/FALL 2020 MOTIVATIONS | SPOTLIGHT

In Fleischer’s FOOTSTEPS

New diabetes institute mputations, vision loss, In 1982, Dr. Bloomgarden opened kidney failure, heart disease: his own endocrinology practice in builds on a legacy A Diabetes and its complications nearby Westchester County, New York, of research and can ravage the human body. “But those where he put his mentor’s lessons into tragedies are not inevitable,” says David effect. “Norman taught us that we could interdisciplinary care K. Bloomgarden, M.D., F.A.C.E., an make a profound difference in the lives endocrinologist in private practice for of our patients,” Dr. Bloomgarden says. BY GARY GOLDENBERG more than 40 years. “They should “Finger-stick glucose monitoring had not happen with dedicated diabetes been introduced a few years earlier. It management.” helped give patients more control over Dr. Bloomgarden’s mission in life their disease, which we could rein- has been to spread that preventive force with education and counseling. creed, first in his own practice and Continuous glucose monitoring today CLOCKWISE FROM TOP: Norman now in his philanthropic endeavors makes that effort even more achievable.” Fleischer, M.D., Einstein professor at Einstein’s Fleischer Institute for Over the decades, Dr. Bloomgarden emeritus of medicine and former chief Diabetes and Metabolism. honed his clinical skills, learning how to of the division of endocrinology at Originally intent on a career in keep diabetes complications to a mini- Montefiore, who died in 2018; the waiting room of the new Fleischer mum. “Helping patients with diabetes rheumatology, Dr. Bloomgarden Institute for Diabetes and Metabolism; switched specialties late in his residency live long and healthy lives is difficult,” he David K. Bloomgarden, M.D., with his at Einstein, following a rotation under says, “but it’s doable with attentive care, wife, Jane Bloomgarden, Ph.D., right, Norman Fleischer, M.D., the founding collaboration, and attention to detail.” and Eva Fleischer, LCSW, who was at the institute’s opening to honor her late director of Einstein’s National Institutes husband; and healthcare staff at work at of Health–funded Diabetes Research BUILDING A CENTRAL HUB the new center. and Training Center. “I was so inspired As Dr. Bloomgarden’s practice grew, by Norman’s ability, knowledge, and so did his frustration that many kindness that I asked if I could do a other diabetes patients were receiv- fellowship with him,” he says. “Happily, ing less-than-optimal care. Four years he took me on, and the rest is history.” ago, he talked with Dr. Fleischer about

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of his three sons, Noah, to become an Obesity worsens diabetes, and unless CONTINUING TO GROW endocrinologist. Dr. Noah Bloomgarden you treat the former you’ll never be able Thanks to Dr. Bloomgarden and also had the good fortune to study to manage the latter.” To that end, the other donors, the Fleischer Institute under Dr. Fleischer and continues both Fleischer Institute is planning to open is increasingly able to meet the needs Dr. Fleischer’s and his father’s devotion a comprehensive weight-loss program of people with diabetes. In 2019, the to the field as a member of the Einstein along with an obesity research center. institute’s staff of more than 30 phy- and Montefiore faculty. Close collaborations—between sicians, psychologists, nurses, techni- “Norman was an inspirational figure, researchers in diabetes and obesity, cians, dietitians, and administrators the grandfather of everything we do between the lab and the clinic, and had an average of 730 patient visits per here in endocrinology. There’s no better between generous partners—have been month—double the number in 2018. name to be attached to this institute,” and will continue to be a priority. “We “Unfortunately, Norman didn’t says its inaugural director, Jill Crandall, need to make sure that our research live to see the Fleischer Institute,” Dr. M.D., chief of the division of endocri- findings inform our clinical care, and Bloomgarden says. “But I think he nology, professor of medicine, and the vice versa,” says Jeffrey Pessin, Ph.D. would be proud of what it has become. Jacob A. and Jeanne E. Barkey Chair in He directs the Einstein–Mount Sinai And I hope all who share this commit- Medicine at Einstein. Diabetes Research Center (a component ment will join me in helping expand “One way we’re honoring his legacy of the Fleischer Institute) and oversees this young institute’s growth.” is to create a place where patients can get the work of more than 90 diabetes inves- truly comprehensive care,” Dr. Crandall tigators. He is also a professor of med- Endocrinologist Noah Bloomgarden, M.D., tends to a patient at the new Fleischer Institute. adds. “For those with type 2 diabetes, icine and of molecular pharmacology that might mean treating both diabetes and the Judy R. and Alfred A. Rosenberg TO DONATE launching an institute dedicated to his late father-in-law, Albert Willner, and obesity, since it’s very common for Professorial Chair in Diabetes Research einstein.yu.edu/giving/Fleischer diabetology, both locally and nationally. M.D., an orthopedist and philanthro- patients with diabetes to be overweight. at Einstein. “Montefiore physicians and Einstein sci- pist. “His philanthropy inspired both entists needed a place to come together my wife [Jane, a clinical psychologist to capitalize on their expertise, build in private practice and director of the a central hub for innovative care and child/adolescent/parent psychotherapy COUNSELING FOR ‘DIABETES DISTRESS’ research, and fill the void of a com- training program at the Westchester People seen at the Fleischer Institute comes and reduce overall costs.” prehensive center in the Bronx,” Dr. Center for the Study of Psychoanalysis will have access to psychological coun- The institute’s psychological coun- Bloomgarden says. “I was determined to and Psychotherapy and adjunct faculty “One way we’re seling—an important need of many seling services includes the Supporting make it happen.” member at the Ferkauf Graduate School honoring his legacy patients who often experience “dia- Emerging Adults with Diabetes (SEAD) Sadly, Dr. Fleischer died shortly after of Psychology] and me to do charitable betes distress,” the emotional burden program, unique in that it guides that meeting, but Dr. Bloomgarden per- work. He generously set aside funds to is to create a place caused by coping with this chronic young adults with type 1 diabetes severed. He worked with leaders at the make that possible,” he says. where patients disease (page 46). during the difficult transition from pe- hospital and medical school, marshaling The example set by his father— “There’s more awareness than there diatric to adult care (page 43). SEAD’s support to create the Fleischer Institute Kermit Bloomgarden, a noted Broadway can get truly used to be of the mental health prob- one-on-one counseling helps patients leaders—and Dr. Yaron Tomer specif- for Diabetes and Metabolism, which producer—also inspired him. “He was comprehensive care.” lems associated with diabetes, but psy- with diabetes meet their target blood- ically comes to mind—were willing to opened in 2018. It combines research, active during the Hollywood blacklists, chological support is rare,” says Jeffrey glucose levels and avoid serious com- put the resources into this program,” clinical care, and education in one loca- when so many people in entertainment — DR. JILL CRANDALL Gonzalez, Ph.D., professor of medicine plications and hospitalizations, accord- Dr. Agarwal says. “They understand tion, allowing Einstein discoveries to lost their livelihoods,” Dr. Bloomgarden and of epidemiology & population ing to SEAD director Shivani Agarwal, the power of multidisciplinary diabetes help Montefiore patients. says. “He taught me to be more socially health at Einstein. “With the Fleischer M.D., assistant professor of medicine care.” (Learn more about Yaron Tomer, conscious, and I’ve put that energy into Institute’s support, we can make sure at Einstein and director of the Young M.D., professor and chair of medicine INSPIRED PHILANTHROPY my philanthropic work for Montefiore that our patients get this type of care, Adult Diabetes Clinic at Montefiore. and the Anita and Jack Saltz Chair Dr. Bloomgarden is quick to share and Einstein.” and we can demonstrate to providers “A major reason I chose to come in Diabetes Research at Einstein and credit for this accomplishment with Dr. Bloomgarden in turn inspired one and payers that it can improve out- to Montefiore and Einstein was that its Montefiore, on pages 30 and 43.)

62 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 63 64 EINSTEIN :SUMMER/FALL 2020 MOTIVATIONS | YOUR IMPACT | YOUR MOTIVATIONS Social JusticeSocial INTO PRACTICE PUTTING BY TERESACARR O public servicebyworkingtoimprove healthandequityforNewYorkers. Retired StateSupreme CourtJusticeFeliceK.Sheacontinuesalifetimeof well-being, shesays.“Healthcare isa which iscentraltoacommunity’s involves providing goodhealthcare, were mostinneed.” good vehicle forhelpingpeoplewho Justice Shea says.“Lawseemedlikea for makingadifference inthisworld,” me, alawdegree wasaspringboard rights, opportunity, andtreatment.“To equal level ofsocietydeserve at every and personallifeisherbeliefthatpeople years. Running through herprofessional State Supreme formore Court than20 resources,” shesays. works andconnectthemtocommunity “Weefit check. explainhow thesystem onafederalben- getting therunaround of theirhousing.Or maybetheyare at work. Maybe they’ve beenforced out people have beendiscriminatedagainst afford topay,” shesays.Maybe these oflawyers forpeoplewhocan’tshortage tions onceitresumes. “There’s ahuge plans tocontinuegivingfree consulta- Health System forthepasttwodecades, of theboard forMontefiore oftrustees the program, butJustice Shea, amember York CityBar Association. can’t afford itandsponsored by theNew providing free counseltopeoplewho Law, program acommunity-service advice. It’s ofMonday allpart Night plus peoplewhoare lookingforlegal Part ofthatsocial-justice mission Justice Shea ontheNew served York The COVID-19 pandemichalted of 20lawyers and100- walks intoapackedroom Justice Felice K.Shea month,retirednce every for beingonthe bench.”Justice Shea rience, whichwasagoodbackground an enormousamountoflitigation expe- satisfying,”shesays.“Andwas very Igot work ofrepresenting indigentclients “The ing mostofherdaysincourt. branch oftheLegalAidSociety, spend- became anattorneyfortheHarlem years, forafew she working part-time Iwasgoingintopublicservice.” knew jobs atlawfirms,”shesays.“So Ialways “Women weren’t for even interviewed forwomen. opportunities with few graduated three years laterintoafield women inaclasswith235men.She in ColumbiaLawSchoolasoneof10 rare move forthattime—sheenrolled child, Justice Shea madeaboldand In 1947,marriedand withayoung DOING JUSTICE patients.” ofbooksto her wheelingaround carts remember and worked inthelibrary—I also amemberofthewomen’s auxiliary says. “My motherwas Montefiore she trustees,” ents were bothactive Montefiore. “My par- ly’s traditionofserving carried onherfami- justice.” To me,thatissocial Montefiore isallabout. patient-centered, iswhat respectfully given and “And goodhealthcare, human right,”shesays. After havingtwomore children and To thatend,shehas “It fitsintomyidea also has served onthe Mayor’salso hasserved Advisory of ethicalmisconductby judges.She commissioner), whichhearscomplaints Conduct (where shewasformerlya York State CommissiononJudicial She asareferee hasserved fortheNew represented children inFamily Court. working toimprove She thecourts. has In retirement, Justice Shea continues A FORCEFORGOOD retiring attheendof1999. State Supreme until andserved Court before shewaselectedtotheNew York on theCivilandFamilyserved Courts

of life.” people’s quality helping toimprove of doinggood,of — JUSTICE FELICEK.SHEA MAGAZINE.EINSTEIN.YU.EDU

65

Photo reprinted by permission of YANA PASKOVA/The New York Times/Redux MOTIVATIONS | YOUR IMPACT

Committee on the Judiciary, the ON A MISSION TO That idea helped create one of the Dean’s Council of Columbia largest academically affiliated addiction- Law School, and the board of the treatment programs in the United States, Correctional Association of New Improve Health with more than 50 doctors treating York, in addition to her work on 3 Programs That Help the Most-Vulnerable patients in seven primary-care clinics in the Montefiore board of trustees. the Bronx. “We’ve been at the forefront She supports Montefiore instein and Montefiore were financially devastating, says Terra Firma’s of integrating opioid addiction into pri- through unrestricted giving founded on the notion that social program administrator, Mia Stange, mary care,” Dr. Cunningham says. because she values its contributions Ejustice and health are inextricably M.P.H. “Our health center has set up an One way to accomplish that, to the Bronx, home to some of the linked. Here are three local programs emergency pantry with food, household she says, is to provide funds to poorest and most-vulnerable pop- made possible by unrestricted support to items, and emergency cleaning supplies, teach workers across the healthcare ulations in the nation. “It fits into Einstein and Montefiore from individu- as well as bilingual education materi- Terra Firma co-founder Cristina Muñiz de Residents learn how to partner with la Peña, Ph.D., works with a young man. community organizations in the Bronx. my idea of doing good, of helping als, corporations, and foundations. als about COVID-19,” she says. Many to improve people’s quality of life,” of Terra Firma’s youth and families are she says. “This institution provides SUPPORT FOR IMMIGRANT ineligible for federal relief, unemploy- his immigration hearing. “Terra Firma communities, says program co-director community outreach in addition 1 CHILDREN ment, and other safety-net benefits, says helped me learn English, to find a lawyer, Shwetha Iyer, M.D., associate professor to first-rate healthcare and is truly Terra Firma provides healthcare, food, program specialist Felin Martinez. An and to get a job because I need to work of internal medicine and of family and a force for good.” and other necessities to immigrant in-house pantry, she says, “allows them to help my mother,” he says. social medicine at Einstein. “Regardless Her generosity and the con- children and their families. “If we want access to resources they desperately need.” He also received counseling to help of what population you treat, if you don’t tributions of others help fund to improve the well-being of an indi- Leroy, who arrived from Honduras deal with the trauma of his childhood. know who you are serving and the spe- Einstein and Montefiore initiatives vidual or a community, we can’t ignore four years ago, says Terra Firma “is like “I kept having bad dreams. My doctor cific issues they face, you can’t do a good to advance social justice. “We can’t inequalities,” says Alan Shapiro, M.D., part of my family.” (He requested that helped me put the bad stuff behind me,” job taking care of patients,” she says. do the work without the support of its medical director. “By providing vul- his last name not be used.) Separated he says. With experience working as a “One of the first things we do is people like Justice Shea,” says Alan nerable populations with equal access to from his mother at age 8, Leroy grew carpenter and roofer, he says that he’d One goal of Chinazo Cunningham, M.D., spend a month introducing residents to Shapiro, M.D., clinical assistant healthcare and other resources, we can up selling fish and fending off gangs like to own his own business. “I want to is to create a center for addiction. the Bronx—the people living here and professor of pediatrics at Einstein help them live longer, healthier lives.” instead of going to school. At 17, he help other people and give them jobs,” the structural barriers in place,” Dr. Iyer and senior medical director of For many patients in the Bronx, fled to the United States, where he was he says. “That’s my dream.” system—emergency-care physicians, says. In their second year, they learn community pediatrics programs at the COVID-19 pandemic has been reunited with his mother while awaiting obstetricians, pediatricians, and oth- about “liberation medicine” and how to Children’s Hospital at Montefiore. ADDICTION RESEARCH ers—how to identify and treat addic- partner with community organizations. Dr. Shapiro is also the med- By 2005, Chinazo Cunningham, tion. One of her goals is to help create By year three, they are shadowing phy- Terra Firma’s food pantry is a lifeline for immigrant families in the Bronx. From left, 2 ical director of the immigrant Fadhylla Saballos, Felin Martinez, Maria Umpierre-Lopez, and Maria Miranda add M.D., M.S., associate division chief of a center for addiction that will care for sicians in homeless shelters, prisons, and assistance group Terra Firma, a masks to distribute alongside emergency food packages. general internal medicine at Einstein patients, conduct research, and edu- methadone-maintenance centers. collaboration between Montefiore, and Montefiore, had worked for nearly cate healthcare workers as well as the “Young physicians come to realize Children’s Health Fund, and a decade bringing healthcare to the community. “This is how we synergize that the community has tremendous Catholic Charities (see story at marginalized—people who were HIV our efforts across all of Einstein and resources that they can draw on to help right). “I’ve witnessed firsthand positive, addicted to opioids, and Montefiore,” she says. “We’ll be able to improve their health,” she says. The how Terra Firma can lift people up homeless. The U.S. Food and Drug take our work to the next level, com- primary-care and social-medicine resi- and improve the well-being of an Administration had just approved bating addiction in our community and dency has earned a national reputation entire community,” he says. buprenorphine, a breakthrough treat- across the country.” for training physicians who become Justice Shea’s advice to younger ment for opioid addiction that could be leaders in public health, research, educa- people who want to make a differ- used in any setting. Dr. Cunningham TRAINING IN PRIMARY tion, and clinical care. ence is to start small—to look for had an epiphany: “I realized that 3 CARE AND SOCIAL ways to help in their own commu- buprenorphine was going to change INTERNAL MEDICINE TO DONATE nities. “That’s always where the path people’s lives because it could be used in Residents who work with underserved montefiore.org/ toward progress begins,” she says. primary care to treat their addiction.” populations must get to know their SupportMontefiore

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daughter, son-in-law, and two of his programs as well as TPIU to promote Arizona, will carry out the Phase 0/2 grandchildren have moved back to compassionate healthcare. He and his study in patients with recurrent GBM. CLASS NOTES Los Angeles after many years of living wife, Beth, have two sons—one in The Ben and Catherine Ivy Foundation in San Francisco. business, the other in healthcare—and will fund the clinical-trial costs. The care for an English bulldog, Turbo. His therapy is formed by the combina- 1950s 1970s Richard Frankenstein, M.D. ’74, younger son, Jonathan, joined Einstein tion of two U.S. Food and Drug Donald Kline, M.D. ’59, has released Norman Luban, M.D. ’71, retired received a mastership from the American 1980s as a member of the Class of 2024 in Administration–approved technologies: his 11th novel, The Fifth Season. This in 2019 after 42 years of practicing College of Physicians, a national organi- Michael Crain, M.D. ’83, continues August. aminolevulinic acid GBM targeting and and his other novels are available at neurology. Along with celebrating his zation of internists. Dr. Frankenstein is as chair of the department of radiology MRI-guided focused ultrasound. Amazon and Barnes & Noble online 50th Einstein reunion next year, he and a solo practitioner in pulmonary diseases at Middlesex Hospital in Middletown, Stuart L. Marcus, M.D., Ph.D. ’83, (under the name Don Kline). He is his wife will mark their 50th wedding in Orange County, California, and has Connecticut (appointed in 2010), chief founded a company, SonALAsense, to Kenneth Paul Rosenberg, M.D. working on number 12; be sure to look anniversary. He plans on enjoying his held positions in internal medicine at executive officer of Radiologic Associates develop a noninvasive drug/device in ’83, released a book through Penguin for summaries on Facebook. retirement with his family, including Riverside Medical Clinic, Hollywood of Middletown (2010), and executive combination with sonodynamic therapy Random House to accompany his new their grandchildren, in the Washington, Presbyterian Medical Center, and Henry director of the Patient Is U (TPIU) for the treatment of glioblastoma mul- Sundance Film Festival and PBS film. D.C., area and on Cape Cod, where Mayo Newhall Memorial Hospital. He Foundation (2018). Dr. Crain developed tiforme (GBM) and other cancers. The Both are called Bedlam and detail the 1960s they own a second home. has also held several positions with the and maintains several cancer-screening Ivy Brain Tumor Center in Phoenix, mental illness crisis in America. He is an Jonathan Ostrow, M.D. ’62, retired California Medical Association. from active practice several years ago Robert Ritch, M.D. ’72, received the and now volunteers as a physician at Bietti Medal from the International Steven Kussin, M.D. ’74, released two clinics—Casa Latina, a University Council of Ophthalmology this year, his second book, The Slippery Slope of GUIDING PATIENT CARE WITH THE HELP OF A NEW APP of Washington medical student–run which recognizes ophthalmologists who Healthcare: Why Bad Things Happen clinic in Seattle, and Clinica Amistad, have contributed the most––through to Healthy Patients, in April 2020; it is Clinical guidelines, iPhone mobile devices. Dr. Saperstein notes that the a free clinic in Tucson. He stays busy history, ethics, and education––to the dedicated to patient engagement, educa- meant to guide app delivers evidence-based medicine and offers playing bridge and Scrabble and enjoys advancement of ophthalmology. He tion, and empowerment. His first book, evidence-based sources and links to supporting materials so that theater, hiking, music, and the out- also received a Lifetime Achievement Doctor, Your Patient Will See You Now: medicine, are often physicians understand the “why” behind the rec- doors. Unfortunately, he rarely sees Award from the Asia-Pacific Academy of Gaining the Upper Hand in Your Medical hundreds of pages ommendations. (While the app is free for individual other Einstein graduates anymore, but Ophthalmology and the Gold Medal of Care, was named a Top Ten Wellness long and aren’t easy clinicians to try, medical departments interested in does keep in touch with Leon Redler, the Tunisian Ophthalmologic Society title by Booklist and was reviewed by to thumb through customizing the protocols for their specialties may M.D. ’62. in 2019. The New York Times. when physicians are do so only on paid private channels.) seeing patients. Dr. Saperstein graduated from Einstein with Karen Lowenstein Kade, M.D. ’76 Laurence Platt, M.D. ’68, received Roger Duvivier, M.D. ’74, continues , To help solve that distinction in global health research. He recently a Diversity and Inclusion Service to be honored by Einstein’s department retired from practicing dermatology last Yair Yair Saperstein, M.D. ’16, M.P.H. problem, completed a chief residency in internal medicine at Award from the United States Tennis of obstetrics & gynecology and wom- year and moved with her husband, Paul Saperstein, M.D. ’16, SUNY Downstate, working at Kings County Hospital Association, as well as the Local Hero en’s health and the office of diversity Kade, to the west coast of Florida. She M.P.H., co-founded a for-profit health technology com- in Brooklyn. AvoMD is his third startup; the first two Award from the City of Oakland for enhancement through the jointly spon- loves retirement and living in Sarasota pany, avoMD. Its new mobile app allows physicians to are educational nonprofits that operate internation- managing passage of an initiative to sored annual Roger Duvivier, M.D., County. They have two grandkids, with sift through complicated guidelines and delivers up-to- ally: START Science (startScience.org) and TEACH impose a sales tax on sugar-sweetened Lectureship. Dr. Jamila Perritt, an another on the way. date information at the point of care through a mobile (teach4kids.org). beverages sold in the city. In addition, advocate for girls and women, deliv- phone or tablet. A member of the Alpha Omega Alpha Honor Howard Reinstein, M.D. ’78 this year is the 50th anniversary of leg- ered the fifth lecture in April 2019. Dr. , was Dr. Saperstein says the app “helps doctors effective- Medical Society, Dr. Saperstein is an acclaimed classi- islation passed to establish the National Duvivier continues to volunteer with named “Physician of the Year” by the ly use the vast amount of available clinical knowledge to cal concert pianist and a recreational ukulele jammer. Health Service Corps, which launched WINGS and with Rotary International medical staff at Providence Cedars-Sinai provide better care for their patients. It’s an interactive He has received numerous honors, including being from a proposal he wrote and lobbied in Guatemala. He would love to have Tarzana Medical Center in Los Angeles. and efficient way of accessing the guidelines.” named to Jewish Week’s list of “36 under 36” most for while he was a young officer in the his fellow alumni join him in Antigua. He also received a Heart of Gold award A free version of the app can be found at www. influential Jewish Americans, and was a semifinalist in U.S. Public Health Service. from the Child Development Institute. avomd.io, and is downloadable on both Android and the Dell Social Innovation Challenge. And “more importantly,” he says, his

68 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 69 MOTIVATIONS | CLASS NOTES

Partnering with the AFJ and Orbis was introduces high school students to medicine, started Optage Hospice STAY IN TOUCH a natural fit and allows me to follow in careers in medicine. in Roseville, Minnesota, in 2011 for Keep your classmates up to this tradition.” Presbyterian Homes—the third-largest A TRIBUTE TO COVID-19 date by submitting your news Peter J. Taub, M.D., M.S. ’93, is a nonprofit senior housing organization FRONTLINE WORKERS @ professor of surgery, pediatrics, dentistry, in the country. In August 2019 she was to Einstein magazine. We 1990s neurosurgery, and medical education at named the hospice’s medical director. U.S. Air Force Major Michelle look forward to including you. Panayiotis Ellinas, M.D. ’91, has the Icahn School of Medicine at Mount Dr. Hoiland is a mother of three—18- Cunningham, M.D. ’13, took part in Email us at einsteinalumni@ worked as a physician for refugees, part- Sinai in New York City. He serves as the year-old twins and a 14-year-old boy. a special military flyover of northern einsteinmed.org. nering with nongovernmental organiza- program director for the division of plas- She loves Latin dancing, doing cross- California medical facilities last May. She tions as a medical director in Cambodia tic and reconstructive surgery, directing fit exercise, cross-country skiing, and is a flight surgeon and family physician and Kosovo. He also has worked in a the Cleft and Craniofacial Center and enjoying good food. with the 99th Reconnaissance Squadron clinic close to the Mexican border. His the Vascular Anomalies Program. at Beale Air Force Base in California. addiction psychiatrist in Manhattan and international work began while he was The flyover honored the contributions lives with Lynn Novick on the West Side. at Einstein, when he volunteered with Steven Thau, M.D. ’94, was inter- 2010s of healthcare workers, first responders, the Thai Centers for Disease Control. viewed on CNN in May for his suc- Alan Sheyman, M.D. ’10, recently Major Michelle Cunningham, and others combating COVID-19. Dr. Lauren Plante, M.D. ’84, has released His son just started university as a dou- cess in using an oxygen hood as an returned to New York City and is a M.D. ’13 Cunningham accompanied a pilot in one her third book, Respiratory Disease ble major in physics and aeronautical alternative form of oxygenation while practicing medical and surgical oph- of four two-seat supersonic jets, all Northrop T-38 Talons. in Pregnancy, which she co-edited engineering and wants to travel to Mars. decreasing the risk of contamination for thalmologist and retina specialist. He “Even though I fly with my unit frequently, this flyover was surreal,” with Stephen Lapinsky. Cambridge His daughter is 13 and is extremely critically ill COVID-19 patients, sparing and his wife, Masha, have an adorable she says. “We flew low over downtown Sacramento and the hospitals University Press published the book. left-handed: she draws, listens to music, more than 50 percent from having to toddler who likes to create havoc every where I did most of my family medicine residency rotations. I could and writes. He sends his regards from be intubated. Dr. Thau is the chief of so often. Dr. Sheyman misses playing easily imagine the long hours, the constant worry, the change to family Myra Skluth, M.D. ’86, received the Southern Illinois. pulmonary and sleep medicine at Phelps postexam basketball at the Einstein gym routines, and the life-changing challenges that COVID-19 was posing Henry Gift Distinguished Internist Memorial Hospital Center in Sleepy but does not miss the exams. to my friends and colleagues at Einstein and New York City hospitals. Award from the Connecticut chapter of Ira Richterman, M.D. ’91, recently Hollow, New York. He is also the father Although my current work situation may be very different from theirs, I the American College of Physicians at received a promotion to president of Francesca Thau, a second-year medi- Jonathan Koenig, M.D. ’13, married felt proud to be able to honor the work of all healthcare workers in the its annual chapter meeting in October and chief executive officer of OMNI cal student at Einstein. Dani Haber on Nov. 16, 2019, in Palm flyover. I hope they know just how much they are appreciated.” 2019. The award recognizes a lifetime of Orthopaedics and president of OASIS Springs, California. He received his outstanding clinical service to patients Ambulatory Surgery Center, both in Craig Zalvan, M.D., F.A.C.S. ’95, fellowship at Rady Children’s Hospital and notable leadership within the local Canton, Ohio. He is also the president released a book in September 2020, in San Diego. Since August 2019, he medical community. of Starkap Captive Insurance Company. Laryngopharyngeal and Gastroesophageal has been practicing pediatric orthopedic Reflux: A Comprehensive Guide to surgery in Brentwood, California. Norman Saffra, M.D. ’88, has part- Jose Ortiz Jr., M.D. ’92, was named Diagnosis, Treatment, and Diet-Based nered with the American Friends of the 2020 Physician Citizen of the Year Approaches, which also details the Esther Mizrachi, M.D. ’15, is an emer- Jamaica (AFJ) and Orbis International by the Wisconsin Medical Association, benefits of a mostly plant-based, gency medicine physician with Mount

to support an inaugural blindness- an honor given to physicians who Mediterranean-style diet in the treat- Sinai. She and her husband, Jacques, Photos courtesy of U.S. Air Force prevention program in Kingston, have made significant contributions ment of reflux disease. Dr. Zalvan is welcomed their first baby in April. One Jamaica, which seeks to reduce the to their communities. Chief of staff at chief of otolaryngology and medical of Dr. Mizrachi’s greatest memories is of backlog of patients requiring surgery the Mayo Health Clinic in Eau Claire, director of the Institute for Voice and her cloaking her sister, Sarah Mizrachi, and to build capacity for residents at the Wisconsin, he is also on the hospital Swallowing Disorders at Phelps Hospital M.D. ’19, at graduation. University Hospital of the West Indies practice subcommittee and is part of the in Sleepy Hollow, New York. He also is and Kingston Public Hospital. He per- regional management team. Dedicated a partner of ENT and Allergy Associates Ashley Eckel, M.D., Ph.D. ’16, joined formed more than 20 procedures in six to public health initiatives and med- in the Voice and Swallowing Division. the University of Washington, Seattle, Michelle Cunningham, M.D., looks out at the other supersonic jets flying in days there. Dr. Saffra says, “Jewish tradi- ical education, Dr. Ortiz works with department of laboratory medicine, formation in honor of California healthcare workers battling COVID-19. tion dictates that we participate in tikun the Chippewa Valley Free Clinic and Christa Hoiland, M.D. ’97, who is division of hematopathology, in July olam—making the world a better place. Medical Experience Program, which board certified in hospice and palliative 2020 as an assistant professor.

70 EINSTEIN : SUMMER/FALL 2020 MAGAZINE.EINSTEIN.YU.EDU 71 MOTIVATIONS | CLASS NOTES A LOOK

IN MEMORIAM BACK

Montefiore Doctor Who Separated Conjoined Twins Eskandar, M.D., professor and chair of the Leo M. Davidoff Department James T. recognition when he led a team of of Neurological Surgery, the David Goodrich, surgeons at Children’s Hospital at B. Keidan Chair of Neurological M.D., Ph.D., Montefiore (CHAM) during a series of Surgery at Montefiore and Einstein, age 73, a four operations over the course of nearly and the Jeffrey P. Bergstein Chair in renowned pedi- a year to separate 2-year-old boys Carl Neurological Surgery at Einstein. atric neuro- and Clarence Aguirre, who were joined Born in Portland, Oregon, Dr. surgeon who at the top of their heads. In 2016 he Goodrich served in the U.S. Marine served Einstein led a team of 40 doctors in a 27-hour Corps during the Vietnam War. He and Montefiore for more than 30 years, procedure at CHAM to successfully received his bachelor of science degree died March 30, 2020, from complica- separate 13-month-old twins, Jadon and from the University of California– tions associated with COVID-19, in the Anias McDonald. He was consulted on Irvine and his M.D./Ph.D. from Bronx, New York. hundreds of cases, and he traveled the Columbia University. His intern and Director of pediatric neurosurgery at globe sharing his expertise. residency training was completed at Montefiore and professor in the Leo M. Described as a humble and caring NewYork-Presbyterian Hospital and Davidoff Department of Neurological man by his colleagues, every year he the New York Neurological Institute. Surgery, of pediatrics, and of plastic and baked holiday cookies and delivered A fellow of the Royal Society of reconstructive surgery at Einstein, Dr. them to the nurses at CHAM. Outside Medicine in London, Dr. Goodrich Goodrich dedicated his life to saving of work, he was known for his passion served as a member of the American children with complex neurological for historical artifacts, travel, and surfing. Association for the Advancement of conditions. He developed a multistage “Jim was in many ways the heart Science and the American Association approach for separating craniopagus and soul of our department—a master for Neurological Surgeons. twins (those fused at the brain and skull). surgeon, a world-class educator, and a In addition to his wife, Judy In 2004 he gained worldwide beloved colleague for all,” says Emad Laudin, he is survived by three sisters. Photo Credit: Archives of Associated Press Archives Photo Credit:

Shalom Buchbinder, M.D. ’81, age early solitary lung transplants, chair Rose F. Kennedy Intellectual and 66, chair of radiology at the Brooklyn of the department of medicine at Developmental Disabilities Research Hospital Center and a clinical professor Maimonides Medical Center, Brooklyn, Center from 1982 to 1993, first resident Protecting the Bronx of radiology and of obstetrics & June 11, 2020, Thornwood, New York. in neurology at Einstein, professor When pandemic flu threatened New York in 1957, Montefiore Hospital nurse Marjorie Hill received gynecology and women’s health at emeritus in the Dominick P. Purpura the first shot citywide, from Joseph Ballinger, M.D. Like today’s coronavirus pandemic, the 1957– Einstein as well as a Talmudic scholar, Seligman Rosenberg, M.D. ’59, age Department of Neuroscience, and 58 flu outbreak originated in China. It claimed 116,000 lives in the United States and was highly May 2, 2020, Teaneck, New Jersey. 85, retired ophthalmologist, member professor emeritus in the Saul R. Korey of Einstein’s first graduating class, Department of Neurology, May 28, contagious, spreading to more than 20 countries in less than four months. The rapid development Michael Goldstein, M.D. ’63, age clinical assistant professor emeritus of 2020, Stamford, Connecticut. of a vaccine in this country—the U.S. Public Health Service released virus cultures to manufacturers 86, pulmonary medicine, Feb. 20, ophthalmology and visual sciences at in May 1957 and the vaccine entered trials in late July 1957—probably helped curb the number of 2020, Delray Beach, Florida. Einstein, and leader of the Dean’s Club, Grisel Vazquez, age 67, senior deaths in the United States. June 28, 2020, Tenafly, New Jersey. administrative staff member in the Stephan Kamholz, M.D., age 72, department of medicine who retired in longtime member of the Einstein and Herbert G. Vaughan Jr., M.D., 2017 after 30 years of service, March Montefiore community, involved in Ph.D., age 90, director of Einstein’s 27, 2020, Bronx, New York.

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Science at the Heart of Medicine

EINSTEIN IMAGE

The human antibodies that best neutralize the novel coronavirus bind to its spike protein. To develop antibody therapies, the laboratory of Steven Almo, Ph.D., needed to know where the best-neutralizing antibodies bind to the protein. Graduate students Natalia Herrera and Nicholas Morano obtained spike protein by expressing its gene in mamma- lian cells. The New York Structural Biology Center (NYSBC) then obtained cryo-electron microscopy images of ~50,000 particles of the protein. Ed Eng (NYSBC) and Jeffrey Bonanno, Ph.D., research assistant professor in Dr. Almo’s lab, used com- puter programs to rapidly reconstruct those images into a molecular envelope (gray area), allowing the researchers to generate a high-resolution model of the protein’s amino-acid strands (represented as blue, red, and green ribbons). Of greatest interest in this structural model of a spike protein is the top part: the “receptor-binding domain” that latches onto the ACE2 receptors of human cells and is tar- geted by neutralizing antibodies. Image credit: Jeffrey Bonanno, Ph.D.