A New Era Dawns in Cancer Care and Research at Duke

VOLUME 12, ISSUE 1 SPRING 2012

A new era dawns in cancer care and research at Duke

14 Introducing the new Duke Cancer Center

22 Then, now & next: Evolving cancer care

29 Finding better cancer therapies A new home for cancer care—as it should be

After years of diligent planning and the efforts of hundreds For the first time, we have brought oncology clinicians of members of the Duke and North Carolina communities, I and support staff from across the medical center together am proud to report that Duke’s new cancer center welcomed under one roof, and organized them into dedicated, its first patients on February 27, 2012. The opening of integrated teams focused on specific cancer types. Our this landmark facility is truly a historic milestone for patients will benefit from more convenient access to a full Duke Medicine, and perhaps the most tangible symbol of spectrum of specialists—and from an array of thoughtful a new era in cancer care and research at Duke that began amenities and services designed with their total health, in November 2010 with the launch of the Duke Cancer comfort, and well-being in mind. Institute—a strategic reorganization of our cancer care and At the same time, this facility will magnify the clinical research programs designed to accelerate progress against and research impact of the Duke Cancer Institute (DCI), the disease. which is uniting laboratory scientists with physicians We’ve devoted much of this issue of and patient-care staff to forge DukeMed Magazine to these exciting new collaborations that will drive developments, because we believe advances in care. As the primary they are a thrilling advance in our clinical site for DCI, the cancer center teaching, research, and clinical care is a place where patients can access missions—an essential step toward the latest therapies through clinical true transformation in the way that trials—while in turn our clinician- cancer patients are cared for, at Duke scientists glean insights that inform and everywhere. further advances in research. We built the Duke Cancer Center I consider the establishment facility to meet the growing need for of the DCI to be among our most high-quality cancer services in our important and transformative Chancellor Dzau with philanthropist Jonathan Tisch region, where the number of people initiatives during my time as (left) and North Carolina governor Bev Perdue (right) diagnosed with cancer is rising by at the Duke Cancer Center ribbon-cutting ceremony chancellor. To me, this discovery- double-digit percentages every five on February 23, 2012. For more coverage of the care continuum is the promise of grand opening celebration, see page 34. years. We didn’t just consider the Duke Medicine, and what makes us a need in terms of population growth source of real hope to every patient and statistics, though. As anyone who has been touched we serve. To paraphrase Michael B. Kastan, MD, PhD—a by cancer knows, it’s hard to adequately convey the stress renowned cancer scientist whom I appointed as the DCI’s that cancer can put on a patient and his or her family. Apart inaugural director in 2011—at Duke we don’t simply seek to from the physical and mental impact of the disease itself, provide great care, we seek to provide cures. the rigors of the treatment process—from chemotherapy to In terms of cancer, the word cure is an ambitious one— endless appointments and paperwork—can be a gauntlet of perhaps even an outrageous one. But it is true that for the its own. first time in the generation since we launched the war on Through the Duke Cancer Institute, we are working to cancer, we’ve got not only better tools to fight with but also change that reality in two ways: first, by redesigning cancer an environment designed to encourage hope and healing. care to improve each patient’s experience, and second, by We have great expectations. This is an exciting time for facilitating the development and delivery of more effective Duke Medicine, and we look forward to sharing it with you. therapies that will bring new hope for patients everywhere. This new building supports both goals: It is designed to be at once a welcoming, healing environment for patients and a nexus of research and treatment innovation. Victor J. Dzau, MD Chancellor for Health Affairs, Duke University President and CEO, Duke University Health System James B. Duke Professor of Medicine 14 dukeMed m ag a zi n e

VOLUME 12, ISSUE 1, SPRING 2012 22 29

features 14 introducing the new duke Cancer Center Look inside a landmark 22 then, now, next Transforming cancer care from generation to generation 29 found in translation Duke’s design to deliver better cancer therapies

dePartments 2 dukemed now Campus construction, advancing medical education in Tanzania, taking blood-pressure management into the community, more 8 Clinical update Myth-busting kidney donation, detecting prostate cancer in the obese, less is more in knee replacement rehab, new option for heart valve replacement, how stress damages DNA, more 34 Cancer Center Grand opening events 38 dukemed Giving 39 dukemed People 43 new Physicians 52 Cme Calendar DUKE MEDICINE ADMINISTRATION Victor J. Dzau, MD Psychiatry and Behavioral Sciences: Chancellor for Health Affairs, Sarah Hollingsworth Lisanby, MD DukeMed Duke University Radiation Oncology: President and CEO, Duke University Christopher Willett, MD Health System (DUHS) Radiology: duke university Hospital William J. Fulkerson Jr., MD NOW Geoffrey D. Rubin, MD Executive Vice President, DUHS Surgery: Kenneth C. Morris Danny O. Jacobs, MD Senior Vice President, Chief Financial Officer, and Treasurer, DUHS duKe uniVersitY HealtH sYstem Nancy C. Andrews, MD, PhD Board of direCtors Thomas M. Gorrie, PhD, Chair Bell emergency department Dean, School of Medicine Building Vice Chancellor for Academic Affairs Peter Van Etten, Vice Chair Nancy C. Andrews, MD, PhD Catherine L. Gilliss, DNSc, RN Daniel T. Blue Jr. Dean, School of Nursing Jack O. Bovender Jr. Vice Chancellor for Nursing Affairs Richard H. Brodhead, PhD K. Ranga Krishnan, MB ChB Victor J. Dzau, MD Dean, Duke-NUS Graduate Medical Frank E. Emory Jr. School Singapore James F. Goodmon Carolyn E. Henderson Monte D. Brown, MD Danny O. Jacobs, MD Vice President for Administration, duke university Rebecca Trent Kirkland, MD school of nursing Duke University Health System Richard D. Klausner, MD Robert M. Califf, MD John H. McArthur, PhD Vice Chancellor for Clinical Research Lloyd B. Morgan Theodore N. Pappas, MD Karen Frush, MD Carl E. Ravin, MD Chief Patient Safety Officer, DUHS duke Clinic Steven Scott, MD Mary Ann Fuchs, DNP, RN Susan M. Stalnecker Chief Nursing and Patient Care Katherine Keith Thomas Services Officer, DUHS G. Richard Wagoner Jr.

Art Glasgow duKe uniVersitY Board of Vice President and Chief Information trustees mediCal Center Officer, Duke Medicine aCademiC affairs Committee Ellen Medearis Thomas M. Gorrie, PhD, Chair Vice President, Development and Anne T. Bass, Vice Chair Alumni Affairs, Duke Medicine Julie Barroso, PhD Adrienne Clough Construction over the past few years has dramatically reshaped Michael Merson, MD Paul E. Farmer, MD, PhD the medical center campus. (above left to right: June 2009 and Vice Chancellor for Duke-NUS Affairs Donald P. Frush, MD December 2011) Paul Newman Xiqing Gao, JD Executive Director, Felicia Hawthorne (GPSC Student) Private Diagnostic Clinic and Patient Elizabeth Kiss, DPhil Revenue Management Organization Cynthia Kuhn, PhD Michael Marsicano, PhD Thomas A. Owens, MD Alan D. Schwartz Chief Medical Officer, DUHS Laurene Sperling Carl E. Ravin, MD Nancy C. Andrews, MD, PhD* President, Private Diagnostic Clinic Monte Brown, MD* Kevin Sowers, RN Victor J. Dzau, MD* President, Duke University Hospital Catherine L. Gilliss, DNSc, RN* Peter Lange, PhD* Douglas B. Vinsel DukeMed Magazine welcomes comments from our Navid Pourtaheri* President, Duke Raleigh Hospital William G. Anlyan, MD** readers. Write to us via e-mail ([email protected]) Kerry Watson Eugene W. Cochrane Jr.** President, Durham Regional Hospital Jean G. Spaulding, MD** or postal mail: * Ex officio member dePartment CHairs ** Observer DukeMed Magazine Anesthesiology: Mark Newman, MD duKe mediCine Board of Visitors DUMC 3687 Leslie E. Bains, Chair Biochemistry: Durham, NC 27710 William G. Anlyan, MD* Richard Brennan, PhD Kirk J. Bradley Biostatistics and Bioinformatics: Santo J. Costa Elizabeth DeLong, PhD Duncan M. Faircloth* VOLUME 12, ISSUE 1, SPRING 2012 Cell Biology: Michael Fields Michael T. Gminski Brigid Hogan, PhD Editorial Advisory Board: Thomas M. Gorrie, PhD* Community and Family Medicine: George L. Grody Martha Adams, MD J. Lloyd Michener, MD Charles R. Hughes dukeMed Kathryn Andolsek, MD Dermatology: Robert A. Ingram m ag a z i n e Dan Blazer, MD Russell P. Hall III, MD Richard S. Johnson Nelson Chao, MD John D. Karcher Immunology: Sally Kornbluth, PhD David L. Katz, MD Editor: Minnie Glymph Michael S. Krangel, PhD Ted Kunstling, MD David P. King Designer: Jennifer Sweeting Ellen Luken Medicine: Garheng Kong, MD, PhD Mary E. Klotman, MD Donald R. Lacefield Creative Director: Kevin Kearns Lloyd Michener, MD Harry Phillips, MD Molecular Genetics and Microbiology: Milton Lachman* Production Manager: Margaret Epps Joseph St. Geme III, MD Joseph Heitman, MD, PhD Roslyn Schwartz Lachman* Nicholas J. Leonardy, MD Contributing Writers: Douglas Stokke Neurobiology: Brandt C. Louie Sarah Chun Robert Taber, PhD Stephen G. Lisberger, PhD Christy King Mack Carol Harbers Obstetrics and Gynecology: Thom A. Mayer, MD* Greg Jenkins DukeMed Magazine is published twice a year by Charles C. McIlvaine Haywood Brown, MD Kathleen Yount the Office of Marketing and Creative Services. Robert B. Mercer Contributing Photographers: Ophthalmology: Stelios Papadopoulos, PhD DukeMed Magazine David L. Epstein, MD Joshua Ruch Duke Photography: Chris Hildreth, Jared Lazarus, Megan Morr, DUMC 3687 Orthopaedics: Ruth C. Scharf Duke University Medical Center Glenn H. Schiffman Jon Gardiner, and Les Todd James A. Nunley II, MD (interim chair) Durham, NC 27710 Charles W. Stiefel Bill Stagg Pathology: Stewart Turley 919-419-3270 Salvatore Pizzo, MD, PhD James M. Whitehurst [email protected] Pediatrics: Myles F. Wittenstein Web: dukemedmag.duke.edu Joseph St. Geme III, MD Sheppard W. Zinovoy* ©2012 Duke University Health System MCOC-8954 Pharmacology and Cancer Biology: *honorary member Donald P. McDonnell, PhD

2 duke university Hospital

learning Center duke medicine Pavilion emergency department

duke Cancer Center

duke university school of nursing

duke Clinic duke medicine Circle

transforming another campus: Duke Raleigh Hospital in Wake County is also in the midst of several major projects to enhance services for its growing patient population. This includes expanding imaging and non- Our changing campus surgical interventional capabilities, Checking in on the medical center expansion of the emergency Google Maps can’t keep up with department, and expanding surgical facilities with the addition of two THE OPENING OF THE NEW DUKE Building opened in 1930, the 104,000-square- new operating rooms. Learn more at CANCER CENTER in February marked a major foot Learning Center will provide students dukeraleighhospital.org. milestone in a sweeping plan to transform and with the latest in educational technologies and integrate the medical center campus. a team-based learning design. It also houses Since leaders announced the plans to add a 350-seat auditorium to accommodate the new facilities to meet increasing demand for medical center’s growing needs. clinical care, enhance the patient experience, Next to open, in mid-2013, will be Duke and support innovative education and Medicine Pavilion—a 580,000-square-foot, research, construction crews and cranes have eight-story addition to Duke University swarmed around the campus to make the Hospital. With the building’s exterior nearly vision a reality. complete, construction teams are now First to open, the Duke Cancer Center working on the interior, which will include brings 267,000 square feet of dedicated space 18 operating suites, imaging, and 160 for the care of cancer patients (read more, patient- and family-centered critical- and page 14). Space vacated by cancer services intermediate-care patient rooms to meet other projects to meet needs in the years in the adjacent Edwin A. Morris Building growing demand. ahead, including an addition to the School and Duke Clinic will be used to expand the Altogether, the new buildings will add of Nursing building as well as a new Duke footprint for other growing services and almost a million square feet to campus. New Eye Center building that will expand clinical to bring related services closer together to gardens, revised vehicle and pedestrian traffic facilities to better serve the 80,000-plus streamline care delivery—including opening patterns, and a campus-wide wayfinding patients Duke Eye Center now sees each a new acute-care sickle cell treatment facility, scheme will unite new and existing facilities year. Duke has received Certificate of Need creating multidisciplinary thoracic and and complete the transformation. Over time, approval from the State of North Carolina abdominal transplant clinics, and expanding Duke Medicine plans to recruit nearly 1,000 for the new facility, and is more than two- non-chemotherapy infusion services. new staff, while the projects themselves have thirds of the way towards the fund-raising The cancer center will be followed late this supported as many as 1,000 construction goal to start construction. Learn more at year by the opening of the School of Medicine jobs at a time. dukemedicine.org/giving. Learning Center. The first new home for The activity won’t stop after these projects Keep up with construction progress at medical student education since the Davison wrap up: planning is already under way for dukemedicine.org/construction.

Visit Duke Medicine online at dukemedicine.org DukeMed Spring 2012 3 Documenting Duke Medicine DUKE PEDIATRICIAN John Moses, MD, believes so deeply in the of their patients and their response to medical treatment—and that this power of documentary work to inspire physicians, he found a way to kind of insight can improve the efficiency and effectiveness of medical put cameras and microphones in the hands of residents to let them care. Five residents took part in the inaugural program; 12 currently are experience it for themselves. Moses, an accomplished photographer and enrolled, and there is a waiting list. documentary producer, worked with Liisa Ogburn at the Duke Center The CDS is also offering a continuing education course, “A Day in for Documentary Studies (CDS) to create the Documenting Medicine the Life of a Patient,” for people interested in using photography and project, a collaboration between Duke’s medical center and the CDS. audio to tell the story of a person with a serious medical condition. Begun last year with a three-year grant from the Graduate Medical This four-day intensive workshop will teach the fundamentals of Education Innovation Fund, the program is a first of its kind. Moses and capturing good quality sound and images, discuss the ethics and Ogburn are convinced that training young physicians in documentary constraints of documenting patient stories, and familiarize students practices can give doctors insights into the factors that affect the health with editing software. For more information, visit documentingmedicine.com.

Boone: Emergency medicine resident Andrew Parker, MD, photographed patients admitted repeatedly to the ER for the same nonresolving symptoms. Boone has juvenile rheumatoid arthritis, which causes chronic pain, near blindness, and stiff joints.

stephanie: Former resident Alison Sweeney, MD, photographed babies and mothers as part of her “Life in the NICU” series. Stephanie was born at 34 weeks— six weeks premature.

4 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) DUKE GLOBAL HEALTH INSTITUTE DUKE GLOBAL HEALTH “With the extraordinary health needs in sub-Saharan Africa, in particular Tanzania, we are wise to invest in medical training as one way of addressing the challenges. We are excited by the possibilities this grant provides to the future of Tanzania and medical education, and to extend our partnership with KCMC.” — JOHN BARTLETT, MD

Making MDs in infrastructure to allow for high-speed Tanzania Internet access, AV-equipped classrooms with videoconference capabilities, a NEARLY 200 MEDICAL STUDENTS at computer lab, and medical education the Kilimanjaro Christian Medical Centre laboratory space. Also through the initia- (KCMC) in Tanzania sat for the National tive, the medical curriculum at KCMC will Board of Medical Examiners (NBME) exami- be reviewed and enhanced, particularly nation this past summer. It was the first training in basic and laboratory sciences time the officially sanctioned test had been and research methodology. With guid- given on the African continent. ance from medical education leaders at KCMC administered the test as part Duke University School of Medicine and of the $10-million Medical Education Duke-NUS Graduate Medical School in Partnership Initiative (MEPI) grant awarded Singapore, the curriculum will be revised to KCMC and the Duke Global Health to utilize team-based, problem-based, and Institute in 2010 by the President’s community-based learning methods. Emergency Plan for AIDS Relief (PEPFAR), “With the extraordinary health needs in Fogarty International Center, and the Health sub-Saharan Africa, in particular Tanzania, Resources and Services Administration to we are wise to invest in medical training as strengthen medical education in Tanzania. one way of addressing the challenges,” says The grant expands the decades-long John Bartlett, MD, DGHI associate director partnership between Duke and KCMC for research and co-principal investigator. to train a new generation of Tanzanian “We are excited by the possibilities this physicians with the knowledge and tools to grant provides to the future of Tanzania become their country’s leaders in academics, and medical education, and to extend our research, and policy. partnership with KCMC.” The NBME exam was administered over The KCMC-Duke collaboration is one of the Internet, which was a large feat for a 14 MEPI award recipients. MEPI provides donald: Cindy Feltner, MD, an occupational and university in a low-resource setting where grants to foreign institutions in sub-Saharan environmental medicine fellow, photographed power failures are common. Thanks to African countries to develop or expand and her father, Donald (above), and his co-workers the MEPI award, KCMC’s medical educa- enhance models of medical education. at a coal mine in West Virginia as part of her tion building now has a new technology ongoing project on the management of chronic disease in the workplace.

Visit Duke Medicine online at dukemedicine.org DukeMed Spring 2012 5 Dan Morgan of Durham (above), a 67-year-old retired retail- store executive, has enjoyed success in Check It, Change It. Do as I do In his first four months in the new community-based hypertension manage- A noted Duke cardiologist ment program, he lost 20 pounds and was close to going off the blood pressure practices what he teaches medication he had been on for two years. Morgan believes that the process of creating new, healthy habits has been the most important thing for him. He ROB CALIFF WAS SHOCKED when he works out at the Downtown Durham YMCA every day for an hour, and he has discovered he had hypertension. It had been improved his eating habits significantly. a few years since he’d paid much attention “Honestly, I don’t love the treadmill and the stationary bike,” says Morgan, to his blood pressure—then, in 2010, his whose knees won’t allow him to play as much racquetball as he would prefer. doctor told him it was too high. “But now that it’s a habit, I miss it when I don’t go.” Considering Califf’s life and work, his Although the program asks participants only to check their blood pressure high blood pressure is not surprising. He is at least twice a week, part of Morgan’s new set of good habits includes an executive at a large corporation, he eats checking it every day at the YMCA. He even keeps a chart there of his progress. out frequently, he travels all over the world, Ultimately, such habits are key to consistent BP management. he’s in his late 50s, and he doesn’t care for “I went 90 miles an hour in my career for 40 years, and it was stressful,” exercise. But here’s the twist: Califf is Duke’s Morgan says. “It’s a good time to start a new routine.” vice chancellor for clinical research, he’s a practicing cardiologist, he directs the Duke Translational Medicine Institute, and he’s Check It, Change It is a unique model of (AHA) heard about the effort and contrib- one of the world’s foremost researchers in integrated care for hypertension. The genesis uted substantial funding. cardiovascular medicine. of the project was when Califf and Duke The program began enrollment in Califf had already begun treatment for won an award from the National Institutes of December 2010 after hiring three physician hypertension when he decided to enroll Health to investigate how medical researchers assistants and seven community health in a Duke-led, community-based quality can translate findings more quickly from coaches to serve as patient liaisons. These improvement initiative designed to help an academic setting into the community to Check It, Change It staffers promoted the residents of Durham County control their improve population-based health. program heavily in busy community venues blood pressure. He was the first person to With the award in hand and the knowl- such as churches, mosques, barbershops, enroll in Check It, Change It, a grassroots edge that 30 percent of Durham County schools, libraries, and community centers. effort that is an offshoot of Durham Health residents suffer from hypertension, DHI “We wanted to drive blood pressure care Innovations (DHI), a public-private-academic began to formulate an intervention strategy. outside of traditional health care settings partnership that Califf helped found. Meanwhile, the American Heart Association into the community where people work,

6 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) 1 NEW MASTER’S PROGRAM 2 YEAR PROGRAM 16 STUDENTS IN THE FIRST CLASS 45+ BIOSTATISTICS & BIOINFORMATICS FACULTY AT DUKE

Biostatisticians: Adding to the count

TODAY’S STUDIES OF THE SMALLEST increments of a human—the genome, the gene, the protein, the metabolite—yield a tremendous amount of complex data. That means that today’s biomedical research teams are increasingly reliant live, and play,” says Bimal Shah, MD, a Duke Califf’s results have been good: he has lost on biostatisticians—people who have cardiologist who is co-principal investigator 10 pounds, with a goal of losing five to 10 not only strong statistics skills but also a for Check It, Change It with fellow Duke more; his blood pressure is controlled by one foundation in human biology, and the cardiologist Kevin Thomas, MD, and Sharon medication; and he works out at least 30 ability to communicate statistical principles Elliott-Bynum, PhD, executive director of minutes a day on an elliptical machine. His to multidisciplinary research teams. community health nonprofit CAARE Inc. regular monitoring has allowed him to adjust The demand for biostatisticians is Through eight participating clinics, the dosage of his medicine right away when outstripping the supply. Hence Duke’s new program staff enrolled 2,045 Durham County he notices spikes in his BP. But it has been the Master of Biostatistics Program, which residents. With the Check It, Change It team, human contact of Check It, Change It that he welcomed its first class of 16 students this participants designed a plan to reduce their has found the most helpful. school year. The two-year degree program blood pressure (BP), including diet and exer- “We know that people are busy and lead provides mentored academic training in cise modifications, hypertension educational stressful, complex lives,” Califf says, noting biostatistics, including experiential learning counseling, and/or medication. Physician that program staff helped him stay diligent. opportunities in authentic ongoing research. assistants monitored progress and followed “They’ll get on the phone and give you a “We wanted this to be different from up to make sure participants stayed on track. call if you haven’t entered your data, or your a traditional master’s program,” says Patients checked their own BP at least once data doesn’t look good. Active follow-up and Greg Samsa, PhD, director of graduate a week, either at home or at blood pressure reminders are the most important thing.” studies for the Department of Biostatistics monitoring stations located in 17 convenient The intervention phase of Check It, and Bioinformatics. “We wanted active, locations throughout the community. The Change It ended in February, and preliminary hands-on learning. Biostatistics is a relatively self-check stations automatically entered results are positive. If final results indicate new and rapidly growing discipline, and blood pressure measurements into the AHA’s success, organizers plan to extend the these are the skills we know employers are Heart 360 Web portal, a tool that promotes community-based model to other chronic looking for.” data sharing with primary care providers and health issues such as obesity, diabetes, and The program provides a practice-based Check It, Change It staff. (Those monitoring high cholesterol. They also hope that other learning environment, so that graduates at home entered their data on Heart 360 communities will adopt the model. will leave the program with a portfolio themselves.) The goal was a reduction in BP that demonstrates their mastery of ana- after six months of program participation. lytical skills, biological knowledge, and communication. Learn more at biostat.duke.edu.

Visit Duke Medicine online at dukemedicine.org DukeMed Spring 2012 7 UPDATEClinical

Talking to patients about live Matthew Ellis, MD kidney donation Duke performs about 120 kidney trans- I have to be related to someone to After the surgery, my life will be different, plants every year, and a third are from donate a kidney to him or her. and it might limit what I can do. living donors. Matthew Ellis, MD, medical New antirejection medications make it Careful screening of donors means that only director of Duke’s kidney transplant possible to donate to distant relatives, even people who are in very good health will be program, says many people don’t realize friends. But wanting to donate doesn’t selected—and for those people, the risks of that they can give this gift of life without mean you’re automatically qualified to do future complications are very low. Women endangering their own. He says being so. Duke’s transplant team takes prospective of childbearing age can still have healthy ready to address common misconcep- donors through a careful physical and pregnancies after donating, and the risk for tions about live donations can help pave psychological screening process—much of future kidney disease is not affected by the the way for more kidney transplants— which can be done remotely for donors donation of a single kidney. “Your health and more lives saved. Here are five who live far away—to make sure the donor care needs after the surgery are essentially concerns that a physician can ease when can undergo the surgery with no ill effects, the same as before the surgery,” says Ellis. a patient is considering the donation. physical or otherwise. Kidney donors will need regular blood and urine tests to monitor kidney function, and The surgery is difficult, expensive, and If my intended recipient and I aren’t a they need to watch their blood pressure, so I’ll need to take a lot of time off. match, the process ends there. they must visit their regular physician every Today’s kidney-donation surgery usually Thanks to the new paired kidney donation year—but, Hicks points out, that’s something takes only a few hours, and it requires program, if you and your loved one are not all of us should do anyway. only a few small incisions and two or three a compatible match, you can be put into days in the hospital. “We say it usually Duke doesn’t accept “Good Samaritan” a database that multiple hospitals use to takes three weeks to get back to almost kidney donations. search for other incompatible donor/recipient all of your normal activities, and about six Duke is now accepting altruistic donors— pairs who might fit your criteria—meaning to eight weeks to feel completely back to those who are willing to donate a kidney the other donor gives your loved one a normal,” says Leslie Hicks, RN, Duke’s kidney to a recipient in need, even if that person kidney, and you give yours to their loved transplant coordinator. is a stranger. one. In December 2011, Duke’s transplant All hospital expenses are paid for by the team successfully performed the first such Learn more at dukehealth.org/transplant. recipient’s medical coverage—only costs of “double transplant” in the Triangle—making travel, time off work, and a few post-surgery possible two live-donor transplantations that medications aren’t covered, and there are otherwise might not have happened. several organizations that may help cover those costs for donors who cannot.

8 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) Obesity and prostate caught early,” says David Chu, MD, urology A path to better cancer detection resident and lead author of the study pub- chemo delivery lished in the July 2011 Prostate Cancer and THE DIGITAL rectal exam may have height- Prostatic Diseases. Chu and researchers at AN EMERGING ASPECT of cancer research ened importance for those who are obese. Duke, the Durham VA Medical Center, and is attacking tumors on a cellular level by Researchers at the Duke Cancer Institute Sapienza University of Rome, analyzed data learning exactly how certain molecules move and elsewhere have found that obese men from 2,794 men undergoing prostate biop- through cell membranes. To fully understand were less likely to have abnormal digital sies for this study. the mechanism by which the so-called rectal exams than non-obese patients. This The findings also reconfirmed earlier transporter molecule carries substances such isn’t good news—when the doctors’ office research at Duke that PSA tests often fail to as cancer drugs into cells, scientists had to exam was abnormal, it was likely to be an indicate a potential problem in obese men. determine how this molecule is constructed. advanced prostate tumor. The reason may be In such instances, the PSA protein detected With this knowledge, they can create that earlier, smaller tumors are not discern- in the test reads normal, but may actually be chemotherapies that are delivered more able through excessive girth—a shortcoming at an elevated level that is diluted by a bigger efficiently by the transporter molecule. made worse by the tendency for PSA man’s additional volume of blood. The current A team of researchers at Duke’s Ion (prostate-specific antigen) screenings to also study suggests that while an abnormal digital Channel Research Unit recently mapped the miss early signals of prostate cancer among rectal exam may be an important predictor structure of this key molecule, paving the obese men. for prostate cancer in normal-weight men, it way for more effective cancer drugs with The findings help explain why prostate confers extra significance for obese men. fewer effects to healthy tissue. The research cancer is often more lethal among over- “Physicians should not neglect to do the was published in Nature online on March 11. weight men versus those of healthy weight. digital rectal exam, especially in obese men, Graduate student Zachary Johnson was the Simply put, in obese men, “it’s not getting specifically because they are at high risk for lead author. unfavorable cancer outcomes,” The transporter molecule, properly called a says Lionel Bañez, MD, senior concentrative nucleoside transporter, works author of the study. In fact, the by moving nucleosides, the building blocks of study showed that the digital DNA and RNA, from the outside to the inside rectal exam among obese men of cells. It can also transport nucleoside-like actually detected some tumors chemo drugs through cell membranes. that were not flagged by PSA Once inside the cells, the nucleoside-like screening alone. drugs are modified into nucleotides that are incorporated into DNA in ways that prevent tumor cells from dividing and functioning. “We believe it is possible to improve nucleoside drugs to be better recognized by a particular form of the transporter molecule that resides in certain types of tissue,” says research team leader Seok-Yong Lee, PhD, assistant professor of biochemistry. For his work, Lee won the National Institute of General Medical Sciences Award from the Biophysical Society. Lee’s team determined the chemical and physical principles a transporter molecule uses to recognize the nucleosides, “so if you can improve the interactions between the David Chu, MD, and Lionel Bañez, MD (left to right) transporter and the drug, you won’t need as much of the drug to get it into the tumor cells efficiently,” Lee says.

Concentrative nucleoside transporter molecule embedded in cell membrane DukeMed Spring 2012 9 Why stress is bad FOR YEARS, RESEARCHERS have published papers that associate chronic stress with chro- mosomal damage. Now researchers at Duke have discovered a mechanism that helps to explain the long-speculated stress response— in terms of DNA damage. In the study, conducted by postdoctoral fellow Makoto Hara, PhD, mice were infused with an adrenaline-like compound that works through a receptor called the beta- David Attarian, MD adrenergic receptor. The scientists found that this model of chronic stress triggered certain biological pathways that ultimately resulted Banishing the previous patients talking about how it in accumulation of DNA damage. “This helped them recover, and they think they could give us a plausible explanation of how myth of passive need it. chronic stress may lead to a variety of human knee rehab But here’s the thing: current data don’t conditions and disorders, which range from support it. Over the past 10 years, hospitals merely cosmetic, like graying hair, to life- MEDICINE IS NOT IMMUNE to the that specialize in total joint replacement threatening disorders like malignancies,” seductions of tradition—there are studies have studied the use of CPM versus moving says senior author Robert J. Lefkowitz, MD, to prove it. “A lot of things that we do a patient rapidly into active therapy, says James B. Duke Professor of Medicine and in medicine, we do because we’ve always Attarian, and they’ve found that it is no Howard Hughes Medical Institute investigator, done it, not because there are good data better for a patient than introducing who has studied the beta-adrenergic receptor to support that practice,” says orthopaedic physical therapy shortly after the surgery. for many years. surgeon David Attarian, MD, who knows Duke’s Total Joint Coordination of Care The paper, published in August in Nature, firsthand how difficult it can be to break Committee has developed a new protocol showed that the infusion of an adrenaline-like “bad habits” in practice. regarding knee replacement surgery: compound for four weeks in the mice caused Knee replacement surgery has, for the instead of CPM, the patient receives his or degradation of p53, a tumor suppressor past 30 years, made use of continuous her first physical therapy visit on the day of protein that is considered a “guardian of passive motion (CPM) to aid recovery in the surgery (or the following morning), and the genome”—one that prevents genomic patients. The CPM machine—a device his rehabilitation focuses on active motion abnormalities. In these mice, p53 was present that requires a fair amount of effort on instead of passive. Attarian led a Duke study in lower levels over time. the part of the nurse, therapist, or family of the protocol, and the results mirrored the “We believe this paper is the first to member to put it on the patient without data gathered at other institutions: leaving propose a specific mechanism through hurting the patient—came into popularity out CPM reduces patient pain and resource which a hallmark of chronic stress, elevated after some data showed that it might help drain by cutting out the burden of applying adrenaline, could eventually cause DNA reduce drainage and increase a patient’s and removing the device, which requires damage that is detectable,” Lefkowitz says. range of motion at discharge (which was, at two people and four to six hours’ worth that time, seven to 10 days after surgery). of labor over the course of a day. And Attarian estimates that CPM machines are the patients have the same outcomes at still in use in as many as half of hospitals discharge and three months out, compared that perform total joint replacement. “Some to results from CPM patients. While it took hospitals use it as a way to control costs, some time to convince patients and doctors because it reduces their need for therapists alike, Attarian says, the protocol is now to be on hand,” he says. Moreover, patients used 100 percent of the time at Duke. have come to expect the CPM—they hear

10 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) G. Chad Hughes, MD J. Kevin Harrison, MD

Neighbors was among the early Duke temporary pacemakers to allow accurate participants in the Medtronic CoreValve valve positioning and to treat episodes of transcatheter aortic valve implantation (TAVI) slow heart rates. Two people are assigned clinical trial. Almost a year after the first only to load the valve in the delivery CoreValve implant at Duke, it’s still too early catheter properly. to draw conclusions, but trial leaders say initial The doctors implanted Neighbors’s valve results are encouraging. That’s a positive sign on July 23, 2011, a few days after his 79th in a study in which all patients are high-risk birthday. Hours following the procedure, he for valve treatment, and all patients have walked the hospital hallway with assistance. additional concomitant health problems, such Neighbors now feels so good, he walks twice as lung disease or kidney disease. a day and is signing up for a 12-week physical CoreValve TAVI trial Because other stent-based valves have rehab class. He’s also looking forward to showing impressive shown an increased risk of stroke compared driving again, which along with his reinstated to standard valve surgery, choosing patients vigor will give him freedom that was missing early results cautiously is critical. Cardiologist J. Kevin for three months. “I’m going to get loose,” he Will Neighbors, already a survivor of Harrison, MD, who along with cardiothoracic laughs, “and nobody’s going to catch me.” surgeon G. Chad Hughes, MD, leads the quadruple coronary artery bypass grafting To inquire about enrolling a patient in the study at Duke, says that prospective study and a lower right lobectomy to remove a lung CoreValve TAVI trial, call 919-681-3763. tumor, had a heart attack in May 2011. The participants frequently tell him that their event required no immediate surgery, but it ability to remain somewhat independent is did exacerbate his aortic valve stenosis. key to their quality of life. They are interested Neighbors first came to Duke from his in survival and having their symptoms There are two cohorts to the home in southern Arkansas in 2008, when improve, but if the cure is worse than the CoreValve trial: The first includes he was diagnosed with valve disease. When disease, they aren’t interested. “If they have a only patients with severe aortic valve he returned three years later, his doctors saw stroke and they’re left so that they can’t walk stenosis for whom open surgery is not a once-active man laid low by his aortic valve or they can’t function,” says Harrison, “you an option. All of these patients receive stenosis. Neighbors was so short of breath, haven’t really helped them.” the CoreValve. The second cohort is he would get dizzy and fall if he attempted to Harrison and Hughes lead a large patients who are high-risk for standard walk or to bend over to pick up an object. He team performing the procedure. Despite valve surgery. These participants are was ruled ineligible for open surgery because the extensive preparation by the two randomized one-to-one to receive of the position of bypass grafts under his physicians, Harrison jokes, “It’s like running either CoreValve or standard valve sternum. CoreValve—an experimental, stent- a football team.” They rely on a crew of surgery. Although Duke delayed its based valve-replacement procedure—was his about 15, including highly trained surgical enrollment in the trial by four months only option for treatment. “It was this,” he and cath lab nurses and technicians, to be sure the device had been says, “or nothing at all.” cardiothoracic anesthesiologists, and cardiac thoroughly bench-tested for durability, CT and echocardiography specialists. it’s in the top five of 41 enrolling sites Electrophysiology staff implant and run in the United States.

Visit Duke University Health System online at dukehealth.org DukeMed Spring 2012 11 Cholesterol: Bad to the bone HIGH CHOLESTEROL has another charge on its rap sheet. According to Duke researchers, the condition contributes to a loss of bone density by throwing off the Cesarean birth? body’s careful cellular balance of bone formation and bone loss. The finding may Put boots on the mom change the way people look at both choles- A WOMAN’S RISK of deep vein thrombosis may need anti-clotting medicines throughout terol and the statin drugs that treat it. (DVT) jumps during pregnancy and the six the pregnancy, say the recommendations, “Statin drugs have been associated with weeks afterward—in fact, about one in every published in the September issue of positive effects on bone density, but scien- thousand pregnant women will develop the Obstetrics & Gynecology. tists have thought this effect was separate condition, in which a blood clot forms in an For women who are slated for a cesarean from the drugs’ ability to lower circulating internal vein, typically in the legs. It’s one delivery, which increases the risk of DVT, the cholesterol,” says Donald McDonnell, of the leading causes of pregnancy-related guidelines recommend using compression PhD, chair of the Duke Department of death, in part because few patients are aware boots. These devices, which slip over each leg Pharmacology & Cancer Biology. His of the warning signs. and regularly inflate and deflate to help blood team’s studies, conducted on mice, show Duke’s Andra James, MD, coauthored flow more briskly, are already commonly used otherwise: they found that a byproduct new guidelines from the American College for procedures such as hip replacements. of cholesterol, 27-hydroxycholesterol, of Obstetricians and Gynecologists intended While there haven’t been large studies with promotes the activity of a class of proteins to encourage obstetricians to identify cesarean deliveries to prove how much known as liver X receptors, resulting in patients at high risk for DVT and to closely difference the gadgets could make, James increased breakdown of bone. At the same monitor all patients for DVT. Women with says the group decided to recommend them time, this cholesterol derivative blocks the a history (or even family history) of DVT, or because in other types of surgery, the devices protective effects of estrogen in bone cells. who have certain inherited clotting disorders, can cut the clot risk by two-thirds. This means that lowering the levels of circulating cholesterol may be what’s behind a statin’s effect on bone density and bone loss. The findings also help explain estrogen’s long-documented but poorly understood role in maintaining bone health. “Although estrogens have been used for years for the treatment and prevention of postmenopausal osteoporosis, the mechanisms by which it accomplished its positive actions were unclear,” McDonnell says. “These data not only begin to explain this positive activity of estrogen but also suggest potential new approaches for treating bone loss.”

Andra James, MD

Donald McDonnell, PhD

12 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) ECMO—walking? IN JANUARY 2010, 16-year-old Jessica, suffering from end-stage cystic fibrosis, was transferred to the Pediatric Intensive Care Unit (PICU) at Duke Children’s Hospital with hopes of receiving a double lung transplant. Her lung failure was severe enough that she needed to be placed on extracorporeal Jessica (left) and Gina (right) were among the first patients ever to receive physical therapy membrane oxygenation (ECMO). Even with while on ECMO, an extreme form of life support. The innovative protocol developed at Duke this machine acting as Jessica’s lungs, she was enabled both girls to gain enough strength to undergo lung transplants. too sick and too weak to handle the transplant surgery. Jessica was going to die unless she got much stronger, and fast. The Duke team decided that Jessica’s only chance for survival would be to actively first application of the protocol on Jessica. walking. “I was nervous at first,” she says, participate in a physical therapy program “What’s more, she has a hole in her throat “but I did what they told me.” In fact, she that could increase her strength while on from the tracheotomy and her surgical walked 700 feet while attached to the ECMO ECMO life support. Walking a pediatric interventions are fresh and cause pain. It was machine. “It didn’t seem like a big deal to patient on ECMO, the most extreme form of scary enough just to sit her upright, let alone me. I love marine science and everyone kept life support available, had never been done have her walk. The only thing keeping her talking about this fish tank down the hall, so before, and would require careful planning alive, the cannula coming out of her neck, I decided I was going to go see this fish tank.” and significant staff and technological could come out with one wrong step.” Kosla got three to four hours of exercise a resources. But this unique ambulatory ECMO “There is no chance that these patients day in anticipation of her lung transplant. She approach, developed by a multidisciplinary would have survived without this innovative was put on the transplant list on her 20th team led by director of lung transplantation process, so we had to try it,” says Cheifetz. birthday, and got her lungs six days later. David Zaas, MD, ECMO medical director Jessica was indeed able to become strong She’s currently enjoying life and lungs back Ira Cheifetz, MD, cardiothoracic surgeon enough to walk while on ECMO, and she home in Maryland. R. Duane Davis, MD, and pediatric intensivist received her new lungs just weeks after Zaas explains that these patients do well David Turner, MD, has allowed Jessica and starting the program. Jessica died unexpect- because the physical therapy helps them two other extremely ill patients to receive edly a year after her transplant, but the maintain muscle mass and avoid weakness healthy lungs—and to thrive after trans- lungs she received gave her a year of better associated with critical care, which means plantation. “It’s a new way to deliver life quality of life than her cystic fibrosis had they are less likely to suffer the common support as a bridge to transplant,” says Zaas, ever allowed. transplant complications—most of which “and we’ve shown that you can markedly Another of the first patients to receive don’t come from the transplanted lungs, decrease length of stay, improve outcomes, ambulatory ECMO, Gina Kosla, was airlifted but from the sickness of the patient prior to and lower hospital costs.” to Duke on February 24, 2011, in acute transplant. “We are now trying to determine In this protocol, the ECMO cannula is respiratory failure. Kosla has cystic fibrosis, which other populations can benefit from implanted through the neck (as opposed to and when she developed influenza the virus this unique program,” says Cheifetz, “so the groin) and sedation is completely turned shut down her already clogged lungs. She that more children and young adults can off, so that the patient can undergo active was immediately put on a high-frequency receive this lifesaving measure.” physical therapy. It’s quite a sight to see. oscillating ventilator, but she continued The team published an article on “She’s attached to a tower of pumps and to worsen and was put on ECMO. When these cases in Critical Care Medicine in medicine lines,” says pediatric respiratory she woke up, she was told that in order to December 2011. coordinator Lee Williford, describing the receive a lung transplant, she needed to start

Visit Duke University Health System online at dukehealth.org DukeMed Spring 2012 13 by MINNIE GLYMPH photography by JARED LAZARUS Introducing the new Duke Cancer Center On February 27, 2012, a new landmark opened its doors on Duke’s medical center campus—the seven-story, 267,000-square-foot Duke Cancer Center. More than just state-of-the-art space, it’s an environment designed to transform the experience of every patient welcomed inside.

One of the first patients ever to step the host stations with complimentary facilities didn’t always support that—they inside the new Duke Cancer Center was beverages and snacks and the wonderful were more sterile environments designed there long before opening day. Back resource room and the lounge areas primarily for clinical efficiency. The new in October 2011, 80-year-old Laurence where you can look out into natural light. cancer center is designed from the ground DeCarolis donned hard hat, orange vest, You can tell that so much thought has up with the patient in mind.” and safety glasses to be escorted across gone in to making patients comfortable.” In fact, patients—including DeCarolis a muddy courtyard bustling with heavy and many others—helped inform the equipment to the building-in-progress. Critical needs— design, providing input in early focus DeCarolis, a leukemia survivor, and his and creature comforts groups that was complemented with wife, Elizabeth—both longtime volunteers The Duke Cancer Center has in fact extensive research and additional sugges- with Duke’s Cancer Patient Support required years of thoughtful planning tions from caregiver teams. “We really Program—had been invited to take part and concerted effort. The idea of creating wanted to listen to what people found in a walk-through test of the facility’s a dedicated cancer center at Duke began challenging and what we could do to make wayfinding signage. Along with other taking shape in the mid-2000s, when it the whole experience better for them,” volunteers, they navigated their way became clear that existing facilities were says DCI administrator Carolyn Carpenter. to five sample appointment locations neither designed for the way cancer care For example, in the old space, family following temporary paper signs, and was evolving nor sufficient to meet the members often overflowed from crowded then offered feedback to help make sure growing demand for services. Not only is waiting rooms into the hallway. Research the permanent signage would clearly the Duke Cancer Institute (DCI) currently showed that patients brought an average of direct patients to their destinations. serving more than 50,000 patients a year, 3.5 friends or family members with them, The navigation test was one of many forecasts project a 15.3 percent increase so the new building was designed with times during the multiyear planning in new cancer cases in North Carolina ample, living-room-like waiting areas. For and construction process that patients, between 2010 and 2015—and a 22.4 the 120 patients who receive chemotherapy faculty, staff, and volunteers pitched in to percent increase in the greater Triangle each day, the new facility offers options make this new building the best possible region that is Duke’s home base. of cubicles for privacy, a bright communal environment for delivering and receiving Far beyond simply adding space to space for chatting, or even receiving treat- cancer care. And the team effort toward accommodate more patients, though, ment on the rooftop terrace on pleasant that shared goal has produced a place “We saw a real opportunity to create an days. And healing spaces such as a quiet that’s truly remarkable, says DeCarolis. environment that would dramatically room for meditation are complemented by “You walk in and just say, ‘Oh boy.’ The improve the patient experience,” says practical amenities like a boutique, a phar- initial reaction is one of awe, with that Kevin Sowers, MSN, RN, president of Duke macy, an educational resource center, and fantastic atrium. And then as you come University Hospital. “Our providers have a café serving healthy foods—reflecting in you see all the special touches, like always put the patients first, but older the focus on whole-person care.

DukeMed Spring 2012 15 Elba Street Eye Center Duke DUKE CANCER CENTER AT A GLANCE Fulton Street Hospital Parking

Duke Erwin Road Number of floors: 7 Patient and family amenities: Children’s  Duke Hospital Size: 267,000 sq. ft. Boutique with specialty items for Hospital

cancer survivors Medical Center Greenway Original project budget: $235 million Duke  Outdoor garden terrace with infusion Medicine School of Duke Medicine Circle Trent Drive Construction initiated: Late 2009 area for patients Pavilion Nursing Completion: February 2012 Research Drive  Retail pharmacy Cancer Center Flowers Drive  Patient resource center Duke Medicine Key components: Duke Circle Parking  Café  123 clinical exam rooms Clinic  Quiet room  73 infusion stations  Radiation oncology Sustainability features:  Radiology services  Green roof space  Mammography suite  Use of sustainable building materials  3 new linear accelerators  Energy-efficient mechanical systems  LEED Silver status targeted

“The new cancer center is a wonderful, We’re also building survivorship services else, it wasn’t always easy in the past for beautiful environment in which to deliver around that multidisciplinary care— trial coordinators to find private space the very best cancer care,” says William J. activities like social work, nutritional to discuss enrollment opportunities with Fulkerson Jr., MD, executive vice president counseling, all the things we do to help patients. The new facility not only includes of Duke University Health System. “Caring the patient thrive during and after their dedicated private rooms for these consul- for our patients, their loved ones, and treatment will be much easier to deliver tations, but will actually make clinical each other—that’s what it’s all about.” with this kind of geography.” investigation itself easier, says Kastan. The expanded space provides an “Many clinical protocols are multidis- an enVironment for oPtimal Care opportunity to enhance these kinds of ciplinary in nature, with surgery, imaging, Beyond providing a comfortable and services, adds Carpenter. “With space and chemotherapy components. Having welcoming environment, the Duke Cancer organized around disease groups, we those specialists together in one setting, Center will also enhance the leading-edge can accommodate additional staff to along with dedicated nurses who are in care Duke Cancer Institute is known for, enhance the depth of specialized care tune with every aspect of the treatment says DCI executive director Michael B. we offer. We haven’t historically had a protocols, will make it easier to conduct Kastan, MD, PhD. dietician especially for breast and ovarian complex trials.” One important change is that the cancer, for example, but now there will In such ways, he adds, the building facility brings together almost all cancer be one embedded on the floor where supports the overarching vision for the clinical services on the main medical those services are located. We’ll have DCI, which was created in 2010 under the campus, meaning that patients no longer genetic counselors, new-patient coordina- leadership of Duke chancellor for health have to travel to far-flung locations to see tors, family and marriage therapists, and affairs Victor J. Dzau, MD, to accelerate multiple specialists. Instead, most of the pharmacists dedicated to focusing on the translation of research discoveries into DCI’s 100-plus board-certified physicians specific patient populations, whether it’s improved patient care (see related article, and 500 clinical staff will come together prostate cancer or head and neck cancer. “Found in translation,” page 29). in multidisciplinary teams organized by We want to give patients easy access to a “This is going to be a sea change in disease type—so that patients will have total range of expertise.” patients’ experience,” Kastan says. “The access to a full range of expertise in one opening of this new facility, combined convenient setting. desiGned for ProGress with the creation of the DCI, will enable “It’s one-stop care delivery,” says The new facility is also designed to bolster multidisciplinary teamwork, facilitate Kastan. “The providers’ visits are all clinical research—a key differentiator for the clinical research enterprise, and coordinated and everyone comes to the Duke Cancer Institute, which currently make care more effective, efficient, and the patient, which not only makes for conducts around 700 clinical trials of patient-friendly. It’s really making cancer a better patient experience but better investigational new cancer therapies and care what it should be—an endeavor medical care, because communication treatment approaches at any given time. where everything starts and ends with and efficiency are enhanced by the While these trials can provide patients with the patient in mind.” subspecialists being in close proximity. treatment options they will find nowhere

16 At your service: New-patient coordinators like Kristi Wuellner, Stephanie Pinnell, and manager Deborah Jackson (center) are among the first folks patients meet at the Duke Cancer Institute. The coordinators serve as a sort of concierge to help patients organize their appointments, gather needed records from their community physicians, and get answers to their questions—basically, Pinnell says, “It’s our job to make things easy.” The coordinators, pictured here in the Joan and Bob Tisch & Family Atrium and Reception Area, each specialize in a certain cancer type such as prostate or sarcoma. They also serve as a primary contact for referring physicians.

The Oncology Scheduling Hub directs calls to new-patient coordinators: 919-668-6688.

DukeMed Spring 2012 17 “One of the things I’m excited about is that because this new space streamlines patient visits, I have more time to talk to patients, explain the clinical trials, and answer all their questions,” says Beatrice Nelson, RN, research nurse clinician, who is working with gynecologic oncologist Angeles Secord, MD, to enroll patients in studies of vaccines, antiangiogenesis drugs, and other trials. “So that makes it very research-friendly and easier for the patient. The environment is so relaxing, with private spaces for clinical trial education that are nice and big so the whole family can come in.” Angeles Secord, MD, with Beatrice Nelson, RN (right)

A warm welcome: The cancer center lobby features a working fireplace Laurence and Elizabeth DeCarolis, surrounded with the names of donors who have given gifts of $1 million or volunteers with the Duke more toward progress fighting cancer at Duke. Cancer Patient Support Program Team huddles are easy in the new Duke Cancer Center. With the whole spectrum of cancer specialists together in one building, co-located by disease type, and given ample space for both formal and impromptu conferences, providing truly multidisciplinary care is possible on an unprecedented scale. Pictured here are several members of Duke’s thoracic oncology group, one of the first to formalize the team approach, which offers patients treatment plans based on the collaborative input of experts in medical oncology, thoracic surgery, radiation oncology, pulmonary medicine, and genetics.

Susan Blackwell, PA, Christopher Kelsey, MD, Gordana Vlahovic, MD, Mark Onaitis, MD, and David White, MD

Encouraging words: Designed to promote quiet contemplation, the Healing Path on the ground floor of the Duke Cancer Center atrium features inspiring quotes suggested by patients, families, faculty, and staff. Among them are words from Nancy Emerson, Pam Leight, Susan Moonan, and Terri Schinazi, who authored Finding the “CAN” in Cancer— a book provided by the Duke Cancer Patient Support Program to patients and families coping with cancer. “This new building will make patients more comfortable, I’m sure of that,” says John Emerson, “partly because they won’t have to go hither and yon to see their doctors. The people at Duke have always been so friendly and compassionate, so that hasn’t changed, but this new facility is fantastic.” One of more than 200 volunteers with the Duke Cancer Patient Support Program, Emerson was married to the late Nancy Weaver Emerson, a well-known Duke cancer development officer who died in 2003 after surviving 20 years with breast cancer. Nancy Emerson sparked the idea for the program’s beloved Tree of Hope, which has been lit each holiday season since 1991 in memory and honor of the many cancer patients Duke has served over the years. The Tree is a centerpiece of the Seese-Thornton Garden of Tranquility, which will be relocated to the grounds of the new cancer center in the coming months for the enjoyment of patients and families in the years to come. The start of something new: Volunteer John Emerson on the Bernstein Family Garden rooftop terrace, where patients can opt to receive chemotherapy treatments on pleasant days.

18 The Belk Boutique, named for a $1-million gift from Belk Inc. and operated by the Duke Cancer Patient Support Program (DCPSP), carries a range of specialty items for men and women undergoing cancer treatment—from wigs and turbans for those who have experienced hair loss after treatment, to prostheses and postsurgical garments, to gentle makeup and deodorant for sensitive skin. A self-image specialist offers private consultations to help patients feel confident about their appearance. “There hasn’t really been one place people could go for these specialty products in the past,” says Cheyenne Corbett, PhD, director of the DCPSP, which provides services to help patients cope with emotional, relational, and spiritual issues related to cancer. “The space in this facility really helps us take our services to the next level to better support those facing cancer.”

The Quiet Room offers a calming atmosphere for personal reflection as well as group programs, such as journaling, chair yoga, and mind-body classes. “Mindfulness can be an effective way for patients to deal with all the stresses in their lives—cancer and everything else,” says Tracy Berger (left), a marriage and family therapist who facilitates the Mind-Body Approaches to Coping with Cancer support group along with social worker Greg Bankoski (right). “We try to teach patients that what they think about really has an impact on their physical selves.”

DukeMed Spring 2012 19 Three state-of-the-art linear accelerators not only deliver precise beams of radiation to tumors with minimal effect on surrounding tissues but also feature miniature plan- etariums that take patients’ minds off their treatment with soothing, shifting scenes of day- and nighttime skies— including the occasional shooting star. It’s one of many ways nature has been brought into the Duke Cancer Center, says Tracy Gosselin, MSN, RN, associate chief nursing officer for oncology services. “While patients are receiving radiation treatment, five days a week for three, five, or six weeks, I can imagine they would prefer to be elsewhere. We’ve tried as much as we can to bring in elements that speak to the quality of life people encounter outside of cancer treatment, so that while you’re here, maybe for a little bit of the time you can take your mind away from it all.”

“The machines in our new facility are designed to be user- friendly—not only for patients, but for the therapists who administer the treatment, which means we can give treatments more efficiently and with enhanced safety.” —Christopher Willett, MD, chair, Department of Radiation Oncology

20 The new Duke Cancer Center includes two floors of new imaging equipment, including PET, MRI, CT, and SPECT CT scanners as well as a patient- centered breast imaging facility. “Cancer is a disease that frequently requires imaging—to detect the disease, define its extent, determine treatment response, and monitor for recurrence,” says Geoffrey Rubin, MD, chair of the Department of Radiology. “To minimize any potential risk to patients, we want to expose them to as low a dose of radiation as is reasonably achievable, while still gleaning the knowledge we need to best treat their disease. The equipment in our new platform is absolutely state-of-the-art—it will offer not only the highest image clarity but five to 10 times less radiation per image than the older generation of equipment. It’s perhaps the most advanced imaging suite in the state of North Carolina.”

Tracy Jaffe, MD, chief of abdominal imaging, and CT technologist Cindy Davis Level 5 Hematologic Malignancies Genitourinary

Level 4 Oncology Treatment Center

Level 3 Brain Tumor Gastrointestinal (GI) Melanoma Thoracic

Level 2 Breast Imaging Breast Gynecology Duke Raleigh Cancer Center: In addition to the new cancer center in Durham, Duke Level 1 Cancer Institute brings patient-centered, Radiology multidisciplinary care to patients in Wake County at the recently expanded Duke Level 0 Raleigh Cancer Center (DRCC). “Today, patients have the luxury of having many Main Entrance options, many choices—including where Quiet Room they receive their care,” says Joseph Resource Center Moore, MD, a longtime Duke professor Boutique of hematology-oncology and medical Café director at DRCC. “Our presence in Raleigh Pharmacy provides more options to the people of Labs Wake County, who can receive world-class Duke cancer care in the comfort of their Level 00 own community. In addition, at Duke- Radiation Oncology affiliated hospitals throughout North Sarcoma Carolina, we are helping to provide the citizens of this state with high-quality care from prevention, screening, and diagnosis through treatment and survivorship.”

DukeMed Spring 2012 21 01

NOW 02 transforminG CanCer Care at duKe AS THE DUKE CANCER INSTITUTE ERA BEGINS, FACULTY AND STAFF LOOK BACK ON HOW DUKE HAS CHANGED CANCER CARE FOR THE BETTER—AND WHERE WE’RE HEADED NEXT.

by Carol Harbers photography by Jared Lazarus

decadesNEXT that followed, Duke scientists new Duke Cancer Center, where those 03 and clinicians contributed, discovery by treatment advances will be delivered discovery, to a growing arsenal of tactics to patients in a far more focused and When Evelyn Morgan was hired to prevent and treat the once-unstoppable patient-friendly manner than ever before. as Duke’s first oncology clinical nurse disease—offering new hope to patients in “We’ve come so far in the generation specialist in 1967, she embraced her North Carolina and all over the world. since the war on cancer was declared,” role. “I was drawn to the field because Yet while many have benefited from says Michael B. Kastan, MD, PhD, executive it seemed romantic and challenging. We those advances, the dream of curing director of the Duke Cancer Institute. “But were going to cure people!” she says. people too often remains elusive. With a today truly is the beginning of a new era “But often what we gave patients could vision for accelerating progress, Victor for cancer patients at Duke. We are deter- prove to be no good.” J. Dzau, MD, chancellor for health affairs mined to transform care from diagnosis In those early days, when patients at Duke, led the conceptualization and through treatment and survivorship, often died from the side effects of new creation of the Duke Cancer Institute, making our clinical approach more patient- treatments rather than the cancer itself, which was ultimately launched in 2010. centered, delivering treatments that are researchers and doctors all over the The Duke Cancer Institute represents a more effective and less toxic, and helping country were desperate for a better way. total restructuring of clinical care and each patient not only survive—but thrive.” Just a few years after Morgan started research designed to generate innova-

work on the wards, in the early 1970s, tive ideas and speed the translation of 01 Barnes Woodhall, MD the government would declare “war” scientific discoveries into advances in 02 The Edwin A. Morris Clinical Cancer Research on the cancer menace and create the care. This new approach to cancer care Building, opened in 1978 and named for a nation’s first eight comprehensive cancer and research was catapulted forward in $1-million gift from Edwin and Mary Morris, centers—one of which was at Duke. In the February 2012 with the opening of the provided the ﬁ rst dedicated facility for cancer treatment and clinical cancer research at Duke. 03 Evelyn Morgan

22 “We look forward to going to Duke, actually. We walk out with a smile on our faces. I feel very blessed.” Sabrina Lewandowski, 10-year brain tumor survivor, with Gregory and Layla Lewandowski Duke Cancer Center waiting area

First comes love One morning in 2002, Sabrina Lewandowski awoke with a headache that NEXT THE CASE OF THE BRAIN wouldn’t let up. The then 30-year-old teacher eventually was diagnosed TUMOR CENTER with glioblastoma multiforme, the deadliest form of brain cancer. The upward trajectory of cancer care at Duke’s Peter Bronec, MD, performed surgery, and Lewandowski Duke can be clearly traced in the rise was referred to neuro-oncologist Henry Friedman, MD, deputy director of one of its shining stars, the Preston of the Preston Robert Tisch Brain Tumor Center at Duke, where she was Robert Tisch Brain Tumor Center. In immediately started on chemotherapy and radiation. 1937, Barnes Woodhall, MD, came to In the meantime, her boyfriend, Gregory, proposed—he had purchased Duke as its first chief of neurosurgery a ring while she was in surgery. “Later I begged him not to marry me,” she (and the only neurosurgeon in North says, “because I couldn’t even promise him a year.” Carolina). He established at Duke one But the team at Duke had a plan. “Dr. Friedman told me the plan, and of the first brain tumor programs in he said that if it didn’t work, we had another plan,” she says. She battled the nation—a highly focused program, neutropenia and lost her hair. But the cancer never returned. offering just one treatment: surgical “Rather than settle for the standard of care, we used a rotation of tumor excision. For decades, surgery chemotherapeutic agents following surgery and radiotherapy,” says remained essentially the only treatment Friedman. “We believe she did well because we used multiple agents, which for brain tumor patients, even when is not the norm in this fi eld, but she also may have had a tumor with a Darell Bigner, MD, PhD, now director of unique predisposition to respond to therapy. I choose to believe that our the brain tumor center, arrived at Duke foundation of hope—which embraces more than the standard of care— in 1963. “Patients would die within made the difference.” months,” he says. Ten years on, Lewandowski remains cancer-free. In February 2012 she became the fi rst patient seen in the Preston Robert Tisch Brain Tumor Center’s new Duke Cancer Center clinic—and a fi rst-time mom, welcoming daughter Layla on February 9.

DukeMed Spring 2012 23 “I was just an ordinary person who experienced an extraordinary event with a happy ending.”

Gayle Serls, Duke’s first adult cord-blood transplant patient Duke Cancer Center café

Extraordinary Gayle Serls of Durham says her life is ordinary—and that’s just fine with her. For a time, it was about as far from ordinary as a life can get. In 1995, at 45 years old, Serls was diagnosed with a rare form of acute lymphocytic leukemia, which could not be treated with conventional chemotherapy. Her best hope was an autologous bone marrow transplant, for which she was referred to Johns Hopkins. The night before she was to leave, though, she learned that her cancer had returned, and the procedure could not be performed. “Now I had no hope,” she says. But a new option was taking shape at Duke. Joanne Kurtzberg, MD, had pioneered the use of cord blood transplants to treat children with cancer in 1993—and in 1996, Serls became the first adult to receive the groundbreaking procedure at Duke. Today, Serls is one of the longest-surviving adult cord blood transplant patients in the world, and helps make the lifesaving procedure possible for others through her job at the Carolinas Cord Blood Bank at Duke. Duke physician-scientists continue to pioneer advances in the field, through both the pediatric program and an adult program founded by Nelson Chao, MD, in 1996 (see related story on page 29).

24 The brain tumor group was determined As the advances came from every angle, oncologist, surgeon, and others—in one to find a better way—as evidenced by a patients came from all over to Duke’s day, in the same place, and leave with a history of major breakthroughs, which by-now world-famous brain tumor team. team-built plan for comprehensive care. helped establish Duke’s reputation as a And it truly had become a team, offering In practice, that’s not easy to achieve. In leader in care and research for all cancers. not just surgery but medical and radia- fact, many cancer patients today still start In the 1950s, Woodhall became one of tion treatments, plus extensive support their treatment based on advice from a the first physicians to use chemotherapy— services. Today, specialists of all stripes single specialist. nitrogen mustard—for brain tumors, albeit work closely together to formulate the “The true multidisciplinary clinic is with limited success. He also pioneered best treatment plan, increase the effec- rare,” says Kastan. “Only a handful of the use of animal models to test chemo- tiveness of treatment, give the patient a centers work this way—not even most therapy for the treatment of brain tumors. better experience, and improve outcomes. freestanding cancer centers do it. It is In the 1980s, Duke researchers worked Hope has become the mantra of the very complicated to have all the different with the National Cancer Institute to Duke brain tumor group. “And there is disciplines together, to get physicians establish the Brain Tumor Study Group, hope, there’s just no question about it,” from across the departments and across which introduced radiation therapy as a says chief neurosurgeon Allan Friedman, clinical boundaries together for every treatment option. In the 1990s, Duke’s MD. “Not only does Duke bring brilliant patient. It’s challenging in most settings, Henry Friedman, MD, worked with phar- science to bear in treating patients with and requires a concerted effort. Yet it is maceutical companies and participated in cancer, but we treat the whole person and an absolute requisite for optimal care.” national trials that led to the approval of constantly strive to improve quality of life.” That’s why leaders structured the new temozolomide (Temodar), which signifi- Duke Cancer Institute to make “multi-D” cantly prolonged survival. GETTING TO MULTI-D care a reality—for every patient, in every In 2007, a Duke pilot study led by The history of the brain tumor program clinic. To foster collaboration, DCI clini- Friedman and James Vredenburgh, MD, illustrates the major trends that are cians are organized by disease site (such found that bevacizumab (Avastin)—one driving care at the Duke Cancer Institute as breast cancer or lung cancer), not by of a new category of drugs which Duke today: Unprecedented advances in their discipline (i.e., surgery or medical studies had shown to cut off tumors’ technology and in drug development. A oncology). They also meet regularly with blood supply—could slow the growth focus on the whole person and quality clinical and basic researchers interested of glioblastoma multiforme (GBM), the of life. And a commitment to bring all in the same disease sites to generate new most common and deadly form of brain of those resources together for the ideas for study. The new cancer center is tumor. In 2008, John Sampson, MD, PhD, patient. Key to achieving that is the physically designed to support the multi- presented evidence that a vaccine aimed multidisciplinary clinic—in which experts disciplinary approach, as well (see page 14). at inducing immunity to GBMs may stave from every specialty come together to “It is very resource-intensive in terms off recurrence and more than double deliver integrated care that is completely of physicians’ time,” says Joseph Moore, survival times. And in 2011, Lee Jones, focused on the needs of the patient. MD, a medical oncologist at Duke since PhD, added a new treatment to the mix by Ideally, a multidisciplinary clinic 1975. “But for a patient, it’s very efficient. showing that brisk, regular exercise may means patients meet with all their special- It is a very focused way of diagnosing and also extend survival. ists—medical oncologist, radiation planning treatment.”

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01 Darell Bigner, MD, PhD 02 Allan Friedman, MD 03 Henry Friedman, MD 04 Cancer researchers in the 1970s

DukeMed Spring 2012 25 02

01 Je rey Crawford, MD 02 Early radiation oncology tools: state-of-the-art liquid chromatograph 01 03 Duke University Hospital, 1980 04 A nuclear magnetic resonance 03 04 imaging (MRI) scanner, 1983

The benefits are already clear to those The effects are clear: “Over the past two “Antiemetics changed the playing field,” teams at Duke that practice multi-D care decades, we have made tremendous prog- agrees Crawford. “Once we could manage on a smaller scale. “We understood the ress in the treatment of breast cancer,” he the nausea caused by platinum-based value of this type of care early on,” says says. “Today, depending on what numbers chemotherapy, we were able to further Jeffrey Crawford, MD, medical oncologist you look at, 80 to 90 percent of patients develop those drugs.” A few years later, and associate director of the thoracic who present with early-stage breast cancer he and others at Duke introduced another oncology group, who came to Duke as go on to cure. That kind of success has advance in symptom management a resident in 1974. “It is critical for the been made possible in part by the multi- by leading multicenter trials of GCSF patient to get that combined expertise. disciplinary approach, as we are making (Neupogen), a drug approved by the FDA They come here for expertise, but they are more informed and coordinated decisions in 1991 to treat chemotherapy-related often surprised to see just how much they earlier in the management of patients with neutropenia by stimulating the growth of have access to.” breast cancer.” white blood cells. Multidisciplinary care may have flour- Advances in technology have also ished earlier at Duke than other centers MERCIFUL MEDICINES, contributed to making radiation treat- because of the structure of tumor boards PRECISION CARE ment gentler—and more precise, says at Duke, adds Crawford. The tumor board Another sea change in cancer care comes Christopher Willett, MD, chair of radiation is a standing meeting in which surgeons, as a blessed relief. “Patients suffered so oncology. Intensity-modulated radiation medical oncologists, and radiation oncolo- many side effects from chemotherapy,” therapy and 3D radiation therapy have gist get together to review cases and Evelyn Morgan recalls of her early days refined the delivery of radiation to discuss joint treatment plans. “We never as a clinical research nurse. “The nausea treat tumors while minimizing effects had a generic tumor board here—they was what they feared most.” In fact, on healthy tissue. The introduction of have always been disease-specific,” says many antiemetics were originally devel- imaging technology such as MRI and PET Crawford. “The multidisciplinary clinic is oped as treatments for the side effects improved visualization and detection of an extension of that. Instead of waiting of chemotherapy. cancers and the accuracy of treatment. for the tumor board to meet, we’re able “The introduction of effective And linear accelerators allow therapy to to bring together expertise for individual antinausea medication in the late 1980s be delivered with extraordinary precision. cases immediately. It’s like a live tumor revolutionized care,” says Kevin Sowers, Today, “We’re working to define which board for the patient.” MSN, RN, president of Duke University patients would benefit from radiation For breast cancer, multidisciplinary Hospital, who began his career as a nurse therapy through imaging and, importantly, care also works extraordinarily well, on the hospital’s oncology ward. “When the unique biology of each cancer,” says says Gary Lyman, MD. In Duke’s breast I got started in this field in 1985, we Willett. “Our ultimate goal is to tailor oncology group, he and other medical treated cancer patients with chemotherapy treatment to the individual patient. That oncologists work closely together with in the hospital because of the nausea is really where all of cancer care is going.” specialists in not only surgery and radia- and vomiting. The advances in symptom The new class of drugs known as tion oncology but also imaging, pathology, management drugs changed everything, targeted therapies is a key step toward and others in making the diagnosis, and including moving much of cancer care to that aim. Duke researchers have played with social workers, dieticians, physical the outpatient setting.” key roles in developing and testing therapists, and others in supportive care. many of these new therapies, including

26 “The way I feel, the way I recuperated, it’s hard to believe exercise couldn’t be significant. It enhanced my quality of life. I have no doubt that exercise therapy in the future will become more important in cancer prevention and treatment.” Marc Liles, prostate cancer survivor Patient and Family Resource Center, Duke Cancer Center

The health club When Marc Liles’s doctor recommended surgery for his locally advanced prostate cancer, he wanted a second opinion. “Not because I didn’t have faith in my doctor, but I wanted to do everything I possibly could,” he says. At Duke, Liles met with what he calls “the dream team,” including surgeon Cary Robertson, MD, radiation oncologist W. Robert Lee, MD, and urologist Craig Donatucci, MD. “They spent a couple of hours with me and explained all my options,” says Liles. In the end, Liles did choose radical prostatectomy. A year later, his PSA level is very low, and there is no cancer outside the prostate. In fact, he’s in his best health ever, thanks to his participation in a groundbreaking Duke study of exercise in prostate cancer survivors. “This trial is examining, for the first time, the effects of exercise on erectile function and other cardiovascular risk factors in men undergoing a radical prostatectomy for localized prostate cancer,” says principal investigator Lee Jones, PhD, scientific director for the Duke Center for Cancer Survivorship. Liles says the exercise was great for his overall health and well-being. And Jones believes other patients can reap big benefits, too. “My dream is that when a person walks in with a cancer diagnosis, they are told, ‘This is your therapy, and by the way, here is your referral to an exercise specialist,’” he says.

DukeMed Spring 2012 27 01

01 Tina Piccirilli 02 Researchers working to improve x-rays 03 Lee Jones, PhD, studying exercise 02 03 04 Breast Cancer Survivors Clinic

bevacizumab (Avastin)—first approved SURVIVORSHIP: patients feel during and after treatments, by the FDA for colorectal cancer in 2004— A MEASURE OF SUCCESS but it may also extend their lives. and lapatinib (Tykerb), approved in 2007 More effective treatments have given “Cancer is out of their control, but for treatment of HER2-positive breast rise to more cancer survivors—once an exercise is not, and therefore is very cancer. Unlike chemotherapy drugs, which anomaly, now a fast-growing group. empowering,” Jones says. “My goal is that kill all rapidly dividing cells, targeted Lee Jones, PhD, scientific director of one day exercise therapy will be consid- therapies inhibit molecular pathways the Duke Center for Cancer Survivorship, ered part of standard of care for the specific to certain cancer cells. More believes it was about a decade ago that treatment of many cancers, just like it is focused than chemotherapies, they are widespread attention began to be given to following a diagnosis of cardiac disease.” less toxic—and they also extend survival. the particular needs of survivors. “There In the new Duke Cancer Center, this “When the war on cancer began in are about 13 million cancer survivors in increased emphasis on patients’ quality 1971, we didn’t have the tools we needed the United States today. It’s a direct result of life is evident at every turn—from the to fight cancer,” says Kastan. “Today, of our progress in detecting and fighting café serving healthy foods to the educa- thanks to four decades of laboratory and cancer,” he says. In fact, he notes, the tional resource center to the organization clinical discoveries that are leading to percentage of people surviving cancer of clinical care. earlier diagnoses and better therapeutic long-term has risen from 50 percent in “In this new facility, support services— drugs, we see differences in many arenas, 1975 to 67 percent by 2009. the dietician, social worker, counselors, from acute leukemia to breast cancer to Duke launched its survivorship center and others—are integrated into the brain tumors. Where little hope could be in 2005 to support cancer patients both clinical space along with the multidisci- offered to patients back then, we have during and after their treatment. “We plinary care teams,” says Tracy Gosselin, many success stories now. believe that individuals become cancer MSN, RN, associate chief nursing officer “Even in tumors that are very resistant survivors at the moment of diagnosis for oncology services. to treatment—pancreatic cancers, some and are survivors for the balance of life,” “This really is patient-centered care, lung tumors—we now have nontoxic drugs says director Tina Piccirilli. That holistic where everything is focused on their that can increase survival by two or three view informs the center’s services, which comfort and efficiency. The whole months. That may not seem like much, include a wide range of educational and building, and the whole experience we but it’s promising since it tells us we’re support programs from pharmaceutical offer, says that we are there to promote heading in a good direction,” he adds. and genetic counseling, to physical their healing.” “We’re learning that to really improve the therapy and nutrition counseling, to That’s what it’s all about, agrees Kastan. cure rates, we need to refine our under- support groups and social work. The “The more we can support the patient standing of cancer and tumor biology, center also leads research aimed at physically, socially, and medically, the and have scientists and clinicians work defining the role lifestyle interventions more likely they are to successfully hand-in-hand to apply that understanding play in patients’ overall quality of life. complete their therapy—and the more to each person’s care. Our goal with the For example, research by Jones likely we are to cure them,” says Kastan. DCI is to create those opportunities that and his colleagues has shown that not “That remains our ultimate goal.” will continue to move us forward.” only does exercise improve how cancer

28 SALLY KORNBLUTH, PHD, IS A BIOLOGIST WHO SPENDS A LOT OF TIME THINKING ABOUT FROG EGGS. She studies them to understand apoptosis, the cellular death programming that’s present in all normal frog (and human) cells, but becomes disrupted in cancer cells so that they proliferate unchecked. By “totally pure chance,” she says, Found in she happened to hear about the work of oncologist Neil Spector, MD, a Duke colleague who led the development of the breakthrough breast cancer drug lapatinib translation (Tykerb) and was looking for new ways to by Kathleen Yount help women who become resistant to the drug. Kornbluth’s work on apoptosis led the two researchers to a new approach— they used an existing drug to suppress a protein that regulates tumor resistance, thereby resensitizing the tumors to lapatinib. They hope that someday soon this new treatment method will make its way towards a clinical trial. This process of aligning bits and pieces of knowledge and ferrying them from a cell culture discovery to a human therapy is called translational research. Currently the process takes about 15 years—when it’s successful, that is. That’s not a terribly long time in the realm of science, but time is precious for patients. Speeding up that process—and making it less a matter of chance than Kornbluth and Spector’s happenstance meeting—is one of the driving ideas behind Duke’s massive reorganization of its cancer enterprise into the Duke Cancer Institute (DCI).

How can we find better cancer therapies—faster?

With a bold strategy to spark innovative ideas and bring them into practice, Duke Cancer Institute is designing the answers.

DukeMed Spring 2012 29 “We often hear in the media about great scientific discoveries, like finding a new gene in fruit flies, and the researchers say, ‘At some point, we hope this will help people.’ Since most of us will be touched by disease at some point in our lives, we all want to see those great discoveries applied to advancing treatment and outcomes. And that’s what translational research is all about.” —NEIL SPECTOR, MD CO-DIRECTOR OF EXPERIMENTAL THERAPEUTICS DUKE CANCER INSTITUTE

“Great strides have been made against excellent physicians working in the Since the DCI was created, the disease cancer over the past few decades, but clinic,” says Spector, who is co-director groups have been meeting on a regular there are still too many people whose of the DCI’s Experimental Therapeutics basis—and creating new connections. cancer cannot be effectively treated,” says research program. “The DCI is juxtaposing people who Victor J. Dzau, MD, Duke’s chancellor for Bridging the divides between bench have common interests, helping people health affairs, who led the establishment and bedside—or even among various know who their relevant partners are of the DCI in 2010. “It’s clear that we benches—is a significant challenge. Yet and sparking enthusiasm for new ideas,” need to accelerate progress against this most cancer experts agree that it’s some- says Kornbluth, who is vice dean for devastating disease, which is why we where between these two worlds where basic science in Duke’s medical school. created the DCI.” the big advances in oncology will be made. “For example, [breast oncologist] Kim The unique structure of the DCI The Duke Cancer Institute was built to Blackwell runs clinical trials on lapatinib. represents a more focused, integrated be the bridge. She’s a busy clinician; I’m living in a approach to the cancer problem that It all starts with the framework, says different world. But through interactions brings researchers and clinicians Michael B. Kastan, MD, PhD, executive with Kim and other clinicians in the together to spark innovation across the director of the DCI. The institute is breast cancer working group, now I’m spectrum of cancer types, Dzau says. designed not around various special- thinking, ‘Could we work together?’” “Our vision is to transform cancer care by ties and disciplines, but around the “There is much more communication accelerating the translation of research diseases it seeks to cure. Like a grid of among faculty, much more thought being discoveries into breakthrough treatments intersecting interests and skills, there given to clinical-trial protocol develop- that improve patients’ experience and are 10 disease groups for different ment in all areas,” Kastan says. “We outcomes.” tumor sites—each one drawing together believe that’s step one toward our goal,” clinicians, clinical researchers, and which is essentially to do all phases of maKinG tHe riGHt ConneCtions basic scientists—as well as nine National drug development under one roof, with “Traditionally in universities, and in the Cancer Institute-designated research fewer costs (both human and capital) and biomedical industries, there have been programs focused on crosscutting better results. “New target identification, excellent basic scientists working in the interests such as radiation oncology, drug discovery, development, testing, and laboratory, and then there have been prevention, and cancer genomics. taking that into clinical trials—we want to do the whole spectrum within the DCI.”

30 sParKinG neW ideas Dan George, MD, directs genitourinary on collaborations with even more groups Paradigm shifts take time. But the DCI’s medical oncology at Duke. “I’ve been here across the university—from chemists to new way of attacking old challenges eight years, and though Donald and I have imaging specialists. makes so much sense, Duke faculty always had shared interests, we’ve never “It’s been very rejuvenating to feel members are embracing the change. had the impetus to come together. It was connected across the institution,” says Take Donald McDonnell, PhD. really the DCI umbrella that gave us the George. “One great thing about academics Professor and chair of the Department priority to do that work.” is that this environment allows you to do of Pharmacology & Cancer Biology For patients with prostate cancer, things that you can’t do anywhere else.” and a specialist in the development of lowering androgen levels is one of the drugs that target prostate and breast best available therapies, but a certain tiGHteninG tHe CYCle cancers, McDonnell has been at Duke percentage of men die from recurring of innoVation more than 15 years—but until recently cancer that persists even after inhibiting The notion that a closer connection he had minimal interaction with clini- the production of androgens to nearly between scientists and clinicians could cians looking at the other side of what undetectable levels. McDonnell and reap big rewards didn’t fall from the he was looking at. Now, thanks to the George explored new ways to explain sky, of course. Some Duke teams are DCI, he’s leading a research project that how these tumor cells survive even when living proof. involves colleagues from his own lab, androgen is blocked, and have discovered Nelson Chao, MD, works in stem cell his department, the university, and the a potential antitumor molecule that shows transplantation, an area that he says is, by medical center. “We have come together promise against these recurring cancers. definition, translational. “This is a fairly to produce something that’s made me They’re now in the process of translating new field, so a lot of what we’re doing is phenomenally reinvigorated,” he says. their findings into human trials, relying cutting-edge,” he says. “Our patients are terribly ill, and we’re always running trials to try to make things better.” Toward that end, the Adult Blood and Marrow Program “We are in a time of great progress. he leads formed a cohesive system of constantly going back to the lab to try to To continue, we must have a find new ways to treat the disease and reduce complications from the treatment. coordinated flow of basic research “For us,” he says, “the distance between into translational research. This the laboratory work in mice to humans is relatively short.” means many disciplines working Judging by the leaps made since Duke pioneered the use of cord blood in adult together, and that’s where Duke patients in 1996, the system works. Chao’s excels. It’s not a place of great egos, group conducted the first large study demonstrating success in transplanting but of great collaboration.” stem cells from donors who are not fully matched. They introduced chemotherapy —SALLY KORNBLUTH, PhD that is less aggressive than standard prac- VICE DEAN FOR BASIC SCIENCE tice—thereby making transplant an option DUKE UNIVERSITY SCHOOL OF MEDICINE for patients who would otherwise be deemed too sick or too old. New research into hematopoiesis—understanding what regulates the stem cells that give rise to blood—is testing new ways to trigger stem-cell renewal. And multiple projects are under way to manipulate transplanted bone marrow to reduce or prevent graft- versus-host disease.

DukeMed Spring 2012 31 “Really, it’s a remarkable thing that more on practical experience than on provide. “If there’s anything the era of we’re doing,” says Chao. “Nearly all intimate understanding of cancer biology, genomics is teaching us, it’s that there’s patients can have a stem cell donor.” He says Spector. “Take maximum tolerated no such thing as a single tumor type,” credits the success in part to the fact dose, which is how most chemotherapies Kastan says. “Instead of lung cancer that, in his group, the physicians are also were developed years ago. To kill as being a disease that’s treated by the scientists. “It works for what we do. It many rapidly dividing cells as possible— typical three or four drugs, we’re going means the people in the labs understand knowing that will unavoidably include to have 20 subsets of lung cancer, each what the problems really are, so it gives some normal cells—you had to set the one treated with different drug combina- their work more of a focus.” dose to the limit of what people can stand, tions depending on its biochemistry Chao says he believes the new DCI and then back down a bit.” and genetics.” structure will encourage more groups to This has changed dramatically, says Figuring out those tumor subtypes, strengthen connections to laboratory- Kastan, thanks to molecular and cellular and then matching them with the right based faculty “who can help spin off biology breakthroughs that have opened therapies, is the challenge of the future, discoveries to the clinic.” And, he adds, windows into the inner workings of malig- he says. The less you know about the the DCI’s investment in clinical and nant cells. From these new discoveries mechanism that a drug acts upon, the research resources will lift all boats. the drug arsenal has changed from one of less you know about how the treatment “The work we do is very resource- shock-and-awe to more targeted missiles works and how it will behave in the clinic. intensive,” he says. “I think the DCI will aimed at different cell processes. “Over “Then you risk spending five years in bring shared resources that will give the last 40 years, the problem in cancer clinical trials, coming up with a ho-hum us all more security. Having the right was that we’ve had only a handful of result in patients, and having no informa- people is essential, but so is having the drugs we could use, and they were not tion to figure out how to make it better infrastructure.” very specific and they had a lot of toxici- or why it didn’t work,” says Spector. The ties,” Kastan says. “The problem in the drug goes on a shelf, collecting dust, tHe trouBle WitH tarGets next 20 years is going to be the opposite: when it could quite possibly be effective The timing of Duke’s investments in cancer we’re going to have too many drugs and in a different tumor. research is critical—it is a necessary not know how to use them.” This nearly happened in the case of adjustment to stay effective in the face of Indeed, many potentially effective the new kinase inhibitors for lung cancer, mushrooming numbers of cancer therapies. drugs are at our fingertips. But our Kastan notes. These drugs are highly Historically, the war on cancer has technologies and tools are outpacing our effective, but only in a small percentage been a somewhat empiric one, based ability to interpret the information they of patients. “And they almost missed it.

32 “I do believe we’ll develop much more effective drugs over the next 10 years—ones that really hit the Achilles’ heel of cancer. You can see the science that’s being generated lead in that direction. And I want us to be in the position to make and translate those discoveries.” —MICHAEL B. KASTAN, MD, PhD EXECUTIVE DIRECTOR, DUKE CANCER INSTITUTE

The researchers just barely noticed that a to conduct experiments that will help multidisciplinary—with surgical, imaging, small subset of people in the trials were us understand the potential application chemotherapy, and other components— responding, and they eventually figured of each discovery, and information on having all of those providers on the same out that those patients had a specific patient outcomes to understand how it site makes participation much easier. mutation targeted by the drug. It may might be relevant,” says Spector. “Duke The new building includes dedicated only work in 10 percent of lung cancer is one of only a handful of places in the space for clinical trial consultation and patients—but you know, that’s 10 percent.” world with the capability to build a data- coordination, making standard what was To find those needles in the haystack, base of this magnitude. The more patients previously a rare luxury for clinical trial to actually deliver on the ideas generated we care for, the larger the database will coordinators—privacy and quiet space by its new collaborative model, the DCI be, and the greater the impact it will have near patient exam rooms to discuss clini- plans to strengthen the pipeline from on the future of cancer research and care.” cal trials, informed consent, and any ques- preclinical testing to clinical research. DCI leaders have also been working tions a patient has about clinical research. “We’re going to have to know much over the past year to strengthen the “To do great research, we have to bring more about the exact setting in which a infrastructure for cancer clinical trials, everyone together—oncologists, surgeons, drug may be useful before we take it into increasing the involvement of biostatisti- biologists, pharmacologists, chemists, trials in humans,” says Kastan. Toward cians to improve data collection and radiologists, and the support staff of that end, “We plan to develop better analysis. “That way,” says Kastan, “we nurses and coordinators,” says Kastan. animal model systems of cancer so that know when we’re finished, we’ll get an “It takes a village to do this right. And by we can improve our understanding of answer that will be interpretable—that following this paradigm, when we do clin- the biology of tumors and test these new we can learn from.” ical trials in patients we will already have therapies more efficiently. That way we learned so much from preclinical testing have lots of information at the outset to GatHerinG tHe trooPs that we can design trials more effectively. tell us how to test the drugs in people— Clinical trials are what drive discoveries That means it takes fewer patients to have and in which people.” into practice, and the studies are funda- a bigger impact, it costs a lot less money, Complementing that resource, the DCI mentally intertwined with patient care. and we make advances faster. is building an enormous data warehouse The new Duke Cancer Center is designed “At Duke, our goal is not just to take of tissue samples from tumors biopsied to encourage patient participation in clin- great care of patients. It’s to take great care at Duke, so researchers can learn more ical research by simplifying a complicated of them and to cure them,” says Kastan. about the molecular pathology of every process and placing it in a central loca- “You can do that only through research.” type of cancer. “We need these samples tion. Because many clinical protocols are

DukeMed Spring 2012 33 Grand Opening Celebration

Duke Medicine celebrated the opening of the new Duke Cancer Center in February with a weeklong series of events for faculty and staff, patients and families, volunteers, donors, and friends. The week began with a dedication and blessing of the hands ceremony for Duke Cancer Institute faculty and staff, and continued with open houses for Duke faculty, staff, and students, and for patients and

community members. 01

See more coverage of the events at dukemedicine.org/ construction.

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01 Hundreds of Duke community members and friends visited the Duke Cancer Center during the grand opening celebrations. 02 02 Blessing of hands ceremony for Duke Cancer Institute (DCI) faculty and staff 03 DCI administrator Carolyn Carpenter and Dr. Joe Moore 04 Duke University Hospital president Kevin Sowers and Evelyn Morgan (see story on page 22) 05 Angie Heilman, Kathy Farrell, Steve Shipes, and Kevin Sowers at the faculty and staff open house 06 David Johnson II and Brittney Tata welcomed guests to the cancer center

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07 NASCAR legend Richard Petty and his wife, 09 Lynda, a patient at the Preston Robert Tisch Brain Tumor Center at Duke, shared their story in a video that premiered during the Grand Opening. (Online at dukecancerinstitute.org) 08 Durham community members Juanita and Kevin Montgomery with Chancellor Victor Dzau

13 09 A tour of the Quiet Room during the open house for cancer patients, survivors, and community members 10 Bob Harris, “Voice of the Blue Devils,” and Phyllis Harris 12 11 Faculty physicians Dr. David Witsell, Dr. David Brizel, and Dr. John Kirkpatrick 12 Chief Nursing and Patient Care Services Officer Mary Ann Fuchs (center) with guests 13 Carolyn Carpenter, DCI executive director Michael Kastan, guest speaker Jamie Valvano Howard, and Kevin Sowers 15 14 Faculty, staff, and administrators gathered for the Duke Cancer Institute Scientific Symposium 15 Dr. Charles L. Sawyers of Memorial Sloan- Kettering Cancer Center delivered the Chancellor’s Lecture, “Overcoming Cancer 14 Drug Resistance.”

DukeMed Spring 2012 35 Grand Opening Celebration

Duke Cancer Center’s grand opening celebration culminated with an official ribbon-cutting ceremony, tours, and dinner celebration for donors and friends of the Duke Cancer Institute.

To see three special videos produced for the event, please visit dukemedicine.org/giving.

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01 Earl Tye, Mark Toland, Karen Enloe, Joe Morris, Frank 08 Dr. Monte Brown, Dr. William Fulkerson, Reverend Michael Courtney, and Tracy Gosselin in the fifth floor waiting Page, Dean Nancy Andrews, Dr. Thomas Gorrie, Jonathan area of the Duke Cancer Center Tisch, Chancellor Victor Dzau, Governor Bev Perdue, Dr. Michael Kastan, President Richard Brodhead, Kevin 02 Dr. Michael Kastan, Bill Caler, and Chancellor Victor Dzau Sowers, Claire Weinberg, and Michael Fields 03 Jonathan Tisch and Claire Weinberg 09 Chancellor Victor Dzau, Kevin Sowers, and Bill Robertson 04 Dr. Michael Kastan, Karen Armstrong, Mark Armstrong, of Belk Inc. toast the opening of the cancer center’s Cheri Armstrong, Chancellor Victor Dzau Belk Boutique. 05 (Foreground) Reverend Michael Page, President 10 Sebastian, Rosie, Juan, and Diego Vega Richard Brodhead; (background) NC state senator 11 Jim Powell, Dr. Elizabeth Bullitt, Dr. Allan Friedman, Floyd McKissick, Dr. Thomas Gorrie and Ann Powell 06 Dr. Michael Kastan, Ruth Georgiade, Janet Kean, Tom 12 Jonathan Tisch, Lizzie Tisch, and Dr. Henry Friedman Kean, and Chancellor Victor Dzau 13 Mimi Sebates, Jenna Siskey, and Diane Siskey 07 Duke Medicine Orchestra and ribbon-cutting ceremony guests 14 Chancellor Victor Dzau and Jonathan Tisch

DukeMed Spring 2012 37 dukeMed giving

Saying Thank You Gifts from individuals and organizations are the largest source of non-government support for Duke Medicine’s research, education, patient care, and service missions—and we are grateful to all who help us make a difference. To learn more about how you can help, please call 919-385-3100 or visit dukemedicine.org/giving.

Nursing to Benefit from Bovender Bequest Duke University trustee Jack Bovender Jr., From left: Wayne Michaels, producer, MIX 101.5 WRAL-FM; Joseph St. Geme, MD, T’67, G’69, and his wife, Barbara, of Nashville, chair of the Duke Department of Pediatrics and chief medical officer, Duke Children’s Hospital; Bill Jordan and Lynda Loveland, co-hosts, MIX 101.5; Vanna Fox, on-air North Carolina, will give $5 million to Duke personality, MIX 101.5; Ardie Gregory, vice president and general manager, MIX 101.5; University School of Nursing as part of a and Susan Glenn, executive director of development, Duke Children’s Hospital. $25-million bequest announced in December. The bequest also provides $10 million for the Health Sector Management Program at Duke Endowment Gift Fuels Radiothon Raises Duke’s Fuqua School of Business and $10 million for Trinity College of Arts & Sciences. Neurosciences Growth Record $1.2 Million for The gift to the School of Nursing honors The field of neuroscience is widely regarded Duke Children’s Barbara Bovender, who was a head nurse as being ripe for discovery over the next two This year’s MIX 101.5 WRAL-FM Radiothon at Duke University Hospital when she and decades, and now, thanks to a $9-million gift for Duke Children’s Hospital & Health Center Jack married. It also honors Jack’s mother, from The Duke Endowment, Duke Medicine is raised a record-breaking $1,256,037 to brother, and daughter-in-law, who are all poised for rapid and substantial growth. support valuable programs, research, and registered nurses. “As it has so often in the past, The Duke services for the patients at Duke Children’s. “Nurses are playing an increasingly important Endowment has recognized great potential Bill Jordan and Lynda Loveland, MIX 101.5 role in the delivery of health care, and our and has made it possible for Duke to lead morning show talent, were hosts for the school has a strong tradition of preparing both both in basic discovery and in the translation two-day live broadcast in February from the outstanding clinicians and nurse-scientists of discovery into new treatments in this critical McGovern-Davison Children’s Health Center. who can lead health innovations for the field,” says Nancy C. Andrews, MD, PhD, dean The MIX 101.5 Radiothon is Duke Children’s future,” says Catherine L. Gilliss, BSN’71, of the Duke University School of Medicine. largest annual single fund-raising event DNSc, RN, FAAN, dean of the Duke University The Duke Endowment gift, announced in and raises more money per capita than any School of Nursing. “The Bovenders’ support June, has already enabled the recruitment other Children’s Miracle Network Hospitals recognizes the contributions of nursing and of two new department chairs: Sarah H. Radiothon in the United States or Canada. will help us continue to lead.” “Holly” Lisanby, T’87, MD’91, HS’91-’95, in Over the past 18 years, MIX 101.5 has raised Jack Bovender earned an undergraduate psychiatry, and Stephen G. Lisberger, PhD, more than $14 million for Duke Children’s. degree in psychology and a master’s degree in neurobiology. As many as 15 additional In addition to patients, friends of Duke in hospital administration at Duke. He worked faculty members in these departments, and Children’s spoke on air, including Food Lion in the health care industry for 40 years before also in neurology, will be recruited in the president Cathy Green Burns, comedian Jeff retiring in 2009 as chair and chief executive next five years, according to Andrews. Foxworthy, radio show host John Tesh, and officer of Hospital Corporation of America. “We support Duke’s decision to unify the Duke Athletics coaches Mike Krzyzewski, He is a member the Duke University Board disciplines of neurobiology, neurology, and Joanne P. McCallie, and David Cutcliffe. Coach of Trustees and the Duke University Health psychiatry and hope this grant will lead to John Danowski and players from the Duke System Board of Directors. ways to prevent or cure neurological and men’s lacrosse and football teams volunteered “Duke has played an important role in psychiatric disorders that are devastating to in the phone bank. my life,” says Jack Bovender. “It’s rare for a patients and families in the Carolinas,” says single university to be able to offer a world- Mary Piepenbring, vice president of The Duke class education in the liberal arts, in business, Endowment. and in the delivery of quality health care.... Through this gift, Barbara and I want to help pave the way for future students to take advantage of all that Duke has to offer.”

38 DUKEMED PEOPLE

Remembering Mary Duke Biddle Trent Semans

ary Duke Biddle Trent Semans, the scion of the family “My feeling is that we are all here for each other,” Semans M that founded Duke University, died on January 25. told Duke Magazine in 1987. “I take very seriously this She was 91. business of treating your neighbor as yourself, trying to be Although small in physical stature, Semans was a your brother’s keeper. They’re solid maxims for life. You’ve towering figure in progressive causes throughout her life, got to be interested in what besets other people, what their championing education, human rights, and the arts. needs are.” “Mary Semans occupied a unique place in the life of Semans also supported the university and Duke this university,” says Duke University president Richard H. Medicine through the Mary Duke Biddle Foundation (begun Brodhead. “She was our principal link to Duke’s founding by and named after her mother), the Josiah Charles Trent generation and continued her family’s tradition of benevolence Memorial Foundation, the Josiah Charles Trent Collection throughout her life. She supported every good thing at this of the History of Medicine, and the Mary Duke Biddle university, and she was a powerful force for good in Durham Scholarship, among other efforts, according to the Duke and the Carolinas. Above all, she had a generosity toward Medical Center Archives. others and belief in human possibility that made every Victor J. Dzau, MD, chancellor for health affairs and encounter an inspiring event. Duke mourns the passing of CEO for Duke University Health System, says Semans “has one of its greatest friends.” truly been the heart and soul of Duke Medicine.” Semans’s connections to Duke University were deep “Her passion and personal involvement in the everyday and varied, ranging from art history student in the 1930s life of Duke Medicine has been a source of inspiration to to serving on the Board of Trustees from 1961–1981. everyone,” says Dzau. “She spoke often of the importance She also spent decades as a trustee, vice chair, and of humanity in the practice of medicine and effectively chair of The Duke Endowment, a private foundation founded modeled her conviction through personal actions and by by her great-uncle James B. Duke when he gave the monies sharing her unwavering support and encouragement to that transformed Trinity College into Duke University. The Duke physicians and health care providers. She was a very foundation supports higher education, health care, children’s special friend to me, the faculty, and employees across Duke welfare, and spiritual life in North and South Carolina. Medicine. She will be greatly missed.” Semans’s love for Duke University was matched by her Semans is survived by seven children: Mary Trent commitment to her adopted hometown of Durham. The great- Jones, WC’63, of Abingdon, Virginia; Sarah Trent Harris, granddaughter of industrialist-philanthropist Washington WC’63, of Charlotte; Rebecca Trent Kirkland, WC’64, MD’68, Duke, for whom Duke University is named, Semans served as of Houston; Barbara Trent Kimbrell of Sullivan’s Island, mayor pro tem of Durham from 1953–1955. She was a trustee South Carolina; Jenny Semans Koortbojian, G’06, of Durham; of Lincoln Community Hospital from 1948–1976, a facility James Duke Biddle Trent Semans of Chapel Hill; and the Duke family started in 1901 to serve the needs of black Beth Semans Hubbard, T’85, of Los Angeles; 16 grandchildren; patients in Durham. and 29 great-grandchildren.

DukeMed Spring 2012 39 APPOINTMENTS

1 3 8

2 5 6

1 Carolyn Carpenter, formerly interim admin- of the Sloan-Swartz Center for Theoretical 6 adam Perlman, md, began his appoint- istrator for the Duke Cancer Institute (DCI), Neurobiology at UCSF. He is a fellow of the ment as executive director of Duke was announced as the new administrator American Academy of Arts and Sciences and Integrative Medicine in September. Perlman for the DCI and associate dean for the Duke received the Young Investigator Award from was formerly the executive director of the University School of Medicine in January. the Society for Neuroscience, as well as the Institute for Complementary and Alternative Carpenter will continue to have responsi- McKnight Investigator and McKnight Scholar Medicine, chair of the Department of Primary bility for all administrative functions within awards. He spent 11 years as a section Care, and associate professor of medicine the DCI and will continue to serve as the editor and senior editor for the Journal of at the University of Medicine & Dentistry lead academic and clinical service line Neuroscience, and has been the chief editor of New Jersey. administrator. Her collaborations will include of Neuroscience since 2010. Perlman serves as chair of the Consortium the medical school as it relates to academic Lisberger succeeds James McNamara, MD, of Academic Health Centers for Integrative priorities and activities within the DCI. Carl Deane Professor of Neuroscience, who Medicine, comprising 51 leading academic She holds a master of health administra- served as department chair since 2002. medical centers across the country with tion degree from the University of Virginia integrative medicine programs. and is a fellow in the American College of 4 thomas a. owens, md, previously the His diverse research interests include the Healthcare Executives. chief medical officer for Duke University effects of multivitamin supplementation on Hospital and chief of the Hospital Medicine school performance in underserved children, 2 michel landry, Phd, previously an assistant Program, began his new role as chief medical the efficacy of massage for osteoarthritis of professor in the Department of Physical officer for Duke University Health System on the knee, and the use of complementary and Therapy at the University of Toronto, has February 1. alternative medicine in patients with cancer. been named chief of the Doctor of Physical In overseeing medical affairs throughout Therapy Program at Duke. He will begin his the health system, Owens’s responsibilities will 7 michael Platt, Phd, professor of neurobi- appointment on July 1. include working with Karen Frush, MD, chief ology, has been appointed the new director Landry is an active health policy and health safety officer, to set the health system quality of the Duke Institute for Brain Sciences. services researcher with particular interest agenda, and ensure alignment of physicians Platt’s interests include utilizing economics in the balance of supply and demand in and physician services with health system and evolutionary biology to study how health and rehabilitation, creating forecasting strategic plans and clinical program priorities. organisms confront information-processing models to develop a sustainable workforce He will oversee an integrated primary care problems and how the organisms’ neural of health care professionals, and community- service that brings together Duke Primary circuit mechanisms that guide decision- based rehabilitation on a global-health level Care, the Department of Community & making are shaped as a result. His priorities for people with disabilities. Family Medicine, and the Division of General include engaging interdisciplinary collabora- He will hold concurrent positions as adjunct Internal Medicine clinics, while also working tions within the medical school and the associate professor at the University of to develop approaches to a patient-centered university and promoting high standards of Toronto and adjunct assistant professor at the medical home. Owens will also be charged educational development for undergraduate, University of North Carolina at Chapel Hill. with playing an important role as the physi- graduate, and postdoctoral students. cian leader for health system-wide health 3 stephen G. lisberger, Phd, a nation- care reform planning and innovation. 8 mark stacy, md, professor of medicine, ally renowned investigator who studies has been appointed as vice dean for clinical how brain mechanisms transform visual 5 theodore Pappas, md, Duke Minimally research in the Duke University School motion into accurate eye movements, has Invasive Surgery Professor of Surgery, was of Medicine. He has been a key driver in been named chair of the Department of appointed as vice dean for medical affairs improving Duke’s clinical research practice Neurobiology. Lisberger, a Howard Hughes for the Duke University School of Medicine and in developing the site-based research Medical Institute investigator and former and began his role in July. He will serve as a director community. In his new role, Stacy professor of physiology at the University of liaison between the Dean’s Office and clinical will continue to work in partnership with California, San Francisco, assumed his role at faculty, working with clinical department Sally Kornbluth, PhD, who recently transi- Duke on January 1. chairs as well as providing strategic direction tioned into her new role as vice dean for Lisberger is the founding director of for Duke’s medical and nursing schools and basic science. the W.M. Keck Foundation Center for Duke University Health System. Theoretical Neurobiology and a co-director

40 honors & awards

Amy Abernethy, MD, associate professor of medicine in medical oncology and associate professor in the School of Nursing, was named president-elect for the American Academy of Hospice and Palliative Medicine.

Nancy Andrews, MD, PhD, dean of the Edwards Frank Haynes Montefiori School of Medicine, was honored with the 2011 American Society of Hematology Mentor Award in Basic Science during the The Bill & Melinda Gates Foundation awarded The award recognized the transformative society’s annual meeting in December. three grants to Duke for HIV projects in the insights of Heitman’s work in fungi and the Collaboration for AIDS Vaccine Discovery evolutionary origins of sexual reproduction. Adrian Angold, MBBS, associate professor (CAVD) program. The total amount is approxi- of psychiatry and behavioral sciences, was mately $37.2 million: Michael Hershfield, MD, and David named president-elect of the International Pisetsky, MD, PhD, professors of medicine, Society for Research in Child and Adolescent Michael Frank, MD, Samuel Katz Professor were designated as masters of the American Psychopathology (ISRCAP), an organization of Pediatrics, received a three-year, $892,000 College of Rheumatology. The highest dedicated to furthering the research and grant to study HIV’s interaction with the honor bestowed by the college, the title is treatment of childhood mental disorders. human immune system, particularly the complement proteins that coat invading viral conferred on individuals who have made envelope antigens to facilitate the body’s outstanding contributions to the field of Bruce Capehart, MD, assistant professor natural immune response. rheumatology through scholarly achievement of psychiatry and behavioral sciences, and/or service. was selected as a co-chair of the Service Barton Haynes, MD, Frederic Hanes Members, Veterans, and Military Families Professor of Medicine, director of the Center Joanne Kurtzberg, MD, professor of Task Group within the National Network for HIV-AIDS Vaccine Immunology, and pediatrics, received the Lifetime Achievement of Depression Centers (NNDC) in August. director of the Duke Human Vaccine Institute, Award from the Pediatric Blood and Marrow Capehart, a leader in the fields of PTSD and received a three-year, $11.7-million award Transplant Consortium. She is the fourth traumatic brain injury, will support NNDC’s to study the best way to create effective recipient of this award and was recognized efforts to make diagnosis of mood disorders vaccine immunogens that mimic the proteins for a career that exemplifies the mission “affordable, accessible, and acceptable.” on the HIV outer envelope that will help to stimulate the right antibodies to neutralize of the consortium, “to support research the virus at the time of transmission. and education to improve the availability, Nelson Chao, MD, Donald D. and Elizabeth safety, and efficacy of hematopoietic cell G. Cooke Cancer Research Professor, has David Montefiori, PhD, professor of surgery transplantation and other cellular therapeutics been named to the National Biodefense and director of the Laboratory for AIDS for children and adolescents.” Kurtzberg Science Board of the US Department of Vaccine Research and Development in the was honored during the 2012 Tandem Health & Human Services. His three-year term Department of Surgery, received a five-year, BMT Meetings of the American Society for began in February. $24.6-million grant to continue his team’s Blood and Marrow Transplantation and the efforts in the Comprehensive Antibody Center for International Blood and Marrow Victor J. Dzau, MD, chancellor for health Vaccine Immune Monitoring Consortium. Transplant Research in San Diego in February. affairs at Duke University and president and Much of the research from these grants CEO of Duke University Health System, was will help further the study of the potential Nico Katsanis, PhD, Jean and George presented with the 2011 Henry G. Friesen new vaccine RV144, whose early trials in Brumley Jr. Professor of Cell Biology and International Prize in Health Research Thailand showed promise and generated Pediatrics and director of the Duke Center for in September. His selection cited his optimism that a broadly effective HIV vaccine Human Disease Modeling, is slated to receive “international stature that best exemplifies is finally within reach. the E. Mead Johnson Award for Research Henry Friesen’s prescience, organizational in Pediatrics at the 2012 Pediatric Academic creativity, and broad impact on health Barton Haynes, MD, Frederic Hanes Societies Annual Meeting in Boston in April. research and health research policy.” Professor of Medicine and director of the The award honors clinical and laboratory Duke Human Vaccine Institute, received research achievements in pediatrics and is Christopher Edwards, PhD, associate the Alexander Fleming Award for Lifetime considered the most prestigious award in professor in psychiatry and behavioral Achievement from the Infectious Diseases pediatric research. Katsanis is receiving the sciences, was named the recipient of the Society of America in October. award for his research focusing on Bardet- 2012 Dr. Martin Luther King Jr. Community Biedl syndrome, a rare genetic disorder with Caregiver Award in January. The annual symptoms that affect the kidneys and a Joseph Heitman, MD, PhD, James B. Duke award is given by Duke University Hospital variety of other organs, such as the eyes and Professor and chair of the Department of in recognition of an employee who the developing nervous system. Molecular Genetics & Microbiology, received demonstrates a commitment to supporting an NIH MERIT Award from the National the community. Edwards received a $5,000 Institute of Allergy and Infectious Diseases. award toward his volunteer organization.

DukeMed Spring 2012 41 honors & awards

Jeffrey Swanson, PhD, and Marvin Swartz, MD, professors in psychiatry and behavioral sciences, received the 2011 Carl Taube Award, an honor given by the Mental Health Section of the American Public Health Association, in November. The award is presented to scholars who have Lyman Rivelli Rubin Tomaras made significant contributions in the field of mental health research and treatment.

Seok-Yong Lee, PhD, assistant professor John Olson Jr., MD, PhD, associate Georgia Tomaras, PhD, associate professor of biochemistry, and David Tobin, PhD, professor of surgery, was appointed to of surgery, has been appointed to the assistant professor in molecular genetics & the NIH Center for Scientific Review’s National Institute of Allergy and Infectious microbiology, received the 2011 NIH Director’s Cancer Biomarkers Study Section for the Diseases Advisory Council for the term New Innovator Award for “challenging the term of July 2011–June 2017. Members are of November 2011–October 2015. She status quo with innovative ideas that have the selected on the basis of their demonstrated will participate in performing second-level potential to propel fields forward and speed competence and achievement in their reviews, providing policy advisement, the translation of research into improved scientific discipline as evidenced by the reviewing programs, and developing and health for Americans and others.” quality of research accomplishments and clearing concepts for funding opportunities. publications in scientific journals. Stephen G. Lisberger, PhD, professor and Hai Yan, PhD, associate professor of chair of the Department of Neurobiology, has Sarah Rivelli, MD, assistant professor of pathology, received a $1-million research been awarded the Bernice Grafstein Award psychiatry and behavioral sciences and director grant from Accelerate Brain Cancer Cure and from the Society for Neuroscience. The of the Combined Medicine–Psychiatry the V Foundation in October. award recognizes individuals for dedication Training Program, was recognized with to promoting women’s advancement in an Association of Medicine and Psychiatry neuroscience, specifically by mentoring Service Award during the organization’s Five scientists from Duke University Medical women to facilitate their entry and retention annual meeting in September. In addition, Center were announced in December as the in the field. Rivelli has been named president-elect, with newest fellows in the American Association a two-year term starting in fall 2013. for the Advancement of Science (AAAS): John Looney, MD, professor of psychiatry Richard Brennan, PhD, professor and chair and behavioral sciences, was elected to the Geoffrey Rubin, MD, George Barth Geller of the Duke Department of Biochemistry board of regents of the Southern Psychiatric Professor for Research in Cardiovascular Bryan Cullen, PhD, James B. Duke Professor Association in September. Diseases and chair of the Department of of Molecular Genetics & Microbiology Radiology, has been named president of Mariano Garcia-Blanco, MD, PhD, Gary H. Lyman, MD, professor of medicine, three medical societies. In June he became professor of molecular genetics & was elected to the board of directors of president of the Fleischner Society for microbiology the American Society of Clinical Oncology, Thoracic Imaging and Diagnosis, in September a leading professional organization he became president of the North American Sue Jinks-Robertson, PhD, professor of representing more than 30,000 oncologists Society for Cardiovascular Imaging, and he molecular genetics & microbiology most recently was named president of the and others who care for people with cancer. Donald McDonnell, PhD, Glaxo-Wellcome Society of Computed Body Tomography & Lyman will begin his four-year appointment Professor of Molecular Cancer Biology Magnetic Resonance. in June. As a member of the board, he will and chair of the Duke Department of help set policies, oversee finances, and Pharmacology & Cancer Biology influence the direction of the organization. David Steffens, MD, professor of psychiatry and behavioral sciences and “All of these individuals are world-class scientists who have made discoveries that J. Lloyd Michener, MD, professor and division head of geriatric psychiatry, was drive their fields forward,” says Nancy chair of the Department of Community named president-elect of the American Andrews, MD, PhD, dean of the Duke and Family Medicine, was named as a Association for Geriatric Psychiatry. His term University School of Medicine. “With this member of the National Advisory Council began in March. honor, they join a very distinguished group for Complementary and Alternative of scientific leaders. We are very fortunate Medicine by the NIH National Center for Richard Surwit, PhD, professor of to have so many people of this caliber on Complementary and Alternative Medicine. psychiatry and behavioral sciences, was our faculty.” selected as the recipient of the 2012 Society of Behavioral Medicine Distinguished Scientist Award. His award will be announced in April during the society’s 33rd Annual Meeting & Scientific Sessions.

42 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) D uke wELCOMES new physicians

ANESTHESIOLOGY Residency: Anesthesiology, Fellowship: Pain Management, Weill Cornell Medical Center Tri-Institute Fellowship, Weill (New York), 1988-1992 Cornell Medical Center/ Fellowship: Cardiovascular Memorial Sloan-Kettering Anesthesiology, Weill Cornell Cancer Center/Hospital for Medical Center (New York), Special Surgery (New York), 1992; Postdoctoral Research, 2011 University of California, Other Degree: PhD, San Francisco, 1992-1994 Pharmacology, Duke University, Brad M. Taicher, DO 2005 Tania R. Peters, MD Particular Clinical Interests and Particular Clinical Interests Brandi A. Bottiger, MD Skills: Pediatric anesthesia, and Skills: General medical Particular Clinical Interests pediatric ultrasound-guided COMMUNITY AND dermatology with a focus on and Skills: Adult cardiac regional anesthesia FAMILY MEDICINE acute care and dermatologic and thoracic surgery, trans- DO Degree: Philadelphia surgery esophageal echocardiography, College of Osteopathic MD Degree: University of swallowing dysfunction after Medicine (Pennsylvania), 2006 Maryland School of Medicine, cardiopulmonary bypass and Residency: Anesthesiology, 2007 transesophageal echocardiog- Thomas Jefferson University Residency: Internal Medicine, raphy, crystalloid and colloid Edmund H. Jooste, MB ChB Hospital (Pennsylvania), 2010 Washington Hospital Center in postoperative outcomes and Particular Clinical Interests and Fellowship: Pediatric (Washington, DC), 2008 renal function Skills: Pediatric anesthesiology, Anesthesiology, Children’s Dermatology, Duke University MD Degree: Pennsylvania State pediatric cardiac anesthesiology Hospital of Philadelphia Medical Center, 2011 University College of Medicine, MB ChB Degree: University of (Pennsylvania), 2011 2006 Pretoria (South Africa), 1995 Megan M. Adamson, MD Other Degree: MS, Physiology, Residency: Anesthesiology, Residency: Anesthesiology, Particular Clinical Interests and Georgetown University Pennsylvania State University Columbia University Medical Skills: Care for the entire family, (Washington, DC), 2000 Medical Center, 2010 Center (New York), 2004 women’s health MBA, Health and Medical Fellowship: Adult Cardiothoracic Fellowship: Pediatric MD Degree: Boston Services Administration, Anesthesia, Duke University Anesthesiology, Children’s University School of Medicine St. Joseph’s University Medical Center, 2011 Hospital of New York, (Massachusetts), 2008 (Pennsylvania), 2004 Columbia University, 2005 Residency: Family Medicine, Duke University Medical Center, 2008-2011 Sarah Wolfe, MD Particular Clinical Interests and Skills: HIV-related dermatoses, DERMATOLOGY infectious disease dermatology, general dermatology MD Degree: University of Oklahoma College of Medicine, 2007 Hiep T. Dao, MD Lenny Talbot, MD Residency: Internal Medicine, Particular Clinical Interests and Grace C. McCarthy, MD Particular Clinical Interests and University of Texas Medical Skills: Regional anesthesiology, Particular Clinical Interests and Skills: Surgical anesthesiology Branch, 2007-2008 peripheral nerve blocks for Skills: Cardiothoracic anesthesia and acute postoperative pain Dermatology, Duke University postoperative pain control MD Degree: University of management Medical Center, 2008-2011 MD Degree: Georgetown Virginia School of Medicine, MD Degree: Duke University University School of Medicine 2006 Heather P. Lampel, MD School of Medicine, 2007 (Washington, DC), 2007 Residency: Anesthesiology, Particular Clinical Interests Residency: Anesthesiology, DUKE PRIMARY CARE Residency: Internal Medicine, Duke University Medical Center, and Skills: Extensive patch Duke University Medical Center, St. Joseph Mercy Hospital 2006-2010 testing for contact dermatitis 2007-2012 (Michigan), 2008 Fellowship: Cardiothoracic investigation; skin cancer Anesthesiology, Georgetown Anesthesia, Duke University surveillance and surgical and University (Washington, DC), Medical Center, 2010-2011 nonsurgical treatments; facial 2008-2011 (Chief Resident, rejuvenation including Botox 2010-2011) and volumizing procedures MD Degree: Ohio State University College of Medicine, 2002 Residency: Family Medicine, Andre E. Bell, MD Mayo Clinic Scottsdale Duke Primary Care Thomas J. Van de Ven, (Arizona), 2002-2003 Brier Creek MD, PhD Occupational and Particular Clinical Interests Particular Clinical Interests Environmental Medicine, and Skills: Family medicine, Atif Y. Raja, MD and Skills: Management of University of Pittsburgh preventive care, patient Particular Clinical Interests neuropathic and oncologic (Pennsylvania), 2003-2005 education Manuel L. Fontes, MD and Skills: Compassionate chronic pain syndromes Dermatology, University of MD Degree: Ohio State Particular Clinical Interests care for patients receiving MD Degree: Duke University California, Irvine, 2008-2011 University College of Medicine, and Skills: Perioperative care cardiothoracic procedures School of Medicine, 2006 Other Degree: MPH, University 1998 for patients undergoing MD Degree: University of North Residency: Internship, UPMC of Pittsburgh (Pennsylvania), Residency: Family Medicine, cardiothoracic surgical Carolina at Chapel Hill School Shadyside (Pennsylvania), 2007 2005 St. Mary’s Family Practice procedures, clinical outcomes of Medicine, 2006 Anesthesiology, Duke University (Wisconsin), 2002 research, transesophageal Residency: Anesthesiology, Medical Center, 2010 echocardiogram, ICU, teaching UNC Hospitals, 2010 MD Degree: University of Fellowship: Cardiothoracic Massachusetts Medical School, Anesthesiology, Duke University 1988 Medical Center, 2011

Visit Duke Medicine online at dukemedicine.org DukeMed Spring 2012 43 Usha R. Donthireddi, MD John R. Guzek, MD Sanjay Patel, MD Adrienne C. Tounsel, MD Timothy R. Heacock, MD Duke Primary Care Duke Primary Care Wake Forest Family Duke Urgent Care Duke University Hospital Creedmoor Road Harps Mill Physicians Particular Clinical Interests Particular Clinical Interests Particular Clinical Interests Particular Clinical Interests and Particular Clinical Interests and Skills: Urgent care, family and Skills: Hospital medicine, and Skills: General internal Skills: Diagnosis and treatment and Skills: Chronic disease medicine, minor wound care, ultrasound-guided bedside medicine, including prevention of simple and complex adult management, evidence-based mentoring procedures, pulmonary and treatment problems, including mood medicine MD Degree: Wayne State medicine MD Degree: Osmania Medical disorders, diabetes, high blood MD Degree: Temple University School of Medicine MD Degree: Case Western College (India), 2000 pressure, and heart, kidney, University School of Medicine (Michigan), 2008 Reserve University School of Residency: Internal Medicine, and liver problems (Pennsylvania), 1982 Residency: Family Medicine, Medicine (Ohio), 2008 Forest Hills Hospital, North MD Degree: University of Residency: Family Practice, The Toledo Hospital (Ohio), Residency: Internal Medicine, Shore–Long Island Jewish (New Pittsburgh School of Medicine Montgomery Hospital 2008-2011 Duke University Medical Center, York), 2002-2005 (Pennsylvania), 1978 (Pennsylvania), 1982-1985 2011 Residency: Internal Medicine, Mercy Hospital (Pennsylvania), HOSPITAL MEDICINE 1981-1983 Other Degree: MPH, University of North Carolina at Chapel Hill

Christine M. Drower, MD Sabana S. Pathan, MD Christopher A. Jones, MD Duke Urgent Care Duke Primary Care Duke University Hospital Particular Clinical Interests and Henderson Cody A. Chastain, MD Particular Clinical Interests and Skills: Urgent care, pediatric Particular Clinical Interests Durham Regional Hospital Skills: Symptom-based care population, family medicine, and Skills: Continuity of care, Particular Clinical Interests and for all patients with advanced outpatient procedures Pearl D. Johnson, MD patient advocacy, preventive Skills: Health care epidemiology, illness, with special emphasis on MD Degree: Drexel University Duke Urgent Care medicine for all ages, women’s patient safety and quality the elderly, those with cancer, College of Medicine Particular Clinical Interests and health, colposcopy, pediatric MD Degree: Loma Linda and those at the end of life (Pennsylvania), 2008 Skills: Urgent care services, sports physicals, University School of Medicine MD Degree: Jefferson Medical Residency: Family Medicine, MD Degree: Loyola University office-based surgical and (California), 2008 College of Thomas Jefferson Duke University Medical Center, Chicago Stritch School of dermatologic procedures, Residency: General Internal University (Pennsylvania), 2006 2008-2011 Medicine (Illinois), 1979 chronic illness management, Medicine, Duke University Residency: Internal Medicine, Residency: Family Medicine, urgent care Medical Center, 2008-2011 Alpert Medical School, Brown University of Tennessee MD Degree: Medical University University (Rhode Island), 2009 College of Medicine, St. Francis of Silesia (Poland), 2006 Fellowship: Geriatric Medicine, Hospital, 1979-1982 Residency: Family Medicine, Duke University Medical Center, Hennepin County Medical 2010 Center (Minnesota), 2011 Hospice and Palliative Medicine, Duke University Medical Center, 2011

Tierney Grandis, MD Duke Primary Care Mebane Ellen F. Eaton, MD Particular Clinical Interests and Durham Regional Hospital Skills: General family practice Particular Clinical Interests including well-child checks and Michele D. Nacouzi, MD and Skills: Medical education, well-woman care, management Duke Primary Care quality improvement of chronic disease Brier Creek Caleb E. Pineo, MD MD Degree: University of MD Degree: University of North Particular Clinical Interests and Duke Primary Care Alabama School of Medicine, Carolina at Chapel Hill School Skills: Women’s health care, Brier Creek 2007 Muhammad Haroon Khan, of Medicine, 2006 general medical care Particular Clinical Interests Residency: Internal Medicine, MBBS Residency: Family Medicine, MD Degree: New York Medical and Skills: Compassionate and Stanford University Hospital Duke University Hospital Moses Cone Family Practice College, 1991 quality primary care, care for (California), 2007-2010 (Chief Particular Clinical Interests (North Carolina), 2006-2009 Residency: Family Practice, families, disease prevention, Resident, 2010-2011) and Skills: Inpatient care Other Degree: MS, Whittier Presbyterian Hospital chronic disease management of internal medicine and Neuroscience, Duke University, (California), 1992-1994 MD Degree: University of North cardiology patients 2001 Carolina at Chapel Hill School MBBS Degree: Khyber Medical of Medicine, 2008 College, University of Peshwar Residency: Family Medicine, (Pakistan), 1997 UNC Hospitals, 2011 Residency: Internal Medicine, Other Degree: MPH, UNC Robert Packer Hospital School of Public Health, 2007 (Pennsylvania), 2002-2003 Internal Medicine, Robert Packer Hospital (Pennsylvania), 2003-2005

44 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) Snehal I. Patel, MD Michael E. Blocker, MD Durham Regional Hospital General Internal Medicine Particular Clinical Interests Particular Clinical Interests and Skills: Hospital medicine, and Skills: General infectious consultative general internal diseases, HIV care, travel medicine for hospitalized medicine patients, health systems MD Degree: University of design and improvement, Massachusetts Medical School, innovative care models, clinical 1994 Kristin E. Meade, MD information technology Residency: Internal Medicine, Melissa A. Daubert, MD Heather R. Gutekunst, MD Durham Regional Hospital MD Degree: University of Texas UNC Hospitals, 1994-1997 Cardiology Pulmonary, Allergy, and Particular Clinical Interests and Southwestern Medical School, Fellowship: Infectious Diseases, Particular Clinical Interests and Critical Care Skills: Palliative care for patients 2008 UNC Hospitals, 1997-2000 Skills: Women’s cardiovascular Particular Clinical Interests and of all ages across diverse clinical Residency: Internal Medicine, health, cardiac computed Skills: Allergic and immunologic settings, medical ethics with University of Texas tomography in acute chest disorders, including general special focus on the ethics Southwestern Medical Center, pain and adult congenital heart allergy and immunology, food of providing ICU-level care 2008-2011 disease, echocardiography and drug allergies, asthma, to children and young adults (TTE/TEE in 2D and 3D, stress eosinophilic esophagitis, with complex chronic medical testing), nuclear cardiology hives, angioedema, bee/ conditions MD Degree: Albert Einstein insect stings, venom allergies, MD Degree: Stanford University College of Medicine, Yeshiva allergen immunotherapy, atopic School of Medicine (California), University (New York), 2005 dermatitis, contact dermatitis, 2006 Residency: Internal Medicine, urticaria, anaphylaxis, and J. Matthew Brennan, MD Residency: Internal Medicine Columbia University Medical common variable immune Cardiology and Pediatrics, Duke University Center (New York), 2005-2008 deficiency; assessment of Particular Clinical Interests and Medical Center, 2006-2010 Fellowship: Cardiology, Stony immunologic function and Skills: Acute and chronic care Fellowship: Pediatric Palliative Brook University Medical Center immunologic mechanism Julius M. Wilder, MD, PhD of patients with valvular heart Care, Akron Children’s Hospital (New York), 2008-2011 of IVIG, mast cell disorders, Durham Regional Hospital disease and advanced coronary (Ohio), 2010-2011 allergic rhinitis, conjunctivitis, Particular Clinical Interests and artery disease and chronic sinusitis Skills: Hospital medicine MD Degree: University of MD Degree: Brody School MD Degree: Duke University Mississippi School of Medicine, of Medicine at East Carolina School of Medicine, 2008 2003 University (North Carolina), Residency: Internal Medicine, Residency: Internal Medicine, 2004 Duke University Medical Center, University of Chicago Hospital Residency: Internal Medicine 2011 (Illinois), 2006 and Pediatrics, Maine Medical Other Degree: PhD, Medical Fellowship: Cardiology, Duke Center, 2004-2006 Social and Health Policy, Duke University Medical Center, 2010 Internal Medicine and Pediatrics, University, 2007 Interventional Cardiology, Duke Jennifer L. Garst, MD Georgetown University Hospital David Y. Ming, MD University Medical Center, 2011 Medical Oncology (Washington, DC), 2006-2008 Duke University Hospital Particular Clinical Interests and Fellowship: Allergy and Clinical and Emergency Medicine MEDICINE Skills: Lung cancer (non-small Rebecca A. Burbridge, MD Immunology, University of Particular Clinical Interests and cell and small cell), lung cancer Dana P. Albon, MD Gastroenterology Virginia, 2008-2010 Skills: General internal medicine as a women’s health issue, lung Pulmonary, Allergy, and Particular Clinical Interests and general pediatrics, care cancer clinical trials and clinical Critical Care and Skills: Advanced of hospitalized adults and research, general hematology Particular Clinical Interests and endoscopy, including children, resident and medical and medical oncology, Skills: Lung transplantation endoscopic ultrasound (EUS) student education supportive care for lung MD Degree: University of and endoscopic retrograde MD Degree: University of Texas cancer patients, multimodality Medicine and Pharmacy Iuliu pancreatography (ERCP) Medical Branch School of treatment approaches for lung Hatieganu (Romania), 2001 MD Degree: West Virginia Medicine, 2006 cancer, lung cancer vaccine Residency: Internal Medicine, University School of Medicine, Residency: Internal Medicine clinical trials, customized and Moses Cone Hospital (North 2003 and Pediatrics, Duke University personalized approaches to Carolina), 2005-2008 Residency: Internal Medicine, Medical Center, 2010 managing lung cancer, lung Michael R. Harrison, MD Fellowship: Pulmonary and West Virginia University, cancer screening and high-risk Medical Oncology Critical Care, Wake Forest 2003-2006 (Chief Resident, evaluations, thoracic oncology Particular Clinical Interests Jacqueline U. Okere, MD University Baptist Medical 2006-2007) including mesothelioma, and Skills: Drug development Duke University Hospital Center, 2011 Fellowship: Gastroenterology, carcinoid, and other rare and investigation of novel Particular Clinical Interests and Duke University Medical Center, malignancies involving the therapies for bladder, kidney, Skills: Hospital medicine 2007-2010 Maureen P. Andreassi, MD chest and lungs and prostate cancers; targeted MD Degree: Northeastern Advanced Endoscopy, Duke General Internal Medicine MD Degree: Medical College of therapy; antiangiogenic Ohio Universities Colleges of University Medical Center, Particular Clinical Interests and Georgia, 1990 therapy; molecular imaging in Medicine and Pharmacy, 2008 2010-2011 Skills: General internal medicine Residency: Internal Medicine, drug development; biomarkers; Residency: General Internal MD Degree: SUNY-Stony Brook University of Texas Southwestern, clinical care of bladder, kidney, Medicine, University of South University School of Medicine Parkland Memorial Hospital, prostate, and testicular cancers Florida, 2008-2011 (New York), 1994 1990-1993 MD Degree: Tulane University Residency: Internal Medicine, Hematology–Oncology, Duke School of Medicine (Louisiana), UNC Hospitals, 1994-1997 University Medical Center, 2004 1993-1996 Residency: Internal Medicine, Tulane University, 2007 Fellowship: Medical Oncology, University of Wisconsin, 2009

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Kamran Mahmood, MD Justin T. Mhoon, MD Jonathan P. Piccini Sr., MD Pulmonary, Allergy, and Neurology Cardiology Patrick T. Hickey, DO Critical Care Particular Clinical Interests Particular Clinical Interests and Neurology Particular Clinical Interests and Skills: Diagnosis and Skills: Evaluation, management, Particular Clinical Interests and and Skills: Thoracic oncology, treatment of neuromuscular and catheter ablation of atrial Skills: Movement disorders, airway disorders, pleural disorders, including peripheral fibrillation, supraventricular Parkinson disease, progressive disease, interventional neuropathies, myopathies, tachycardia, and ventricular supranuclear palsy, corticobasal Mahesh J. Patel, MD pulmonology, advanced ALS, and myasthenia gravis; tachycardia; pacemaker and ganglionic degeneration, Cardiology diagnostic bronchoscopy, chemodenervation for cervical defibrillator implantation and multiple system atrophy, Particular Clinical Interests endobronchial ultrasound, rigid dystonia, spasticity, and migraine laser lead extraction; cardiac tremor, restless leg syndrome, and Skills: Preventive and bronchoscopy, airway laser headache; peripheral nerve resynchronization therapy tics, Tourette syndrome, rehabilitative cardiology, and thermal therapy, stent ultrasound; clinical EMG/NCS MD Degree: Northwestern myoclonus, dystonia, ataxia, exercise physiology, heart failure placement, pleural procedures MD Degree: University of University Feinberg School of Huntington disease, chorea, MD Degree: Tulane University including pleuroscopy, general South Florida College of Medicine (Illinois), 2002 tardive dyskinesia, Wilson School of Medicine (Louisiana), pulmonology, critical care Medicine, 2006 Residency: Internal Medicine, disease, treatment with 2003 MD Degree: King Edward Residency: Internal Medicine, Johns Hopkins Hospital botulinum toxin, deep brain Residency: Internal Medicine, Medical College (Pakistan), Medical College of Georgia, (Maryland), 2002-2005 stimulation University of Texas 1995 2006-2007 Fellowship: General Cardiology, DO Degree: Michigan Southwestern Medical Center, Residency: Internal Medicine, Neurology, Duke University Duke University Medical Center, State University College of 2006 Nassau University Medical Medical Center, 2007-2010 2005-2009 Osteopathic Medicine, 2006 Fellowship: Preventive Center (New York), 1998-2001 Fellowship: Neuromuscular Electrophysiology, Duke Residency: Neurology, Michigan Cardiology, University of Texas (Chief Resident, 2001-2002) Medicine and Electromyogra- University Medical Center, State University, Garden City Southwestern Medical Center, Fellowship: Pulmonary, Critical phy, Duke University Medical 2009-2011 Hospital, 2007-2010 2007 Care, and Sleep Medicine, Center, 2010-2011 Other Degree: MHS, Clinical Fellowship: Movement General Cardiology, Duke University of Illinois at Chicago, Research, Duke University, 2009 Disorders, Duke University University Medical Center, 2011 2002 Medical Center, 2010-2012 Interventional Pulmonology, Duke University Medical Center, 2010-2011 Other Degree: MPH, University of Illinois at Chicago, 2005

Stephanie G. Norfolk, MD Pulmonary, Allergy, and Fatima A. Rangwala, Adam I. Perlman, MD Critical Care MD, PhD Jason I. Koontz, MD, PhD General Internal Medicine Particular Clinical Interests and Medical Oncology Cardiology Particular Clinical Interests Skills: Lung transplant, ICU Particular Clinical Interests Particular Clinical Interests and and Skills: Comprehensive MD Degree: Case Western and Skills: Gastrointestinal Skills: All aspects of cardiac integrative medicine Reserve University School of oncology, including pancreatic, electrophysiology, including consultation, integrative Robin Mathews, MD Medicine (Ohio), 2005 hepatobiliary, esophageal, pacemaker and defibrillator approaches to pain Cardiology Residency: Internal Medicine, gastric, colorectal, and implantation; cardiac management, cancer, and Particular Clinical Interests and University Hospitals of anal cancers resynchronization therapy; lifestyle-related issues Skills: General and noninvasive Cleveland/Case Medical Center MD Degree: University of evaluation, management, MD Degree: Boston cardiology, inpatient and (Ohio), 2005-2008 Cincinnati College of Medicine and catheter ablation of University School of Medicine outpatient consultative services, Fellowship: Pulmonary, Allergy, (Ohio), 2005 atrial fibrillation and flutter, (Massachusetts), 1994 advanced coronary disease and and Critical Care Medicine, Residency: Internal Medicine, supraventricular tachycardia, Residency: Medicine, ischemic heart disease, heart Duke University Medical Center, Duke University Medical Center, and ventricular arrhythmias Boston Medical Center failure management, secondary 2008-2011 2005-2008 MD Degree: Harvard Medical (Massachusetts), 1994-1996 prevention of cardiovascular Fellowship: Hematology– School (Massachusetts), 2002 Preventive Medicine, disease Oncology, Duke University Residency: Internal Medicine, Boston Medical Center MD Degree: New York Medical Medical Center, 2008-2011 Duke University Medical Center, (Massachusetts), 1996-1998 College, 2002 Other Degree: PhD, University 2002-2004 Fellowship: General Internal Residency: Internal Medicine, of Cincinnati (Ohio), 2005 Fellowship: Cardiovascular Medicine, Boston Medical Stony Brook University Medical Disease, Duke University Center (Massachusetts), Center (New York), 2002-2005 Medical Center, 2004-2009 1996-1998 (Chief Resident, 2005-2006) Cardiac Electrophysiology, Other Degree: MPH, Boston Fellowship: Cardiology, Stony Duke University Medical Center, University (Massachusetts), Brook University Medical Center 2009-2011 John J. Paat, MD 1996-1998 (New York), 2006-2009 Other Degree: PhD, General Internal Medicine Advanced Training in Harvard Medical School Particular Clinical Interests and Cardiology, Duke University (Massachusetts), 2002 Skills: Evaluation of wellness and Medical Center, 2009-2011 the prevention and management of chronic disease; symptoms and concerns in context of overall function; comprehensive continuity of care

46 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) Fellowship: General Medicine Faculty Development, University of North Carolina at Chapel Hill, 2005-2007 Other Degree: MM, University of Georgia, 1987

Jennifer A. Walker, MD General Internal Medicine Michael L. Reynolds, MD John W. Schmitt, MD Derek W. DelMonte, MD Tamer H. Mahmoud, Particular Clinical Interests Neurology Gynecologic Specialties Cornea and External Disease MD, PhD and Skills: General internal Particular Clinical Interests Particular Clinical Interests Particular Clinical Interests and Vitreoretinal Diseases medicine, preventive medicine, and Skills: General neurology, and Skills: Well-women care, Skills: Corneal transplantation; and Surgery Service management of chronic neuromuscular disease, EMG/ general office and surgical cataract surgery using Particular Clinical Interests diseases such as diabetes and NCV, EMG-guided botulinum gynecology astigmatism- and presbyopia- and Skills: Diagnosis and hypertension toxin injections for spasticity MD Degree: University of Texas correcting intraocular treatment of retinal diseases, MD Degree: Medical College and other neurologic disorders School of Medicine at San lenses; laser refractive vision with special interest in macular of Georgia School of Medicine, MD Degree: University of Texas Antonio, 1983 correction; new therapies for degeneration, diabetic 2003 Medical Branch School of Residency: OB–GYN, Duke corneal ectasia (thinning) and retinopathy, retinal vascular Residency: Internal Medicine, Medicine, 1996 University Medical Center, infectious keratitis diseases, complex retinal Duke University Medical Center, Residency: Neurology, 1983-1987 MD Degree: University of detachment, small gauge 2007 University of Texas Medical Michigan Medical School, 2006 vitrectomy, and long-acting Branch School of Medicine, Residency: Internship, Evanston intraocular implants Texas Medical Center, 2000 OPHTHALMOLOGY Northwestern Healthcare MD Degree: Ain-Shams OBSTETRICS AND Fellowship: EMG/ (Illinois), 2006-2007 University (Egypt), 1992 GYNECOLOGY Neuromuscular Disease, Duke Ophthalmology, Duke Eye Residency: Ophthalmology, University Medical Center, 2001 Center, 2007-2010 Duke Eye Center, 2003 Fellowship: Cornea, External Fellowship: Medical and Disease, and Refractive Surgery, Surgical Diseases of Retina and Bascom Palmer Eye Institute, Vitreous, Duke Eye Center, University of Miami Miller 2005 School of Medicine (Florida), Other Degree: PhD, 2011 Ophthalmology, Supreme Council of Universities (Egypt), Anna H. Bordelon, MD 2005 Comprehensive Beverly A. Gray, MD Ophthalmology General OB–GYN John H. Strickler, MD Particular Clinical Interests and Particular Clinical Interests Medical Oncology Skills: Cataract surgery, corneal and Skills: General OB–GYN, Particular Clinical Interests transplant surgery, intraocular including pediatric and and Skills: Treatment and lenses, ocular surface disorders, adolescent gynecology; family management of gastrointestinal allergic eye disease, refractive planning; caring for patients malignancies, including surgery, general ocular disease with pregnancy loss, anxiety, esophageal, gastric, pancreatic, and corneal disease Preeya K. Gupta, MD and depression and colorectal cancers; MD Degree: University of Cornea and External Disease MD Degree: University of North development of novel therapies Virginia School of Medicine, Particular Clinical Interests and S. Grace Prakalapakorn, MD Carolina at Chapel Hill School through phase 1 and phase 2 2003 Skills: Corneal transplantation Pediatric Ophthalmology of Medicine, 2007 clinical trials Residency: Ophthalmology, (PK, DSEK); refractive surgery and Strabismus Service Residency: OB–GYN, Duke MD Degree: University of Duke Eye Center, 2006-2009 (PRK, PTK, custom LASIK, Particular Clinical Interests and University Medical Center, 2011 Chicago Pritzker School of Fellowship: Cornea, External femtosecond laser, phakic Skills: Medical and surgical

Medicine (Illinois), 2005 Diseases, and Refractive intraocular lens [implantable management of pediatric eye Residency: Internal Medicine, Henry N. Pleasant Jr., MD Surgery, Wilmer Eye Institute Collamer lens, Visian ICL]); disorders and adult/childhood University of Washington and General OB–GYN at Johns Hopkins (Maryland), cataract surgery (presbyopia- strabismus; congenital/pediatric Affiliated Hospitals, 2005-2008 Particular Clinical Interests 2009-2010 correcting intraocular lenses, cataracts; intraocular lens Fellowship: Hematology– and Skills: All areas of general astigmatism-correcting implants; amblyopia; diplopia; Oncology, Duke University OB–GYN, including routine intraocular lenses) ocular motility disorders; Medical Center, 2008-2011 pregnancy care, medical and MD Degree: Northwestern nasolacrimal duct obstruction; surgical management of benign University Feinberg School of screening and treatment of gynecologic conditions, family Medicine (Illinois), 2006 retinopathy of prematurity Teresa L. Tullo, MD planning, management of Residency: Ophthalmology, MD Degree: Emory University General Internal Medicine menopause, and abnormal Duke Eye Center, 2010 School of Medicine (Georgia), Particular Clinical Interests and bleeding Fellowship: Cornea and 2005 Skills: Treatment and prevention MD Degree: Brody School Refractive Surgery, Minnesota Residency: Transitional of osteoporosis; non- of Medicine at East Carolina Eye Consultants, Phillips Eye Internship, Scripps Mercy pharmacologic management University (North Carolina), Institute, 2011 Hospital (California), 2005-2006 of overweight, metabolic 1992 Ophthalmology, Emory syndrome, and fatty liver; Residency: General OB–GYN, University Hospital (Georgia), diabetes; hypertension Carolinas Medical Center 2006-2009 MD Degree: University of North (North Carolina), 1996 Fellowship: Pediatric Carolina at Chapel Hill School Ophthalmology and Strabismus, of Medicine, 2001 Duke Eye Center, 2010-2011 Residency: General Internal Other Degree: MPH, Emory Medicine, Moses Cone University School of Public Memorial Hospital (North Health, 2005 Carolina), 2001-2004

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Usha P. Reddy, MD Rhett K. Hallows, MD Rachel M. Reilly, MD Ann M. Buchanan, MD Oculoplastics and Adult Reconstruction Trauma Infectious Diseases Samuel B. Adams Jr., MD Reconstructive Surgery Particular Clinical Interests and Particular Clinical Interests Particular Clinical Interests and Foot and Ankle Surgery Particular Clinical Interests Skills: Complex hip and knee and Skills: Acute orthopaedic Skills: HIV, tropical medicine, Particular Clinical Interests and Skills: Oculoplastics replacement/reconstruction trauma surgery, including infectious diseases and Skills: Management of all and reconstructive surgery, and revision surgery, hip and fractures of the pelvis, MD Degree: Brody School disorders of the foot and ankle; conditions of the eyelids, knee revision arthroplasty acetabulum, and periarticular of Medicine at East Carolina treatment of osteochondral lacrimal system, orbit in (for failed total knee and hip fractures; patients with University (North Carolina), lesions of the talus; total ankle children and adults replacements), computer- nonunions and malunions 2002 replacement; orthobiologic MD Degree: Alpert Medical navigated joint replacement MD Degree: University of Residency: Pediatrics, University applications to foot and ankle School, Brown University MD Degree: University of Utah Cincinnati College of Medicine of Rochester (New York), 2002- surgery, including stem-cell (Rhode Island), 2005 School of Medicine, 2003 (Ohio), 2005 2006 therapies and platelet-rich Residency: Ophthalmology, Residency: Orthopaedic Residency: Orthopaedic Fellowship: Pediatric Infectious plasma Bascom Palmer Eye Institute, Surgery, University of Utah, Surgery, UNC Hospitals, 2005- Diseases, Duke University MD Degree: Jefferson Medical University of Miami, 2009 2008 2010 Medical Center, 2008-2011 College of Thomas Jefferson Fellowship: Oculoplastics and Fellowship: Total Joint Fellowship: Orthopaedic Other Degree: MPH, Maternal University (Pennsylvania), 2004 Reconstructive Surgery, Duke Arthroplasty, Duke University Trauma, R. Adams Cowley and Child Health, University of Residency: Orthopaedic Eye Center, 2011 Medical Center, 2009 Shock Trauma Center North Carolina at Chapel Hill, Surgery, Duke University (Maryland), 2010-2011 2007 Medical Center, 2010 Diploma, Tropical Medicine Fellowship: Foot and Ankle and Hygiene, Gorgas Course Surgery, Union Memorial PATHOLOGY in Clinical Tropical Medicine Hospital (Maryland), 2011 (Peru), 2004 Elizabeth N. Pavlisko, MD Particular Clinical Interests and Skills: Pulmonary pathology, cardiovascular pathology, transplant pathology (heart Jullia Rosdahl, MD, PhD Richard C. Mather III, MD and lung), autopsy pathology, Glaucoma Service Sports Medicine interstitial and occupational Particular Clinical Interests and Particular Clinical Interests lung disease, pleural and Skills: Diagnosis and treatment and Skills: Hip arthroscopy, pulmonary malignancy, of glaucoma, cataracts, and sports injuries of the asbestos-related lung disease, Grant Garrigues, MD general diseases; glaucoma hip, femoroacetabular lung tissue fiber burden analysis Rebecca J. Chancey, MD Sports Medicine laser; incisional surgical impingement, cartilage and via electron microscopy Blood and Marrow Particular Clinical Interests therapies; cataract surgery meniscus injuries, cartilage MD Degree: Medical University Transplantation and Skills: Arthroscopic, joint MD Degree: Case Western restoration and transplantation, of South Carolina College of Particular Clinical Interests replacement, and reconstructive Reserve University School of shoulder replacement and Medicine, 2006 and Skills: Pediatric blood and surgery of the shoulder and Medicine (Ohio), 2004 reconstruction, reverse Residency: Anatomical and marrow transplantation elbow; treatment of rotator Residency: Internal Medicine, shoulder arthroplasty, shoulder Clinical Pathology, Duke MD Degree: Washington cuff tears, labral/Bankart/SLAP Caritas Carney Hospital, Tufts instability, rotator cuff injuries, University Medical Center, 2010 University in St. Louis School of tears, impingement syndrome, University (Massachusetts), ACL reconstruction Fellowship: Pulmonary Medicine (Missouri), 2008 cartilage defects, arthritis, 2004-2005 MD Degree: Duke University Pathology, Duke University Residency: Pediatrics, Duke instability, stiffness, nerve Ophthalmology, Massachusetts School of Medicine, 2005 Medical Center, 2011 University Medical Center, 2011 compression, throwing athletes, Eye and Ear Infirmary, Harvard Residency: Orthopaedic and traumatic injuries University, 2007-2010 Surgery, Duke University MD Degree: Harvard Medical Fellowship: Glaucoma, Duke Medical Center, 2010 PEDIATRICS School (Massachusetts), 2005 Eye Center, 2010-2011 Fellowship: Sports Medicine, Residency: Orthopaedic Alaina M. Brown, MD Other Degree: PhD, Case Rush University Medical Center Surgery, Duke University Neonatology Western Reserve University (Illinois), 2011 Medical Center, 2010 Particular Clinical Interests and School of Medicine (Ohio), Fellowship: Shoulder and Elbow Skills: Neonatal resuscitation 2002 Surgery, The Rothman Institute/ MD Degree: University of Thomas Jefferson University Virginia School of Medicine, (Pennsylvania), 2011 2008 Richard J. Chung, MD Residency: Pediatrics, Duke Primary Care University Medical Center, 2011 Particular Clinical Interests and Skills: Primary and consultative care for adolescents and young adults with a particular focus on routine and preventive care, acute care, and chronic issues, including obesity, eating disorders, and concerns related to growth and development MD Degree: Yale University School of Medicine (Connecticut), 2005

48 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) Residency: Internal Medicine– Residency: General Psychiatry, RADIOLOGY Pediatrics, Duke University Duke University Medical Center, Medical Center, 2005-2009 2011 Fellowship: Adolescent Fellowship: Child and Medicine, Children’s Hospital Adolescent Psychiatry, Duke Boston (Massachusetts), University Medical Center, 2011 2009-2011 Other Degree: MPH, University of North Carolina at Chapel Hill, 2004 Rebecca L. Smith, MD Julie K. Wood, DO Critical Care Medicine Blood and Marrow Adam C. Braithwaite, MD Particular Clinical Interests and Transplantation Community Radiology Skills: Pediatric critical care for Particular Clinical Interests Particular Clinical Interests and children from birth through and Skills: Pediatric blood and Skills: Advanced breast imaging adolescence marrow transplantation and the early detection of MD Degree: Drexel University DO Degree: Philadelphia breast cancer, trauma imaging College of Medicine College of Osteopathic Deanna M. Green, MD MD Degree: New York Medical (Pennsylvania), 2003 Medicine (Pennsylvania), 2008 Pulmonary and Sleep College, 2002 Residency: General Pediatrics, Residency: Pediatrics, Duke Medicine Heather R. Romero, PhD Residency: Internal Medicine, North Carolina Children’s University Medical Center, Particular Clinical Interests Medical Psychology Carolinas Medical Center Hospital, 2003-2006 (Chief 2008-2011 and Skills: Management of PhD Degree: Clinical (North Carolina), 2002-2003 Resident, 2006-2007) cystic fibrosis and CF-related Psychology, Seattle Pacific Diagnostic Radiology, Duke Fellowship: Pediatric Critical complications, chronic lung University (Washington), 2009 University Medical Center, Care, Children’s Hospital of PSYCHIATRY disease of infancy, asthma, Residency: Clinical 2003-2007 Pittsburgh (Pennsylvania), 2007- general pulmonary diseases Neuropsychology, Duke Fellowship: Breast and 2010 such as recurrent pneumonia University Medical Center, Abdominal Imaging, Duke MD Degree: University of 2008-2009 University Medical Center, Florida College of Medicine, Fellowship: Neuropsychology, 2007-2008 2004 Duke University Medical Center, Residency: Pediatrics, Johns 2009-2011 Lauren J. Ehrlich, MD Hopkins University, 2004-2007 Pediatric Radiology Fellowship: Pediatric RADIATION ONCOLOGY Particular Clinical Interests and Pulmonary, Johns Hopkins Skills: Pediatric radiology University, 2007-2011 Naomi O. Davis, PhD MD Degree: University of Other Degree: MHS, Clinical Child and Adolescent Pennsylvania School of Epidemiology, Johns Hopkins Priti Tewari, MD Psychiatry Medicine, 2005 Bloomberg School of Public Blood and Marrow Medical Psychology Residency: Transitional Health, 2008-2010 Transplantation Particular Clinical Interests Internship, Albert Einstein Particular Clinical Interests and Skills: Evaluation and Medical Center (Pennsylvania), and Skills: Stem-cell and treatment services for ADHD 2005-2006 bone-marrow transplantation (child, adolescent, and adult), Diagnostic Radiology, for malignant and non- parent training (individual and Casey Tudor Chollet, MD Hospital of the University of malignant pediatric disorders, group services), academic skills Particular Clinical Interests Pennsylvania, 2006-2010 including pediatric cancers, support and Skills: General radiation Fellowship: Pediatric Radiology, inherited metabolic disorders, PhD Degree: Clinical oncology Duke University Medical Center, immunodeficiencies, and Psychology, University of MD Degree: University of 2010-2011 hemoglobinopathies; long-term Massachusetts, 2007 Tennessee College of Medicine, follow-up; supportive care; Residency: Clinical Psychology, Dorothee K.D. Newbern, MD 2006 quality of life UNC Hospitals, 2006-2007 Endocrinology Residency: General Internal MD Degree: Ross University Fellowship: Pediatric Particular Clinical Interests Medicine, University of School of Medicine (Dominica, Psychology, UNC Hospitals, and Skills: Type 1 diabetes, Tennessee, 2006-2007 West Indies), 2003 2011 hypoglycemia, hypothyroidism, Radiation Oncology, Loyola Residency: Pediatrics, State Other Degree: MA, Child Graves disease University Medical Center University of New York at Development, Tufts University MD Degree: Wake Forest (Illinois), 2007-2011 Downstate, 2003-2006 (Massachusetts), 2000 University School of Medicine Fellowship: Pediatric (North Carolina), 2005 Hematology–Oncology, Danielle M. Seaman, MD Residency: Pediatrics, Duke Children’s Hospital at Cardiothoracic Imaging University Medical Center, Montefiore, Albert Einstein Particular Clinical Interests and 2005-2008 College of Medicine, 2006- Skills: Cardiothoracic imaging Fellowship: Pediatric 2009 MD Degree: Case Western Endocrinology, Duke University Pediatric Bone Marrow Reserve University School of Medical Center, 2008-2011 Transplantation, Duke Medicine (Ohio), 2005 University Medical Center, Residency: Diagnostic 2009-2011 Radiology, University of Erikka D. Dzirasa, MD Cincinnati (Ohio), 2010 Child and Adolescent Fellowship: Cardiothoracic Psychiatry Imaging, Duke University Particular Clinical Interests Medical Center, 2011 and Skills: Advanced psychopharmacology, cognitive behavioral therapy, mood and anxiety disorders, ADHD, eating disorders MD Degree: Duke University School of Medicine, 2006

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Nancy J. Crowley, MD Gayle A. DiLalla, MD Shelley Hwang, MD Aaron C. Lentz, MD Surgical Oncology Surgical Oncology Surgical Oncology Urology Obinna O. Adibe, MD Particular Clinical Interests and Particular Clinical Interests and Particular Clinical Interests and Particular Clinical Interests Pediatric General Surgery Skills: Breast disease, breast Skills: Breast disease, breast Skills: Diagnosis and treatment and Skills: Reconstructive Particular Clinical Interests cancer cancer of early-stage breast cancer, urology with a specific and Skills: Advanced pediatric MD Degree: Duke University MD Degree: University of management of patients at focus on minimally invasive minimally invasive surgery, School of Medicine, 1985 Missouri–Kansas City School of high risk for breast cancer, approaches to urethral stricture neonatal surgery, anorectal Residency: General Surgery, Medicine, 1987 surgical treatment of patients disease, urinary incontinence, malformations, inflammatory Vanderbilt University, 1985- Residency: General Surgery, with breast disease ureteral obstruction, fistula bowel disease, prenatal 1988 University of Florida– MD Degree: University of repair, genitourinary trauma, counseling, fetal therapy, Fellowship: General Surgery, Jacksonville, 1992 California, Los Angeles, David sexual dysfunction, prostate pediatric outcomes research Duke University Medical Center, Geffen School of Medicine, enlargement, and video- MD Degree: University of 1988-1990 1991 urodynamic evaluation Medicine and Dentistry of New Research, General Surgery, Residency: General Surgery, MD Degree: University of North Jersey–New Jersey Medical Duke University Medical Center, Kaiser Permanente Los Angeles Carolina at Chapel Hill School School, 2001 1990-1993 (California), 1991-1992 of Medicine, 2005 Residency: General Surgery, General Surgery, Weill Cornell Residency: Surgery, UNC University of Connecticut Medical Center (New York), Hospitals, 2005-2006 Health Center, 2001-2004, 1992-1996 Urologic Surgery, UNC 2006-2008 Fellowship: Breast Surgery, Hospitals, 2006-2010 Fellowship: Fetal Surgery Memorial Sloan-Kettering Fellowship: Reconstructive Research, Children’s Hospital Matthew G. Hartwig, MD Cancer Center (New York), Urology, Female Urology, and of Philadelphia (Pennsylvania), Cardiovascular and Thoracic 1996-1997 Urodynamics, Duke University 2004-2006 Surgery Surgical Oncology, Singapore Medical Center, 2010-2011 Pediatric Endosurgery, Particular Clinical Interests General Hospital, 1997-1998 Children’s Hospital of Alabama, and Skills: Thoracic oncology Other Degree: MPH, University 2008-2009 Calhoun D. Cunningham with an emphasis on minimally of California, Berkeley, 2006 Pediatric Surgery, Children’s III, MD invasive approaches to lung Mercy Hospital and Clinics Otolaryngology–Head and and esophageal cancer; video- (Missouri), 2010-2012 Neck Surgery assisted thoracic surgery Particular Clinical Interests (VATS) and robotic-assisted and Skills: Disorders of the thoracic surgery (RATS); Richard E. Cooper, MD ear in adults and children, benign and malignant diseases General Surgery including skull-base tumors, of the lung, esophagus, Particular Clinical Interests and acoustic neuromas, glomus mediastinum, and chest wall; Michael E. Lipkin, MD Skills: Thyroid and parathyroid tumors; chronic ear infections, surgical treatment of end- Urology surgery, breast surgery, hernia cholesteatoma, and eardrum stage lung disease, including Particular Clinical Interests and surgery perforations; sensorineural lung volume reduction and Nandan Lad, MD, PhD Skills: Medical and surgical MD Degree: Keck School of and conductive hearing loss; lung transplantation; ex vivo Neurosurgery management of kidney stone Medicine of the University of cochlear implantation, BAHA lung perfusion; donation after Particular Clinical Interests and disease, minimally invasive Southern California, 1988 implants, and implantable cardiac death; extracorporeal Skills: Movement disorders, urologic surgery, endoscopic Residency: General Surgery, hearing aids; otosclerosis life support for respiratory deep brain stimulation, management of urinary tract Phoenix Integrated Surgical MD Degree: Medical University failure medically refractory pain, obstruction, robotic and Program, Banner Good of South Carolina College of MD Degree: Duke University spinal neurosurgery, peripheral laparoscopic urologic surgery Samaritan Medical Center Medicine, 1996 School of Medicine, 2001 nerve surgery, general adult MD Degree: University of (Arizona), 1993 Residency: Otolaryngology, Residency: Surgery, Duke neurosurgery Medicine and Dentistry of New Medical University of South University Medical Center, MD Degree: Chicago Medical Jersey–New Jersey Medical Carolina, 2002 2001-2007 (Chief Resident, School at Rosalind Franklin School, 2003 Fellowship: Otology– 2007-2008) University of Medicine and Residency: Urology, New York Neurotology, House Ear Clinic Thoracic Surgery, Duke Science (Illinois), 2004 University Medical Center, (California), 2004 University Medical Center, Residency: General Surgery, 2009 2008-2010 (Chief Resident, Stanford University Medical Fellowship: Endourology, 2010-2011) Center (California), 2004-2005 Laparoscopy, and Robotics, Fellowship: Research, Thoracic Neurosurgery, Stanford Duke University Medical Center, Surgery, Duke University University Medical Center 2011 Medical Center, 2003-2005 (California), 2005-2011 Fellowship: Stereotactic and Functional Neurosurgery, Stanford University Medical Center (California), 2008-2009 Other Degree: PhD, Rosalind Franklin University of Medicine and Science (Illinois), 2004

50 Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853) Residency: Surgery, West Residency: General Surgery, Virginia University Hospitals, Baylor College of Medicine 1997-1998 (Texas), 1977-1981 Neurosurgery, West Virginia General Surgery, Creighton University Hospitals, 1998-2003 University (Nebraska), 1981-1982 General Surgery, Henry Ford Hospital (Michigan), 1982-1983 Thoracic/Cardiovascular Catherine A. Lynch, MD P. Joshua O’Brien, MD Surgery, Wayne State University Jonathan C. Wendell, MD Emergency Medicine General Surgery (Michigan), 1984-1986 Emergency Medicine Particular Clinical Interests and Particular Clinical Interests Fellowship: Thoracic/ Particular Clinical Interests and Skills: Clinical and research and Skills: Abdominal aortic Cardiovascular Surgery, Wayne Skills: All aspects of out-of- focus in trauma and injury care; aneurysms, peripheral vascular State University (Michigan), hospital emergency care and health disparities research in disease, dialysis access, 1983-1984 disaster medicine with focus on Jonathan C. Routh, MD injury and emergency care in endovascular therapies Endovascular Surgery, Columbia mass-gathering/event medicine Urology the United States and in low- MD Degree: Joan C. Edwards University Medical Center MD Degree: University of Particular Clinical Interests and and middle-income countries School of Medicine at Marshall (New York), 2007 Arizona College of Medicine, Skills: Reconstructive surgery MD Degree: University of University (West Virginia), 2004 2007 of congenital anomalies Medicine and Dentistry of Residency: General Surgery, Residency: Emergency of the genitourinary tract New Jersey–New Jersey Marshall University School of Medicine, University of (hypospadias, cryptorchidism, Medical School, 2005 Medicine (West Virginia), 2009 Maryland, 2010 intersex, obstructive uropathies Residency: Emergency Fellowship: Vascular Surgery, Fellowship: Pre-Hospital and [hydronephrosis], vesicoureteral Medicine, Yale-New Haven Duke University Medical Center, Global Disaster Medicine, Duke reflux, exstrophy); management Hospital (Connecticut), 2009 2011 University Medical Center, 2011 of urinary-tract infections, Fellowship: Emergency incontinence, and enuresis Medicine/International Health, in children; management Emory University (Georgia), of neurogenic bladders in Lisa A. Tolnitch, MD 2011 children; general pediatric Surgical Oncology urology; consultation for fetal Particular Clinical Interests and uropathies; urologic neoplasms Skills: Breast disease, breast in children cancer MD Degree: University of North MD Degree: University of Carolina at Chapel Hill School Louisville School of Medicine Philip A. Omotosho, MD of Medicine, 2002 (Kentucky), 1983 Charles R. Woodard, MD Metabolic and Residency: Urology, Mayo Clinic Residency: General Surgery, Otolaryngology–Head and Weight Loss Surgery (Minnesota), 2008 UNC Hospitals, 1983-1988 Neck Surgery Particular Clinical Interests Fellowship: Pediatric Urology, Particular Clinical Interests Carrie R. Muh, MD and Skills: Minimally invasive Children’s Hospital Boston and Skills: Facial plastic Neurosurgery and bariatric surgery, gastro- (Massachusetts), 2011 and reconstructive surgery, Particular Clinical Interests esophageal reflux, esophageal Pediatric Health Services including rhinoplasty, and Skills: Pediatric brain motility disorders, hiatal hernia, Research, Harvard Medical nasal surgery for breathing tumors, pediatric spine tumors, abdominal wall hernias School (Massachusetts), 2010 obstruction, surgical treatment posterior fossa tumors, genetic MD Degree: Pennsylvania State Other Degree: MPH, Harvard of the aging face (browlift, tumor syndromes, Chiari University College of Medicine, School of Public Health blepharoplasty, face-lift, neck malformations, craniosynostosis 2004 (Massachusetts), 2010 lift), cosmetic facial implants, and craniofacial surgery, Residency: General Surgery, cosmetic injectables and fillers Charles J. Viviano, MD, PhD tethered cord and spina bifida, Baystate Medical Center/Tufts (Botox, Dysport, Restylane, Urology hydrocephalus, spasticity, University School of Medicine Juvederm, Radiesse), surgical Particular Clinical Interests and vagal nerve stimulators for (Massachusetts), 2009 reconstruction following Mohs Skills: General adult urology, epilepsy and the evaluation Fellowship: Minimally Invasive surgery for facial cancers, including kidney stones, and treatment of other Surgery, Duke University management of facial paralysis, BPH, hypogonadism, erectile neurosurgical disorders of Medical Center, 2011 maxillofacial trauma dysfunction, hematuria, and childhood MD Degree: Eastern Virginia vasectomy MD Degree: Columbia Medical School, 2005 MD Degree: University University College of Physicians Residency: General Surgery, William P. Sweezer Jr., MD of Connecticut School of and Surgeons (New York), 2003 University of Virginia Health Cardiovascular and Thoracic Medicine, 2000 Residency: General Surgery, System, 2005-2006 Surgery Residency: Urology, University Neurology, Emory University Otolaryngology–Head and Particular Clinical Interests and of Connecticut Health Center, School of Medicine (Georgia), Neck Surgery, University of Skills: Adult cardiac surgery, 2000-2006 2003-2004 Virginia Health System, thoracic surgery, peripheral Other Degree: PhD, Toxicology, Neurological Surgery, Emory 2006-2010 vascular surgery, endovascular University of North Carolina at University School of Medicine Fellowship: Facial Plastic Kenneth O. Price, MD surgery, mediastinal tumors, Chapel Hill, 1994 (Georgia), 2004-2010 (Chief and Reconstructive Surgery, Neurosurgery thoracoscopic surgery, thoracic Resident, 2009-2010) Stanford University Medical Particular Clinical Interests surgical oncology Fellowship: Pediatric Center (California), 2010-2011 and Skills: General adult MD Degree: Meharry Medical Neurosurgery, Children’s neurosurgery, cervical College (Tennessee), 1977 Healthcare of Atlanta and and lumbar spine surgery, Emory School of Medicine, peripheral nerve entrapment, 2010-2011 carotid artery surgery Other Degree: MS, Political MD Degree: Wake Forest Science/Health Policy, University School of Medicine Massachusetts Institute of (North Carolina), 1997 Technology, 1997

Visit Duke Medicine online at dukemedicine.org DukeMed Spring 2012 51 2012 Duke CME Calendar continuing medical education AT DUKE For more information on the courses listed below, please contact the Duke Office of Continuing Medical Education at 919-401-1200 or visit cme.mc.duke.edu.

On-site courses DATE LOCATION CREDITS Dermatology Society for Investigative Dermatology 2012 Annual Meeting May 9–12 Raleigh, NC 36.5

RADIOLOGY 22nd Annual Duke Review Beach Course July 23–27 Myrtle Beach, SC 21.0

Radiation Oncology 5th Annual IMRT/IGRT North Carolina Symposium May 5 Durham, NC 6.75

Online courses DATE CREDITS Duke Cardiology e-Rounds Congestive Heart Failure 1950-2010: A 60-Year Perspective Through June 30 1.0 Duke Cardiology at the American Heart Association Meetings Through June 30 1.0 Late-Breaking Science: Highlights of the ESC Through June 30 1.0 Myocardial Mechanics: More than Meets the Eye Through June 30 1.0 New Developments in Therapies for Acute Heart Failure Through June 30 1.0 Revascularization for Chronic Total Occlusions Through June 30 1.0 What's Hot in Cath Lab Research Through June 30 1.0 What's Hot in EP Research at Duke Through June 30 1.0 What's Hot in Heart Failure Research Through June 30 1.0 What's Hot in Prevention Research Through June 30 1.0 What's Hot in the Echo Lab at Duke Through June 30 1.0

CHAMBER Peer-to-Peer Podcast Diagnosis of HER2-Overexpressing Breast Cancer Through May 16 0.5 Case Presentation: Treating HER2-Overexpressing Breast Cancer Through June 9 0.5

CHAMBER On-Demand Webinar Treating HER2-Driven Breast Cancer Through May 12 0.75 Coping with Breast Cancer: Emotional Well-Being Through June 16 0.75 Assessing Toxicity Through June 16 1.0

Duke Clinical Medicine Series Endocrinology Conference 2011: Graves Disease Through May 19 0.5 Endocrinology Conference 2011: What's New in Diabetes Mellitus Treatment Through May 26 0.5 Endocrinology Conference 2011: The Weak and Dizzies—Medications for Thyroid Disease Through June 2 0.5 Pulmonology Conference: ILD in 2010—Recognition, Approach, and Treatment Options Through June 2 0.5 Cardiology Conference 2011: ACC.11 and the i2 Summit Results Discussion Through June 16 0.5 Cardiology Conference 2011: Atrial Fibrillation—Achieving Safer Anticoagulation Through June 23 0.5 Cardiology Conference 2011: A Look into the Future of Antiplatelet Therapy Through June 30 0.5 Cardiology Conference 2011: Current Concepts and Future Directions Through July 7 0.5 Cardiology Conference 2011: The Evolution of the Coronary Stent—Addressing Current Limitations Through July 14 0.5 Cardiology Conference 2011: Bioresorbable Stents—From Concept to Clinical Use Through July 28 0.5 Nephrology Conference 2011: Management of Diabetes in Patients with Abnormal Renal Function Through July 21 0.5

Sedation Management in the Critically Ill and Perioperative Patient Through May 22 1.0 Glioblastoma Phase 2 Updates on the Management of Brain Tumors: Clinical Column Series Through May 24 2.25 Therapeutic Advances in the Management of Psychoses: Volume 3 Through June 9 1.0 Meet the Professors CD-ROM: Clinical Investigators Consult on Challenging Real Cases Through June 19 1.25 of Patients with Prostate Cancer Of Ends and Means: Toward Optimized Outcomes in Atrial Fibrillation Through June 22 2.5 Emerging Treatment Options for the Prevention of Atrial Fibrillation-Related Stroke Through June 23 1.25 CHAMBER Patient Visit Simulator: Management of HER2-Amplified Breast Cancer Through July 21 1.0 CHAMBER Standardized Patient Video: Side Effects of Adjuvant Treatment—Cardiotoxicity Through July 21 0.25 Confronting the Limitations of Dual Antiplatelet Therapy Through July 24 2.25 Updates in Neuro-Oncology: 2011 Annual Meeting of the American Society of Clinical Oncology Through July 28 0.75

52 We’ve discovered a powerful weapon in the war on cancer: You.

Cures for cancer. It’s an ambitious goal, but the truth is, it’s attainable—with your help.

You can help move cancer research forward. Research that could mean promising new drugs and treatments, more precious time for patients, even cures.

Your gift to the Duke Cancer Fund provides essential dollars that we can apply quickly and strategically to fund groundbreaking research and innovative treatments. Your donation will foster working partnerships between our patients and our scientists, pushing out the frontiers of cancer research while giving patients the gift of another cherished month, another treasured season, another priceless year.

All of us at the Duke Cancer Institute earnestly invite you to lend your strength to our fi ght against cancer.

To learn more about how you can become a partner in the fi ght, please visit dukecancerfund.org or call 919-385-3129 today.

DUKE CANCER

dukecancerfund.org 919-385-3129 DukeMed Magazine Non-profit Org. DUMC 3687 U.S. Postage PAID Duke University Medical Center PPCO Durham, NC 27710

201013001

m ag a zi n e volume 12, issue 1, Spring 2012

Opening new doors With the launch of the Duke Cancer Institute in November 2010 and the opening of the new Duke Cancer Center in February 2012, “This is the beginning of a new era in cancer care and research at Duke,” says Michael B. Kastan, MD, PhD, who became the DCI’s first executive director last fall. “Many challenges remain in battling cancer, but I believe that these groundbreaking initiatives will greatly facilitate our ability to bring advances from the lab into clinical practice and to transform the way that cancer patients are cared for.” Learn more in this special issue of DukeMed Magazine.

DukeMed Magazine is printed on Forest Stewardship Council-certified paper, manufactured from wood harvested from well-managed forests certified by Bureau Veritas Certification.