Always at the cutting edge

Department of Medicine 2019 Annual Report Acknowledgments

The Department of Medicine would like to extend gratitude to the many people who contributed to this report, including Department leadership, Division Chiefs, administrators, and faculty members. We also thank Gigi Korzenowski and Jerry Clark of Korzenowski Design, and Kallie Gregg and Sophie Afdhal of the Department of Medicine. Much of the photography and photo research for this report were conducted by BIDMC’s James Derek Dwyer and Danielle Duffey. Jane Hayward, Lindsay Oslund, Heather Derocher, and Ann Plasso all provided expert copy editing and design consultation. We also thank the Communications and Marketing Department. Last but not least, we wish to thank all of the individuals featured in these pages for their collaboration and for all they do for the Department of Medicine, our patients, and the medical center. Table of Contents

Acknowledgments...... 2 Leading Minds: Education at Harvard Medical School...... 24 From the Chair...... 4 Early Investigator, Timely Advances: Departmental Organization...... 4 Sol Schulman, MD, PhD...... 28

From the CAO...... 5 Exceptional Mentorship and Career Development, Supporting New Leadership...... 9 Cutting-Edge Research...... 30 Vice Chair Updates...... 8 Cutting-Edge Conversations...... 34 Breaking Ground on a Cutting-Edge Medical Education Leadership...... 36 New Inpatient Building...... 12 Selected Publications...... 37 Coming Together as a New System...... 14 Research Funding: A Pioneer of Perception: Academic Year 2018-2019...... 44 Mark Andermann, PhD...... 16 In Memoriam...... 45 Awards & Honors...... 18

Clinical Volume at the Cutting Edge...... 20

Taking Bedside Rounds Anywhere and Everywhere...... 22 This report is interactive. Navigate using the Table of Contents above and the links throughout the report.

2 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 3 Departmental Organization

As of 2020

From the Chair Administration Clinical Divisions Research Divisions From the CAO Since coming together as part of Beth Israel Lahey Health As I write this message, we are completing a several month Mark Zeidel, MD ALLERGY AND INFLAMMATION HEMATOLOGY AND CLINICAL INFORMATICS last year (for more information, visit page 14), the Department journey through the first—and we hope the only—crisis phase Department Chair HEMATOLOGIC MALIGNANCIES Peter Weller, MD Yuri Quintana, PhD of Medicine has been proud to be an integral part of the new of the COVID-19 pandemic. The report in your hands describes David Avigan, MD Kevin Maguire, MS Division Chief Division Chief system as we continue to emphasize our mission: providing the achievements of one of America’s premier Departments of Division Chief Chief Administrative Officer Amanda Yano-Litwin, MHA extraordinary care to our patients, training the next generation Medicine prior to the onset of the COVID-19 epidemic. CLINICAL NUTRITION Mark Aronson, MD Division Administrator Christine VanDeWege, MA of physicians and scientists, and engaging in groundbreaking Bruce Bistrian, MD, PhD, MPH During this past academic year, the Department continued Vice Chair, Quality Division Administrator research across all of our Divisions. its tradition of providing superb, high quality care to ever- CARDIOVASCULAR MEDICINE Division Chief Donald Cutlip, MD INFECTIOUS DISEASES It has been an incredibly eventful beginning for our new system, increasing numbers of outpatients and inpatients, both on Robert Gerszten, MD Vice Chair, Clinical Care EXPERIMENTAL MEDICINE and I could not be more proud of how BILH and the Department BIDMC’s main campus and at an ever-growing number Division Chief Peter Weller, MD of Medicine has responded to the many challenges we faced and of community health centers. We continued to expand our in the Community Division Chief Jerome Groopman, MD John DiGiorgio, MPS-HHS continue to face. structural heart and congestive heart failure programs, we Grace Huang, MD Division Chief Division Administrator Amanda Yano-Litwin, MHA enhanced our interdepartmental collaborative efforts in Vice Chair, Career Throughout the entire coronavirus pandemic, from our early Division Administrator HEMOSTASIS AND THROMBOSIS transplantation, and we continued to expand our innovative Development and Mentoring ENDOCRINOLOGY, preparedness plans and managing the surge in Massachusetts, approaches towards immunotherapy in cancer care. At the DIABETES AND METABOLISM MEDICAL ONCOLOGY Robert Flaumenhaft, MD, PhD to recovering and beginning to adapt to a ‘new normal,’ the Barbara Kahn, MD Division Chief Department acted quickly, effectively, and collaboratively to care same time, we continued the planning for our new inpatient Vice Chair, Research Strategy Evan Rosen, MD, PhD David F. McDermott, MD building and we have accelerated our collaborative clinical Division Chief Division Chief for our patients and for one another during unprecedented times. Eileen Reynolds, MD IMMUNOLOGY efforts throughout the Beth Israel Lahey Health network. Every member of our Department contributed to managing Vice Chair, Education Amanda Yano-Litwin, MHA Christine VanDeWege, MA Cornelius Terhorst, PhD Our educators led the way in developing new curricula at this crisis: the Vaccine and Virology lab is at the forefront of the Division Administrator Division Administrator Division Chief Harvard Medical School and continued to recruit and train C. Christopher Smith, MD race to develop a vaccine, faculty provided surge coverage superb classes of interns, residents, and fellows. Again, our Associate Vice Chair, GASTROENTEROLOGY NEPHROLOGY INTERDISCIPLINARY MEDICINE for inpatient COVID-19 floors, staff converted clinical spaces to Education educators were honored repeatedly for their dedication, Nezam Afdhal, MD Martin Pollak, MD AND BIOTECHNOLOGY accommodate additional patients on ventilators, and residents ingenuity, and effectiveness. developed a program to donate iPads to connect loved ones with Anjala Tess, MD Division Chief Division Chief Ary Goldberger, MD isolated patients. These are just a few examples, among many, Our researchers continued to break new ground in cancer, Associate Vice Chair, Division Chief Sara Montanari Kerry Falvey that demonstrate the versatility, talent, and commitment we have vaccine development, rheumatologic, metabolic, renal, Education Division Administrator Division Administrator within the Department and at BIDMC. and cardiac diseases, and we continued to strengthen Peter Weller, MD SIGNAL TRANSDUCTION our mentoring of young investigators and junior faculty Vice Chair, Research GENERAL MEDICINE PULMONARY, CRITICAL Alex Toker, PhD It’s been a year of ups and downs met by change and innovation, members of all types. We welcomed Gyongyi Szabo, BIDMC’s CARE AND SLEEP MEDICINE and I’m eager to see what the coming months bring for the Tim McDermott, MHA Eileen Reynolds, MD Division Chief new Chief Academic Officer, to our Department. As a truly Richard Schwartzstein, MD Department of Medicine, BIDMC, and Beth Israel Lahey Health. Executive Director, Finance Division Chief outstanding Hepatologist and liver investigator, Dr. Szabo will Division Chief TRANSLATIONAL RESEARCH I hope you are as well. and Business Operations Blair Bisher, MHA AND TECHNOLOGY INNOVATION collaborate with Dr. Afdhal and colleagues in the Division of Renee Wheeler Paul Hart Miller Division Administrator Gastroenterology, Hepatology and Nutrition to further develop a Division Administrator Steven Freedman, MD, PhD comprehensive liver research program of international stature. Director, Business GERONTOLOGY Division Chief and Network Development RHEUMATOLOGY AND Although this Annual Report describes the year’s events prior Lewis Lipsitz, MD CENTER FOR VIROLOGY Scot Sternberg, MS CLINICAL IMMUNOLOGY to the pandemic, reflecting on the past year from this new Division Chief AND VACCINE RESEARCH Kevin Maguire, MS, perspective renews the pride we have in our missions and our Director, Quality Improvement George Tsokos, MD Chief Administrative Officer, Kerry Falvey confidence that these missions will endure and flourish, no Division Chief Dan Barouch, MD, PhD Department of Medicine Division Administrator Division Chief matter what challenges the pandemic has in store. Patricia Harris Division Administrator

Mark L. Zeidel, MD Chair, Department of Medicine

4 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 5 New Leadership

in many clinical innovations in the potent induction of anti- role, Dr. McDermott will serve and kidney cancer. Dr. it revolutionizes the way cancer such as the application of tumor immunity and disease as the head of a distinguished McDermott is a renowned and ultimately other diseases are vibration-controlled Transient regression. faculty of medical oncologists clinical oncologist and treated and diagnosed. Elastography to stage liver and physician leaders with researcher whose pioneering A Professor of Medicine at a diverse array of clinical, work focuses on finding novel Dr. McDermott is the Director fibrosis. This technology has Harvard Medical School, Dr. of the Immuno-Oncology and effectively replaced liver biopsy educational, and research therapies to enhance the Avigan leads the Cell Therapy expertise in innovative research immune response to cancer. Cutaneous Oncology Programs for fibrosis staging in the US. and Bone Marrow Transplant and treatment approaches He has made significant at BIDMC, Leader of the Dana Dr. Afdhal also was the lead Program at BIDMC and also for solid tumors. The Medical contributions to the application Farber/Harvard Cancer Center investigator on multiple global serves as Co-Director of the Oncology Division will of checkpoint inhibitors for renal Kidney Cancer Program, clinical trials evaluating direct- Immunotherapy Institute, further the delivery of high- cell carcinoma and melanoma co-Principal Investigator of acting anti-viral therapy for alongside David McDermott, caliber cancer patient care and has focused on developing the National Cancer Institute, Hepatitis C Virus (HCV) resulting MD, and Jacalyn Rosenblatt, by incorporating targeted “targeted” immunotherapies for the recipient of a Specialized Nezam Afdhal, MD in the cure of many patients David Avigan, MD MD. The Immunotherapy David F. immunotherapy for a growing patients with solid tumors. Programs of Research Excellence with HCV. He continues to be Institutes’ work is already list of cancer diagnoses. grant focusing on kidney cancer, Nezam Afdhal, MD, was a leader in developing global David Avigan, MD, has been making a dramatic impact McDermott, MD Alongside David Avigan, MD, and a Professor of Medicine at on scientific discovery and Dr. McDermott is a nationally Dr. McDermott serves as co- Harvard Medical School. named Chief of the Division of eradication strategies for HCV. appointed Chief of the newly created Division of Hematology advancing patient care with its David F. McDermott, MD, and internationally recognized Director of the Immunotherapy Gastroenterology, Hepatology Dr. McDermott is a Dr. Afdhal has served on and Hematologic Malignancies, hallmark integration of clinical has been named Chief of the medical oncologist, clinical Institute, also a part of the Cancer and Nutrition. He is the demonstrated innovator in his part of the Leon V. & Marilyn and translational research. Division of Medical Oncology researcher, and expert in Center. With Deputy Director, Charlotte and Irving Rabb multiple state, national, and field and will continue to be an L. Rosenberg Clinical Cancer at the Leon V. & Marilyn L. three fields of research and Jacalyn Rosenblatt, MD, they Professor of Medicine at international advisory boards Nationally, Dr. Avigan serves as integral leader in cancer care at Center. Within the Division, Rosenberg Clinical Cancer clinical management: cancer are working on harnessing the Harvard Medical School. His for liver disease. He is also principal investigator and leader BIDMC through his new role. he will lead an accomplished Center at BIDMC. In his new immunotherapy, melanoma, potential of immunotherapy as an editor of the Journal of in a first-of-its-kind national new role is a continuation of group of clinicians and Viral Hepatitis, a member of trial involving 10 leading cancer his 19 years at BIDMC as a researchers, working tirelessly to multiple editorial boards, and centers. The trial is working clinician, researcher, educator, offer the highest level of patient on a cancer vaccine model and mentor within the Division. a reviewer for many major care and seek better treatments developed by Dr. Avigan, in which He succeeds J. Thomas Lamont, journals in gastroenterology as they design personalized patient derived tumor cells are MD, who led the Division for and liver diseases. He is the therapies that improve quality fused with dendritic immune author of more than 250 of life for patients with blood over 20 years and continues cells to form a hybridoma, original manuscripts, reviews, cancers and disorders. to work at BIDMC as Emeritus forming the basis for a patient- and editorials, and his work Chief of the Division. specific vaccine. He was named has been featured in the New Dr. Avigan is an internationally recognized researcher a Game Changer in 2015 by The Dr. Afdhal is a distinguished England Journal of Medicine, for his groundbreaking Boston Globe for this research. clinical leader and for 15 years Hepatology, Gastroenterology, work in developing novel was the Director of Hepatology Dr. Avigan has made an and the Journal of Hepatology, immune therapies based on at BIDMC, where he created ongoing impact in the fields among other leading journals. personalized vaccines and of cancer therapies and both the Liver Center and the In 2016, he delivered a TEDx their advancement into clinical cancer care during his time innovative inpatient Epstein-Trey Talk entitled “25 Years from trials and the clinic. He is a at BIDMC and will continue service to provide specialized Discovery to Cure: The Hepatitis widely published scholar and this work at the cutting edge clinical care to BIDMC patients C Story.” Dr. Afdhal has received his investigations have focused as Division Chief. with liver diseases. Dr. Afdhal numerous awards, including on tumor immunotherapy and was an NIH-funded researcher the American Liver Foundation its incorporation into bone for 20 years, conducting both Award for Excellence, a Fulbright marrow transplantation. His basic and translational research Scholarship, and an Honorary ongoing work is developing a on liver fibrosis, as well as Doctor of Science from the tumor vaccine model in which patients undergo vaccination multiple collaborative NIH- Royal College of Surgeons with dendritic cells fused with funded clinical trials on viral in Ireland. autologous tumor cells resulting hepatitis. His work has resulted

6 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 7 New Leadership (continued) Vice Chair Updates

the biology of dyspnea, and and Nutrition. Her research and Education training for residents interested graduates of the program helped develop and validate clinical interests include innate in improving medicine and have gone on to hold leadership the Multidimensional Dyspnea immunity of the liver and the Eileen Reynolds, MD healthcare delivery through roles in medical education Profile to assess overall gut-liver axis, with investigations Vice Chair for Education innovations in technology, and publish in the medical breathing discomfort and focused on alcoholic hepatitis, business, and health systems. education literature. emotional responses to air non-alcoholic fatty liver disease, C. Christopher Smith, MD The wildly successful Hack-a- hunger. A teacher of physiology and viral hepatitis. She has Associate Vice Chair thon was the first BIG event of Trauma-Informed Care (TIC): and pathophysiology for more received uninterrupted National for Education 2019, an intensive brainstorming The leaders of our Harvard than 20 years at HMS, he is the Institute of Health (NIH) grant event bringing together students student clinical skills curriculum recipient of multiple national support since 1989, including Anjala Tess, MD and residents across the Harvard course are incorporating the teaching awards and the the MERIT Award, and currently Associate Vice Chair principles of TIC into history- author of more than 130 peer- has six NIH grants. She has Medical School network and for Education taking and physical exam skills. reviewed articles. His textbook, published more than 200 peer- MIT to consider novel approaches Students are first taught the Richard Respiratory Physiology: A Gyongyi reviewed journal articles and is care for our residents and to healthcare informed by Clinical Approach, received the Szabo, MD, PhD a fellow of several professional Education has always been one their patients, implementing artificial intelligence. fundamental concepts of TIC via Schwartzstein, MD 2006 Dr. Frank H. Netter Award associations, including the of the many areas in which our resident population health team didactics and online materials, for Special Contributions to Gyongyi Szabo, MD, PhD, American Gastroenterological Department shows innovation, meetings and pre-visit huddles. Live Model Simulations: Over then practice these skills with Richard M. Schwartzstein, MD, Medical Education. Hon. ScD, a highly recognized Association, the American expertise, and passion – work Finally, the project will develop a the past few years, internal observation and coaching by was named Chief of the Division leader in education and the College of Physicians, and that is always at the cutting novel Health Systems Curriculum medicine has seen an increase faculty preceptors. The TIC of Pulmonary, Critical Care and In addition to his clinical field of immunology, was the American Association for edge! The Department’s to train residents in the most in the use of bedside ultrasound curriculum is also being rolled Sleep Medicine. and research activities, appointed Chief Academic the Study of Liver Diseases. educational programs serve imaging to enhance the care out to residents and across the Dr. Schwartzstein assumes this Dr. Schwartzstein has also important domains of Population Officer at BIDMC. In her new Dr. Szabo is a member of the 164 residents, over 100 fellows, Health. The curriculum includes of our patients. While BIDMC department’s non-physician leadership role after 33 years in worked to enhance BIDMC’s Hungarian Academy of Sciences role, Dr. Szabo spearheads and hundreds of medical a comprehensive high value has been teaching and using clinical staff. the Division, including 14 years reputation as a leading center the medical center’s robust and serves on advisory boards students, including over 150 in care component, a broad health ultrasound for years, we as Associate Chief. He succeeds of medical education. Since research and teaching of several federal agencies and Primary Care Innovation Harvard Medical School clinical equity curriculum, and training designed a new ultrasound J. Woodrow Weiss, MD, Professor 2004, he has served as the Vice programs while identifying and leading academic institutions. clerkships annually. Nearly 200 training using live models as Laboratory: The primary care of Medicine at Harvard Medical President for Education and supporting a broad range of She served as President of on physician wellness. of our faculty members teach in part of our academic half day program and our clinical practice School, who was appointed Executive Director of the Shapiro basic, translational, and clinical the American Association for undergraduate HMS courses, Resident as Leader Curriculum: leadership have created an Chief of the Division in 1999. Institute for Medical Education. research priorities. Succeeding the Study of Liver Diseases in curriculum. During each four- Clinical leadership is essential to innovation lab for residents who Dr. Schwartzstein earned his The Shapiro Institute develops Interim CAO Jeffrey Saffitz, 2015 and she is the inaugural and both our clinical clerkships hour session, residents rotate post-graduate medical training, are members of the primary care medical degree from HMS talent among clinician- MD, her work will further Editor-in-Chief of Hepatology and clinical are award-winning. through five different stations, track. This novel program aims and trained at what was then educators through its Rabkin BIDMC’s considerable scientific, Communications. yet skills for clinical leaders utilizing ultrasounds to evaluate Each year, we engage in many to use our primary care annual Beth Israel Hospital, ultimately Fellowships and has provided research, and education have historically been taught live models. With expert faculty new education projects. Below, serving as chief medical a model for the Academies of curricula. BIDMC currently Dr. Szabo will further our top- through an apprenticeship guidance, each resident has operating plan to train residents resident. He completed his Medical Education at medical tier research and educational has more than 2,500 clinical we’ve highlighted just a few of model, resulting in variable ample time to practice obtaining in health systems research, training in the then-combined schools and other hospitals programs, fostering our work research studies underway the most exciting new ideas and resident readiness to lead teams. different ultrasound views, primary care innovation, program between the Brigham nationally and internationally. with her exemplary expertise. and trains more than 650 educational enhancements that To address this training gap, including basic echocardiogram, and quality improvement, by and Women’s and Beth Israel Dr. Schwartzstein’s education residents and fellows annually. are underway: the residency program combining education and Hospitals in Pulmonary and research focuses on the pleural ultrasound, and Dr. Szabo’s priorities include implemented a longitudinal practice operations into an Critical Care Medicine. Prior development of pedagogical AMA Residency Innovation abdominal ultrasound. exploring new opportunities Resident-as-Leader curriculum interdependent and mutually to the official recognition approaches to enhance Grant: With the support of and building partnerships to for rising PGY2 residents and The BIDMC Clinician Educator beneficial team that produces of the discipline known as analytical reasoning, techniques serve the academic community, this grant, the educational is developing a novel, validated, Track for Fellows: This is the better care for patients, better Emergency Medicine, Dr. to maximize the benefits of enhancing the depth of leadership team for ambulatory direct observation-of-leadership first focused education track for training for residents, and Schwartzstein directed the small group teaching, and translational and clinical training is transforming the way emergency department at the assessment of the role of instrument. Direct observations internal medicine fellows in the sustainability to our large sciences, supporting faculty ambulatory training is designed former Beth Israel Hospital, simulation in medical education. of residents following curricular nation. Recognizing the unique academic primary care practice. development, and broadening and implemented, moving our ultimately transforming it into For nine years, Dr. Schwartzstein intervention have revealed a challenges in subspecialty Over the past year, with the educational opportunities. residents toward a population a division of the Department of directed the Academy at significant increase in clinical education, our program support of the laboratory practice health strategy. The project will Medicine before it became an HMS and led the steering An accomplished researcher, leadership skills and reduced combines a longitudinal didactic and mentorship from local develop a novel educational independent department. committee for the medical Dr. Szabo continues her own performance variation curriculum, mentored research in experts, residents developed school’s new curriculum, which and clinical dashboard to track work in the Department of across residents. medical education, and teaching an innovative transitional care As a clinician-researcher, was implemented in 2015. Medicine within the Division of the impact of their innovations Dr. Schwartzstein investigates experiences across the medical management program and Gastroenterology, Hepatology, and also measure the health BI Innovation Group (BIG) Hack- center. Participants have come a predictive model for patient of our training program. The a-thon: Developed and led by a from seven different BIDMC retention in primary care. project explores the intersection group of residents, BIG provides subspecialty fellowships, and of education and clinical a community, resources, and 8 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 9 Vice Chair Updates (continued)

Research Quality Career Development Clinical Care Barbara Kahn, MD, MS Mark Aronson, MD and Mentoring in the Community Vice Chair, Research Strategy Vice Chair, Quality Grace Huang, MD Donald Cutlip, MD Peter Weller, MD As Vice Chair for Quality, I’m Vice Chair, Career Development Vice Chair, Clinical Care Vice Chair, Research proud of our Department’s and Mentoring in the Community Quality Improvement and A core component of the Patient Safety program, which As the Vice Chair for Career Our Department has a long Department of Medicine’s is among the most widely Development and Mentoring, history of providing clinical mission is cutting-edge respected in the country. We my goal is to serve the care at the cutting edge. research. Discoveries by have strived to create an professional development needs Traditionally, for our patients our investigators lead to the members in the Department of organization that ensures highly Review Committee. of our faculty as they advance Another avenue for career living in communities outside collaborations with affiliated prevention, cure, and improved Medicine have active grants, reliable care, with follow-up These analyses often lead their careers in cutting-edge development and mentoring at of the Boston area, receiving partners to share resources treatment of human diseases, by which they mentor hundreds on all tests and referrals using to significant changes in how clinical care, education, and BIDMC is The Franklin Epstein these state-of-the-art therapies and manage efficiencies, as well as enhancement of the more trainees and laboratory closed-loop methods. Some we deliver care, and in many research. One way we support Society, led by Dr. Steven required traveling into Boston. we’ve had demonstrated quality of life for those who staff. Our research funding in recent examples of our QI cases, the resident is the key our colleagues is by offering Freedman. As our Research Vice With the growth of our network, successes in shifting cutting live with chronic diseases. the 2018-2019 Fiscal Year was program’s interventions include to enacting the transformation. one on one Harvard Medical Chairs noted in their message, patients’ desire for local edge care to the community. In our roles as Vice Chairs over $180 million, consisting developing systems to reliably Many of our trainees go on School CV consultations, which the Epstein Society supports the care, and limited capacity We’re also working to provide of Research and Research of government, foundation, offer Lung Cancer Screening to leadership positions in nearly 60 faculty members needs of our researchers from at the medical center, we’ve access to the medical center Strategy, we consider it of the corporate, and donor sources. to all appropriate patients healthcare quality, both at in the Department availed their time as residents through undertaken an effort to extend when an even higher level utmost importance to develop (See funding details on page based on their smoking history BIDMC and elsewhere, as a themselves of over the last their mid-career stages. As these higher-level services from of care becomes necessary. and support an outstanding 36). We continue to be one of and age, building medication result of their experiences here. year. Dr. Thomas Lamont, the group continues to grow in our academic medical center Providing the right care at the research program at the the best-funded medical school safety guidance programs into Emeritus Chief of the Division size and scope, Dr. Freedman into the community. forefront of discoveries that departments of medicine in the Another venue for our trainees of Gastroenterology, Hepatology reviews grant applications, right place will improve the Provider Order Entry systems, Extending BIDMC’s medical will further medical care. nation, and BIDMC consistently to learn about optimizing and Nutrition, will also assist co-writes institutional letters health of our overall population tracking all consults for timely care to the community ranks as a national leader medical care is the weekly with CV reviews going forward, of support, and hosts monthly as well as the institutions One way the Department responses, and monitoring involves multiple layers of among independent hospitals Morbidity & Mortality particularly for investigators. seminars that cover a wide engaged in this shared mission. ensures that research continues procedures for safety, collaboration. Many times, we in National Institutes of Health conference run by the Chief range of topics, from mentorship to thrive is through our support complications, and efficacy. This year, we implemented a need to increase treatment funding. The Department of Medical Residents. The M&M to seeking industry support. for young investigators. The revised annual faculty review capabilities in the community Medicine plays a large role For nearly 20 years, all of our conference not only reviews Franklin Epstein Society, directed process, in order to best through physician recruitment. and accounts for nearly 70% medical residents have learned clinical teaching points, but by Dr. Steve Freedman, mentors make use of faculty’s career In other cases, physicians of that funding. the language and methodology also analyzes how care was over 30 young researchers with of analyzing cases from a QI delivered and focuses on conference meetings with their based primarily in the medical active Career Development This year, our faculty published perspective as part of a QI whether we could have Division Chiefs. We also plan to center may need to travel to (K) Awards from the National paradigm-shifting research in rotation. Throughout the QI done better. pilot an electronic version of this the community to provide care Institutes of Health as they the world’s leading scientific rotation, residents participate process going forward. or direct new services. The transition toward Research and medical journals, including Our goal is to make QI and overarching objective is that in all hospital QI conferences Additionally, we instituted Project (RO1) Grants to launch Nature, Science, Cell, Lancet, patient safety integral to all care received in the community and work with their preceptors writing groups for faculty, where their independent academic and the New England Journal of of our residents’ education, is of the same high quality and colleagues on QI projects. colleagues working on similar careers. The Epstein Society not Medicine (see more publications because we believe this is that would be received at the During their rotation, residents paper formats committed to only develops a collaborative on page 37). Our investigators one of the best ways to ensure medical center. By combining perform a root cause analysis meeting regularly to support community of new investigators, also continue to be recognized the care we provide is of the these strategies alongside of an adverse event or medical each other in the process of but also offers institutional for their excellence in research, highest quality. error with guidance from an writing a manuscript from start support and feedback related both via honors and awards expert faculty preceptor and to finish. We’re excited that this to career development in basic, from national organizations, then report their findings to the popular service will continue in translational, clinical, and as well as through elections to Department’s Medical Peer the coming academic year. outcomes research. academic societies such as the American Academy of Arts and In addition to the K-Grant Sciences (see more accolades awardees, nearly 300 faculty on page 18).

10 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 11 Breaking Ground on a Cutting-Edge New Inpatient Building

At a world-class institution like BIDMC, innovation is a constant – be it in a lab, as the building will be energy in a clinic, or at a Grand Rounds lecture. Rarely is the innovation quite so efficient and environmentally Get to Know the conscious, consistent with New Building physical as a ten-story structure, but at last June’s groundbreaking ceremony, BIDMC’s commitment to BIDMC began its latest cutting-edge addition to the medical center. environmental stewardship.

The new building will also That addition will be an innovation in healthcare — for The location will also facilitate rooftop green space and a include a medical helicopter approximately 345,000 square the benefit of our patients, our the sharing of clinical support healing garden for patients, landing pad, relocating from foot inpatient building. The new communities, and our region.” services with existing inpatient families, and caregivers. the current location on the roof space will be a modern, state- programs on West Campus. of the adjacent Rosenberg The building was designed The building design is wired of-the-art environment where Building. Helicopter access is with careful attention to key The facility will include up to 128 for the future, accommodating patients will receive the highest crucial to support BIDMC’s considerations, including single-bedded, family-friendly sophisticated technology, caliber of healthcare. It will be important role as a major Level thoughtful input from patient rooms. An expansion advanced treatments, and the medical center’s first new 1 Trauma Center for our region. physicians, staff, patients, and of single patient rooms will team-based care. Advancing building in 20 years, located on the Longwood area community. replace the double-bedded the cutting-edge work of our the corner of Francis Street and “This new building will rise Their collaboration helped rooms currently on West specialists, the building will have Pilgrim Road on West Campus. from BIDMC’s extraordinary to inform the sophisticated Campus. There will also be 30 surgical suites large enough With cognizance of our role in ability to collaborate and design. “This groundbreaking intensive care unit (ICU) rooms to accommodate the most a rapidly changing healthcare innovate, our research and 10-STORIES LEADING-EDGE SURGICAL CONFERENCE SPACE WITH is the culmination of two years environment, the medical center educational missions and SUITES large enough TECHNOLOGY that fosters of planning and community is developing more resources to our primary commitment to APPROXIMATELY to accommodate the the sharing of innovative engagement,” said Walter meet the needs of our patients “ This new structure will propel BIDMC exceptional, compassionate 345,000 SQUARE FEET most advanced surgical scientific and medical Armstrong, Senior Vice and their communities. care for all,” said Kevin Tabb, procedures and knowledge, modern ENERGY-EFFICIENT AND President Capital Facilities forward in delivering on our commitments MD, President and CEO of imaging technology teaching methods, and ENVIRONMENTALLY “This new building will further and Engineering at BIDMC. to the people and communities we serve.” Beth Israel Lahey Health. multidisciplinary teamwork strengthen our ability to deliver SUSTAINABLE DESIGNS VERSATILE DIAGNOSTIC AND The pillars of the building design the highest quality care to our —Peter Healy, President of BIDMC The competition of construction PROCEDURAL SUITES with A MEDICAL HELICOPTER focus on integration within West UP TO 128 SINGLE-BED, patients and fully support our and opening of the new state-of-the-art equipment LANDING PAD — relocated Campus, incorporating both FAMILY-FRIENDLY committed physicians, nurses, addition are expected in to handle the most acute from its current location on the patient-friendly spaces and PATIENT ROOMS and staff,” said Peter Healy, to facilitate delivery of the advanced surgical procedures 2022. With its development at patient needs roof of the adjacent Rosenberg environmental sustainability. President of BIDMC. “This new highest quality care to patients and imaging technology, as the start of the new decade, Building — to support BIDMC’s The building will connect to 30 INTENSIVE CARE UNIT structure will propel Beth Israel in critical condition. To make the well as versatile diagnostic and BIDMC is positioning itself for AN ACCESSIBLE, ROOFTOP important role as a major Level 1 the Rosenberg Building and (ICU) ROOMS Deaconess Medical Center new building a comprehensive procedural suites with state-of- continued success as a leader GREEN SPACE AND HEALING Trauma Center for our region the Farr Building Bridge at forward in delivering on our patient space, the design the-art equipment to handle in patient care. GARDEN for patients, families multiple locations to facilitate commitments to the people and expanded past the hospital the most acute patient needs. and caregivers access for patients, families, communities we serve. We are room and up to the roof, where The same attention has been and caregivers. proud to be at the forefront of there will be an accessible paid to the role of sustainability,

12 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 13 BILH by the numbers

to transform health care in bring a broad range of new HOSPITALS, INCLUDING… Massachusetts into what we health care services to the City 13 Coming Together know it can and should be.” of Quincy. The new initiative ACADEMIC AND TEACHING HOSPITALS provides highly-specialized and 4 “We believe everyone should with Harvard Medical School and Tufts University nationally-recognized models have access to high-quality, School of Medicine Affiliations as a New System of orthopedic care developed affordable care, whether by New England Baptist they live on Cape Cod, the 8 COMMUNITY HOSPITALS Hospital to the community North Shore or somewhere in On March 1st, 2019, BIDMC and the Department of Medicine became part of hospitals in Newburyport and SPECIALTY HOSPITALS for orthopedics and between,” he added. “Through Beth Israel Lahey Health (BILH) – a new healthcare system that brings Beverly. In December, Anna behavioral health local and system partnerships, together academic medical centers and teaching, community, and specialty Jaques Hospital and Beverly C OMPREHENSIVE AMBULATORY as well as the enthusiasm and Hospital began offering the AND URGENT CARE CENTERS hospitals in a shared mission to expand access to exceptional healthcare for talent of all our employees and New England Baptist Hospital providers, we will invest in and more than 1.3 million people in Eastern Massachusetts. model of care for inpatient strengthen community-based joint replacement surgery PHYSICIANS, INCLUDING… care, informed by innovation on the hip and knee, as well 4,300 and discovery.” As part of BILH, BIDMC joined a population health enterprise, through affiliates in Eastern Hospital, Signature Healthcare, as spine surgery. 800 PRIMARY CARE PHYSICIANS colleagues from Addison Gilbert working to strengthen both Massachusetts, which include Southern New Hampshire BILH’s leadership team has In 2018, after the definitive Hospital, Anna Jaques Hospital, quality of care and patient Atrius Health, the Cambridge Medical Center, and St. shaped the legacies of its 3,500 SPECIALISTS agreement was signed and Beth Israel Deaconess Hospital— health outcomes, as well as Health Alliance, the Community Joseph Hospital. member organizations. This the various member hospitals Milton, Beth Israel Deaconess addressing health disparities Care Alliance (Bowdoin Street team includes Gyongyi Szabo, “With the creation of Beth began preparations to form Hospital—Needham, Beth Israel and public health issues. Within Health Center, Charles River MD, PhD, Hon. ScD, Chief NURSES Israel Lahey Health, we have the new system, Massachusetts Deaconess Hospital—Plymouth, the new system, patients have Community Health, and The Academic Officer of BIDMC 9,000 an unprecedented opportunity Attorney General Maura Beverly Hospital, Lahey Hospital access to more than 800 Dimock Center), Fenway Health, and BILH, who began to care for our patients and Healey imposed a number of & Medical Center, Lahey primary care doctors and 3,500 Outer Cape Health Services, her new role in July of 2019. our communities in new and conditions before approving the Medical Center—Peabody, specialty physicians. Notably, South Cove Community Health Dr. Szabo is a member of the EMPLOYEES better ways,” said Kevin Tabb, creation of BILH. Now, a year Mount Auburn Hospital, New patients are increasingly able Center, HCA Parkland Medical Division of Gastroenterology, MD, President and CEO of into the merger, the first report 35,000+ England Baptist Hospital, and to see their care teams closer to Center, HCA Portsmouth Hepatology and Nutrition within Beth Israel Lahey Health, on on those conditions found that Winchester Hospital to form their homes and communities. Regional Hospital, Hebrew the Department of Medicine, March 1st, 2019, the day the new BILH is meeting every imposed PEOPLE CARED FOR the new system. Combined, SeniorLife, Joslin Diabetes as well as an accomplished Additionally, BILH facilitates system launched. “This is just standard, including reaching 1.3 MILLION+ these institutions include four Center, King Edward Memorial physician, scientist and mentor. access to community healthcare the beginning of our journey out to low-income patients and academic and teaching hospitals Hospital, Lawrence General (Read more about Dr. Szabo expanding the availability affiliated with Harvard Medical and the Department’s other of mental health care. School and Tufts University new leaders on page 8). School of Medicine. In a recent interview with the Over the last year, the new “With the creation of Beth Israel Lahey Health, we have Boston Globe, Dr. Tabb reflected Alongside BILH’s 13 hospitals system has begun to implement The Beth Israel Lahey Health logo on the last year’s progress. “We and numerous affiliates, an unprecedented opportunity to care for our patients some of the many plans to represents the three core elements said we were going to do a BIDMC and the Department provide high-quality, affordable of our vision. and our communities in new and better ways.” whole host of things, and we’re of Medicine are committed to care to patients across doing them. We’re moving • Care delivery the idea that everyone deserves —Kevin Tabb, MD, President and CEO of Beth Israel Lahey Health Massachusetts. In October, • Education/ pretty quickly.” high quality healthcare. BILH is BILH announced plans to • Integration discovery

14 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 15 Mark Andermann, PhD Andermann and his team insular cortex appears to lab at BIDMC studies how the with food or water, thus making have developed a mouse simulate a future sated state for brain senses the body’s energy eating and drinking more or model within the Department a few seconds, before returning stores and subsequently uses less rewarding. of Medicine’s Division of to the activity pattern related that information to stimulate “If successful, our approach Endocrinology, Diabetes and to hunger. These findings hunger and compel one to eat. might provide an intervention Metabolism that involves represent initial steps towards The neural circuits involved in that could reduce seeking of monitoring the activity of understanding the neural basis those processes interface with unhealthy rewards—processed hundreds of individual brain of interoception, which could the same neural circuits and A Pioneer foods, drug abuse—without cells in the insular cortex. This allow future research to address processes that Andermann affecting seeking other, model aims to determine key questions for a host of investigates. healthier rewards,” Andermann exactly what is happening in medical issues, including eating of Perception Currently, Andermann’s lab is explains. “This research could the brain when a hungry animal disorders, drug addiction, and working to directly manipulate ultimately provide a roadmap is eating a meal and feeling obesity. Their findings provided specific patterns of activity in to regulate human interoceptive A principal investigator in the increasingly full. direct support for human the insular cortex. They are awareness and predictions Division of Endocrinology, Diabetes studies that hypothesized the In a January 2020 paper in attempting to change the across a range of medical and insular cortex is involved in and Metabolism and an Associate Neuron, Andermann and brain’s simulation of a future psychiatric diseases.” imagining or predicting how we colleagues demonstrated sated state when presented Professor of Medicine at Harvard will feel after eating or drinking. Medical School, Mark Andermann, how the insular cortex region of the brain orchestrates the “Dr. Andermann is developing PhD, is supported by an NIH interpretation of and reaction to unparalleled, technologically- Director’s Pioneer Grant as his signals received from the body. advanced approaches for lab seeks to understand how the The study observed that when understanding how the brain needs of the body are sensed, mice were not fed for many receives and processes signals hours, the activity pattern from inside the body. This learned, and remembered. Anna Olivella by Photo of insular cortex neurons award provides the means to

“At any given moment, our focus away from external stimuli body signals,” Andermann of four awards introduced brains must choose to pay and turn it inward, becoming says. “We know even less about by the NIH’s High-Risk, High- attention to the world around aware of any number of salient the precise brain circuits that Reward Research program “ At any given moment, our us, or to the world inside us.” signals from our bodies—a underlie this awareness.” to fund highly innovative and headache, a stomach cramp— unusually impactful biomedical brains must choose to pay This is a fact that Dr. Mark In the flurry of daily activity through a process called or behavioral research Andermann knows well. As within Andermann’s lab, interoceptive awareness. proposed by extraordinarily attention to the world around he describes that inner world, researchers are working creative scientists. laboratory activity hums around Interoception is how we are to unravel those intricate us, or to the world inside us.” him. A mouse moves within the able to tell when we crave a processes. Andermann, a neuroscientist —Mark Andermann, PhD confines of a massive meal, need a glass of water, by training, was also a past In 2019, Andermann received microscope, so large it fills or are sated of hunger and recipient of another NIH High- a 2019 National Institutes the entire room. The scope’s thirst. For researchers, pivotal Risk, High-Reward Research of Health (NIH) Director’s screens light up with movies of understanding of precisely program honor: the New reflected current levels of greatly expand efforts in this Pioneer Award. The NIH hundreds of individual cells in how the brain can estimate Innovator Award for outstanding hunger. Once they did eat, important, unmet research Director’s Pioneer Award the mouse’s brain, each flashing our body’s state and react young investigators. this pattern shifted gradually area,” says Bradford Lowell, challenges investigators at all as it becomes active. In this accordingly remains elusive. over hours to reflect satiety. MD, PhD, a member of the career levels to pursue new With the support of the Pioneer given moment, choosing to pay Division of Endocrinology, “Despite the broad relevance research directions and Award, Andermann and When mice saw visual attention to the world around us Diabetes and Metabolism and of interoceptive awareness to develop groundbreaking, his team will continue their clues predicting impending provides a peak into the world a Professor of Medicine at HMS. both medicine and psychiatry, high-impact approaches to research to further investigate availability of food—not unlike inside of something else. we know shockingly little about a broad area of biomedical, the role of the brain’s insular a hungry human seeing a sign Andermann and Lowell are Each time someone asks how the conditions that regulate behavioral, or social science. cortex in interoception. for a nearby restaurant—the frequent collaborators; Lowell’s we’re feeling, we direct our our awareness of different The Pioneer Award is one

16 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 17 Awards & Honors

Each year, BIDMC and members of the Department of Medicine earn many local, national, and international awards for their cutting-edge work. This is a sampling of honors received during the 2018-2019 Academic Year.

BIDMC CARDIOVASCULAR MEDICINE GASTROENTEROLOGY, GERONTOLOGY NEPHROLOGY GENETICS HEPATOLOGY AND NUTRITION Named LGBTQ Healthcare Equality Lorraine Britting, NP, received the 2019 Douglas P. Kiel, MD, received the 2019 Samir Parikh, MD, received the 2019 Kevin Haigis, PhD, received the Leader by the Human Rights Campaign Society of Hospital Medicine’s Award Joe Feuerstein, MD, was named a 2019 Frederick C. Bartter Award from the Donald W. Seldin Young Investigator Award, Grand Challenge Award from Foundation for the ninth consecutive year. for Excellence for Nurse Practitioners/ Rising Healthcare Leader in Inflammatory American Society for Bone and Mineral from the American Society of Nephrology Cancer Research UK. Bowel Disease, awarded by the Crohn’s Recognized by Boston Magazine, which Physician Assistants. Research, which is given annually to and American Heart Association. and Colitis Foundation to rising leaders in SIGNAL TRANSDUCTION named 190 physicians and surgeons from Robert Gerszten, MD, received the 2019 a Society member in recognition of Samir Parikh, MD, received the 2018 Sir 45 medical specialties affiliated with the field of Inflammatory Bowel Disease. William Silen Lifetime Achievement Award, outstanding clinical investigation in William Osler Young Investigator Award Alex Toker, PhD, received the 2018 BIDMC in its “Top Doctors” guide. part of the Excellence in Mentoring Awards Sarah Flier, MD, received the 2019 Irving disorders of bone and mineral metabolism. from the Interurban Clinical Club. Mentoring Award from the Biological M. London Teaching Award from Harvard and Biomedical Sciences PhD Progra given by Harvard Medical School. Lewis A. Lipsitz, MD, received the Martha Pavlakis, MD, was named a Medical School. at Harvard Medical School. Kimberly Guibone, NP, received the 2018 Donald P. Kent Award from the 2019 Honoree by the National Kidney Yury Popov, MD, PhD, received the July Gerontological Society of America American College of Cardiology’s Proctor Foundation. TRANSLATION RESEARCH Harvey, MD Young Teacher Award. 2018 Award for Excellence in GI Research (GSA), which is given annually to a GSA AND TECHNOLOGY INNOVATION from the Irving W. and Charlotte F. Rabb member who best exemplifies the highest PULMONARY, CRITICAL CARE & SLEEP MEDICINE Anna Johansson, PhD, serves as the local ENDOCRINOLOGY, Foundation. standards for professional leadership in co-PI for the BRIM (Bias Reduction in DIABETES AND METABOLISM gerontology through teaching, service, Margaret M. Hayes, MD, received the Internal medicine) initiative, a multi-center Barbara B. Kahn, MD, received the GENERAL MEDICINE and interpretation of gerontology 2019 Young Mentor Award at Harvard study, NIH funded study led by investigators Federation of American Societies for Mark Aronson, MD, received the 2019 to the larger society. Medical School. at the University of Wisconsin-Madison that Experimental Biology (FASEB) 2019 William Silen Lifetime Achievement Award, Susan L. Mitchell, MD, received the 2019 Richard M. Schwartzstein, MD, received seeks to evaluate the impact of a pro- Excellence in Science Award. part of the Excellence in Mentoring Awards A. Clifford Barger Excellence in Mentoring the 2019 Outstanding Educator Award diversity intervention designed to address given by Harvard Medical School. Barbara B. Kahn, MD, was elected to Award, part of the Excellence in Mentoring from the American Thoracic Society. implicit bias and involves teaching faculty Emmanuel Awards given by Harvard Medical School. the American Academy of Arts and Richard M. Schwartzstein, MD, Jeremy B. workshops to recognize and mitigate the Mensah, MD, Sciences in April 2019. Richards MD, Asha Anandaiah MD, Amy effects of stereotypes and unconscious bias. MBA, was MEDICAL ONCOLOGY Sullivan EdD, and Margaret M. Hayes MD, Cami Martin, MD, was selected to a recognized as a Deepa received the 2019 Innovation in Fellowship 3-year term to serve on the faculty group 2019 40 Under Rangachari, MD, Education Award for Teaching from the for the American Academy of Pediatrics/ 40 Leader in was named to American Thoracic Society. Section on Neonatal-Perinatal Medicine Minority Health the American fellows symposium in Perinatal and by the National Society of Clinical RHEUMATOLOGY Developmental Medicine. Minority Quality Oncology (ASCO) George Tsokos, MD, was named a Forum. Education 2019 Top-Ranked Expert in Systemic CENTER FOR VIROLOGY Scholars AND VACCINE RESEARCH Lupus Erythematosus Worldwide by Program. Expertscape.com. Dan Barouch, MD, PhD, received the 2019 award for Best Academic Research CLINICAL INFORMATICS Team and The Vaccine Industry Excellence Alexa T. McCray, PhD, was named the Award at the World Vaccine Congress. Chair of the Board on Research Data and Information by The National Academies of Sciences, Engineering, and Medicine. Yuri Quintana, PhD, was elected to the position of Fellow of the American College of Medical Informatics (ACMI) by the American Medical Informatics Society (AMIA). 18 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 19 Clinical Volume at the Cutting Edge

Department of Medicine Clinical Volume at BIDMC’s Boston Hub

Clinical revenue...... $75,445,483

Patient days in hospital...... 117,793

Inpatient discharges...... 17,204

Observation discharges...... 3,212

Work RVUs...... 1,099,937

Outpatient visits...... 318,456

Endoscopic procedures...... 26,629

Cardiac catheterizations...... 4,837

Electrophysiology procedures...... 1,285

Patients in BIDMC’s Boston-based Healthcare Associates primary care practice...... 40,774

20 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 21 The Gage episode represented Adam Rodman, MD a turning point for the podcast, not only in terms of listenership, but when it began its metamorphosis into something more than it was, just as Rodman himself was growing Taking Bedside Rounds as a physician and medical educator. Still telling historical stories, Bedside Rounds now Anywhere and Everywhere also considers the intellectual, social, and cultural currents that shape modern medicine. On his internationally streamed and critically acclaimed Bedside Rounds podcast, hospitalist Adam Rodman, MD, guides listeners through the weird, “For me, it’s all about science and humanity,” Rodman says. wonderful, and human stories that shape modern medicine. “I was inspired to start digging deeper into the why of some of the things we’re trained to do world of medicine. Eventually, in Medicine, then to stay on as he’d learned about Gage in as physicians. I think a lot about what he now jokingly describes a hospitalist. As he began this medical school was a lie. humanism and its connection as a delusion of grandeur, he new endeavor, he faced the “His personality didn’t totally to the complexity of the decided to create his own. decision of either abandoning change!” Rodman explains. “A relationship between doctors the project or incorporating it What began as a side project lot of things were exaggerated and patients.” into his practice and career. amidst the bedlam of resident by doctors at the time to fit in Luckily for his listeners, he chose Bedside Rounds is also no schedules has grown into an a narrative about his case.” to continue. longer Rodman’s hobby, but an how medicine came to be this the patient, but privately think that the actual human body integral part of Rodman’s This revelation helped integral part of his work as a complicated system, but of the something along the lines of, temperature could be in the 97- career; he now records live One of the show’s pivotal shape the course of Bedside medical educator. It’s become decisions that got us where we well, that’s not how it works. As 98 range. Then we have some episodes at the American episodes recounts the story Rounds’ future. an extension of the teaching are, and how looking back to he began to research his reply, really cool data from vaccine College of Physicians (ACP) of Phineas Gage, the famous that he conducts on the wards, connect with our roots can help however, he stumbled into trials in the 1980s and 1990s that annual meetings, nearly 20 19th century American “It was when the podcast in the simulation lab, and in us find opportunities to connect another one of his surprising confirm a fever might actually be colleagues serve on editorial railroad construction worker became more than me the classroom. Though he still with our patients in the present.” discoveries. as low as 99.1 degrees, and 99.9 and review boards, and the ACP who improbably survived an exploring an idea or a records episodes at home, degrees is definitely a fever.” provides Continuing Medical accident in which a large iron historical case, but truly telling sitting under a duvet to create a Rodman cites an example Amidst German manuscripts Education (CME) credit for rod was driven completely a story,” Rodman says. “And soundproof miniature studio, his of a listener question that from the 1850s, Rodman This one moment gets right at listening to the podcast. through his head, destroying acknowledging the larger voice now reaches a massive changed one of his long- found that a large dataset the heart of Bedside Rounds: much of his brain’s left frontal humanistic, important points held perspectives, both when from that era was the basis how Rodman’s own natural The early Bedside Rounds number of physicians, medical lobe. The injury was reported to these stories.” evaluating patients and for determining that the curiosity has led him to new episodes function as extensions students, and curious civilians. to affect his personality and teaching medical students and average human temperature knowledge that not just of Rodman’s personal As the podcast began to behavior over the remaining When asked why Bedside residents. Someone inquired is 98.6 degrees Fahrenheit and improves his own practice as reading, capturing snippets deliberately engage with 12 years of his life to the point Rounds resonates with such about a patient presenting with that 100 degrees Fahrenheit a hospitalist, but also the of his rare free time and bigger ideas behind the As a medical resident in Oregon that he was considered a totally a large and diverse group of a temperature of 99.1 degrees constitutes a fever. medical education of his covering topics from the narratives it shared, listeners in 2014, Dr. Adam Rodman different person. listeners, Rodman turns both Fahrenheit and claiming they students and every listener who death of the Roman Emperor also began to engage “How did they analyze that? listened to science podcasts humble and contemplative. “run low” and thus have a fever. tunes in. By his own hand, his Hadrian to the creation After visiting Gage’s skull at exponentially. Rodman Statistics didn’t exist yet, but like Radiolab and 99% Invisible The listener was curious: “Are wish as a resident for a truly of the smallpox vaccine. Harvard Medical School’s recalls the Gage episode “I think people see this complex, that’s where we determined on his bike ride to the hospital these patients telling the truth? excellent medical podcast Warren Anatomical Museum as the moment where his occasionally alienating system those numbers,” Rodman says and wished there was also a After his residency, Rodman Are they crazy? Am I crazy?” came to fruition. and digging into primary and core listenership expanded— of medicine and they wonder animatedly. “Once statistics compelling, medical podcast— joined BIDMC, first to complete secondary literature about the from several hundred why we do things the way we Initially, Rodman thought his do exist and people start to something that mirrored his a Global Health Fellowship case, Rodman had a startling downloads per episode to do,” he says. “So the podcast response would be to comfort do studies on soldiers, we see own intense curiosity about the in the Division of General realization: almost everything approximately 30,000. is an exploration, not only of

22 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 23 What Does Education Mean to You?

by implementing innovative GENERAL MEDICINE programs like the new Leading Minds: medical education research “ E ducation is all about helping people find their lab, and working with faculty to empower them to pursue passion and making them the best they can be Education at Harvard Medical School education as a career path. at what they love to do.”

In 2011, a major HMS curricular —Sara Fazio, MD Chair of the Principal Clinical Experience Committee “ There’s this famous expression, ‘a curriculum is the manifestation of the soul of an institution’ and reform to improve first- year classroom learning Advisory Dean and Director of the Cannon Society at HMS I believe that’s true of BIDMC. There is something special here about the openness to innovation began under the direction of Associate Director of Education, HMS Center for Primary Care and to creating new things. There is an agility and a nimbleness to BIDMC that is unique.” Schwartzstein and Melanie — David Roberts, MD Hoenig, MD, who co-chaired the steering committee On any given day in the Longwood Medical Area, educational leaders at BIDMC are engaged working on this aspect of the new curriculum. with their students and ever-considering how to best provide the highest caliber of education. HMS NEPHROLOGY students are learning from leaders in numerous specialties, many of whom completed their own “This was a team effort from the educators. There were no top- “ E ducation is what we’re going to learn training at the medical center. The prevailing focus on education at BIDMC has created a strong down mandates about changes together, because I have context but I want culture, built for the students by the faculty and enriched by the work of all. and we had buy-in from all to promote the learner’s interest. My job is the education stakeholders,” said Hoenig. She is a devoted to lay the foundation and spark interest and “The department is continuously of the numerous educational course, students receive year two as they come onto educator who serves as the hopefully magic will follow.” evolving because we value roles she would later hold, training in quality improvement the wards, in her capacity as course director for Homeostasis —Melanie Hoenig, MD education as an activity,” the commitment to education with a later focus on data Associate Site Core I Medicine 2, a required course in the Course Director, Homeostasis II said Anjala Tess, MD. “People at BIDMC turned out to be analysis for research and Clerkship Director. pre-clerkship curriculum that give faculty opportunity and more true than she could implementation science, and integrates the physiology and “The most rewarding thing is guidance in their work and even have imagined. research opportunities at sites pathophysiology of the renal, to see them actively care for if they don’t know the answers, such as Ariadne, Dana Farber, endocrine and gastrointestinal While holding numerous patients and discuss cases that they will help you learn them and Atrius. systems. She also trains PULMONARY, CRITICAL CARE leadership roles, she teaches I know they wouldn’t have been yourself. Some places can residents and Nephrology SLEEP AND MEDICINE students of all levels from Anita Vanka, MD, also a able to a year ago. It’s really have a culture of ‘no’ around fellows and has established medical school up to fellowship. graduate of the residency special and wonderful to see new ideas. Ours is a culture of a program with Brigham This spring, she and co-director program, now leads students that growth,” said Vanka. ‘sounds cool, how?’” and Women’s Hospital for “ E ducation is enhancing curiosity, building on Jennifer Stevens, MD, launched from the very beginning of their Richard Schwartzstein, MD, undergraduate students to curiosity, and supporting it wherever you can When applying for residency the Advanced Integrated time at HMS, as Co-Director leads education at BIDMC give them a taste of kidney find it in your learner.” in 1997, Tess knew already that Science Course on Health of the Practice of Medicine and HMS in countless ways: in medicine and research. she wanted to be a medical Systems Science. Designed with course, the longest class in — Richard Schwartzstein, MD his 25 years of teaching in the educator and chose BIDMC input from students, fellows, the first-year curriculum. In 2015, HMS implemented the Vice President for Education and Executive Director pre-clerkship curriculum, as the intentionally, as it was the and faculty, the QI course is After teaching foundational new curriculum for the pre- of the Carl J. Shapiro Institute for Education and Research at BIDMC Director of the Shapiro Institute only place discussing training the first of its kind for medical clinical skills in year one, she clerkship year. The new format Director of Education Scholarship at HMS for Education and Research, residents in education. Unaware students at HMS. In the 4-week works with students again in utilizes a technique called Case- Chief of Pulmonary, Critical Care and Sleep Medicine

24 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 25 What Does Education Mean to You?

Based Collaborative Learning Los Angeles to help adapt BIDMC remain strong as many GENERAL MEDICINE, (CBCL), which fuses case- similar reforms. of the educators who teach in or SECTION OF HOSPITAL MEDICINE based, problem-based, and “I’ve found that as an educator, contribute to External Education After many years of leading team-based learning. programs and content are education at BIDMC, Both it’s the students that keep you “Education gives the rest of my work meaning. often Department of Medicine “We didn’t just implement a David Roberts, MD, and Sara going. They push the limits of your physicians. Education forges relationships different from new curriculum. We got a grant Fazio, MD, have moved into patient care in an equally rewarding way.” from the university and studied new roles at HMS. Following knowledge and make you want to As these endeavors elevate it. We found that the learning 16 years as the ambulatory learn more and teach better.” and enrich the culture of —Anjala Tess, MD environment was significantly clerkship director and education, there is a prevailing Associate Vice Chair for Education better,” said Schwartzstein. subsequently overall Director —Sara Fazio, MD drive to keep BIDMC at the Program Co-Director for the HMS CRICO Fellowship in Patient Safety and Quality of the Core Internal Medicine forefront of education and to Ahead of implementation, Program Director for the Masters in Healthcare Quality and Clerkship at BIDMC, Fazio found Drawing from her clinical an array of learners, using new make the necessary shifts to Schwartzstein’s physiology Safety at HMS a true passion in early medical experience, she has already technology and techniques. In meet their learners’ needs and course piloted CBCL and education. She now serves as developed a model for a four- six years, it has established a prepare them for a changing showed that students who the Advisory Dean and Director year primary care curriculum, wide range of programs that professional and societal PULMONARY, CRITICAL had struggled in prior courses of the Cannon Society, and designed to ensure all students run on every continent except landscape. Medical education is CARE AND SLEEP MEDICINE performed better in CBCL than Chair of the Principal Clinical have a strong foundation in the Antarctica and are teaching changing. The role of physicians in the “standard” problem Experience Committee, where primary care competencies. As online, in person, and in a is changing. Teaching with that based learning tutorials. The “Education means creating a system where she oversees the core clinical an Advisory Dean, she mentors hybrid fashion across the world. in mind involves both educating new system emphasizes pre- anyone can learn whatever they want to learn, curriculum at HMS. and engages with HMS students the educator and listening to class preparation and fosters “We built our online learning daily and throughout their the students. however they want to learn it, whenever they a learning environment in She is currently shepherding the platform for incoming medical four years. want to learn it.” which students are pushed to next wave of change at HMS students and then when “We have to get away from think critically and apply their for the students’ core clinical “I’ve found that as an educator, we opened it up to public a mode of teaching that —David Roberts, MD knowledge to solve problems. year, examining the clerkships it’s the students that keep you applications, we had interest emphasizes, ‘this is what’s in my Dean for External Education at HMS which have not undergone going. They push the limits of from lots and lots of people and head and my job is to put it in “We are trying to create such a reform in decades. For your knowledge and make you companies like Novartis, and your head,” said Schwartzstein. life-long learners and that HMS students, BIDMC is the want to learn more and teach Google. If you had told me five “We are helping the students doesn’t mean we have to primary clinical site where all better. The students benefit from years ago that we would be develop their thinking skills. The cover everything, because the clinical work during the first two this environment of collegiality, running programs in Malaysia, biggest thing is empowering GENERAL MEDICINE, goal is creating learners who years of medical school occurs. passion, and drive, but we Mongolia, Egypt, London, learners to think through SECTION OF HOSPITAL MEDICINE are curious and constantly Given Fazio’s experience as an benefit from it too. We benefit Dubai, Shanghai, and so on, I problems, to develop deeper assessing their own knowledge. educator and a former BIDMC tremendously,” said Fazio. would have been surprised,” understanding.” Each learner has a responsibility “Education is a dynamic pipeline. Our learners resident and chief resident, she said Roberts. for fueling their own fire to “We’re constantly adapting is uniquely insightful and well- After many years as the continually teach us and make us grow as learn,” said Hoenig. the curriculum to fit the themes positioned to apply her extensive Principal Clinical Experience The essence of his role is educators, just as much as we are hopefully Director overseeing all the creating things that did not exist that are happening, not just in The curriculum came to fruition in knowledge to change the way teaching them and helping them grow into the clerkships, Roberts is now the before. No other medical school medicine but culturally,” said 2019 as HMS graduated the first that students learn during this Inaugural Dean for External is teaching executive education Vanka. “And our students are professionals they aspire to be.” class of the new model’s learners. pivotal year, providing more Education at HMS. In 2014, the programs and at this point, no driving it too. Any time you Following implementation at authentic roles in patient care —Anit a Vanka, MD Office for External Education other medical school is creating have your learners driving HMS, Schwartzstein advised and a system to improve Site Co-Director of Practice of Medicine Course at BIDMC was founded to create extensive online learning for change, you are always on schools in London, Miami, and competency-based assessment. Co-Director of the Practice of Medicine Course at HMS innovative programs that reach future physicians. Roberts’ ties to the cutting edge.” Associate Director of the Holmes Society at HMS Associate Core I Site Director at BIDMC

26 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 27 everywhere, but if the flashlight of Hemostasis and Thrombosis “Training as a physician-scientist own entity with his own lab. Sol Schulman, MD, PhD is telling you to look at A, B, C, while seeing patients in a is invaluable,” said Schulman. “This award is essentially and D, you can look at those weekly clinic through the “As a doctor, you’re seeing the aiming to tell creative, talented instead of the full 20,000 genes.” Division of Hematology and problems patients are facing people to take a chance,” Oncology. As a non-malignant and understanding what is said Schulman. “I’m excited Schulman graduated in 2012 hematologist with an expert important in a different way. It’s to have this opportunity, and from HMS’ combined MD/PhD focus on bleeding and energizing every time you see I couldn’t do it without my program, a track specifically clotting disorders, he looks at a patient and have to tell them, mentors’ support.” Early Investigator, designed for physicians who molecular genetic sequencing ‘I don’t know what you have,’ to are inclined towards a career Schulman cites Tom Rapoport, of his patients. As a researcher, then go back to the lab and try in academic research. As a PhD, Bruce Furie, MD, Robert he then seeks to identify to figure out why they have this Timely Advances physician-scientist at BIDMC, Flaumenhaft, MD, PhD, and Ken possible pathways for bleeding problem.” Schulman conducts his research Bauer, MD among his mentors further examination. A physician-scientist in the Division of Hemostasis and Thrombosis, Sol Schulman, MD, within the Division He also works as an Instructor of and emphasized how thankful PhD, received a 2019 NIH Director’s Early Independence Award in support of his ongoing Medicine at HMS and is a co- he is to be in an environment director of the HST Hematology with an abundance of selfless research into tissue factor and its contribution to the pathogenesis and inheritance of Course for Spring Semester, a colleagues. broadly defined hemorrhagic and thrombotic diseases. joint Harvard and MIT program “Dr. Schulman is a generational he participated in during his talent in the area of Hemostasis training. He is now educating and Thrombosis,” said Among the dreaded phrases in “I’m a high-risk, high-reward coagulation cascade. The to create systematic genetic future physician-scientists and Flaumenhaft. “His enthusiasm medicine are the words ‘I don’t type of scientist and that historic approach in clotting variation; instead of waiting encouraging them to pursue for science is contagious and he know.’ But to researchers, those approach is designed for the research has focused on the for the rare patient to present careers in Hematology, with is attracting young investigators words can also be a catalyst. grant’s mechanism,” Schulman patient’s plasma. Once blood with a clotting problem, his his own work as an example into our field. It is heartening A way of saying ‘our knowledge says. “If an experiment is most is centrifuged, all the cells go idea is to systematically of what’s possible. Schulman to know that someone with is expanding.’ likely to work—if I’m going to to the bottom and the plasma eliminate the genes one by was recognized with Celgene’s Sol’s talent and thoughtful show that A goes to B and remains on top. As a result, one. This genetic approach Future Leader in Hematology A lack of knowledge is the root personability is carrying on everyone thinks it’s going to when the blood is analyzed, allows Schulman to identify Award and the American of the problem for individuals the important tradition of new pathways that regulate Society of Hematology with rare bleeding disorders, mentorship in the area of the start of blood clotting on Scholar Award. as many will never receive a blood clotting and bleeding.” the surface of the cell. molecular diagnosis. Similarly, While the default pathway for Schulman can quickly point about half of the heritability “I am much more interested “The functional genetic screens physician-scientists is to receive to the impact the NIH award for thrombotic disorders, such we do on the cells are part of a K-grant award and work makes. “The most exciting as pulmonary embolism, in finding something that finding what may be having under a mentor, the NIH award thing about the award is the remains unexplained. Despite an impact on the start of the establishes Schulman as his opportunity to explore more constant progress fueled by is really different and totally blood clotting process,” said ideas, to not have to put some new technologies, there remain Schulman. “The genome is a things away for a year,” he more questions than answers. unexpected.” —Sol Schulman, MD, PhD big place and you can’t look said. “This allows me to build a Dr. Sol Schulman is working bigger team and explore more to change that as the recent of my ideas over the short term, recipient of the NIH Director’s work—then to me that’s not that researchers only study the as well as build towards more Early Independence Award. The interesting. I am much more plasma without any of the long-term projects.” award supports outstanding interested in finding something missing cells, especially the junior scientists with the that is really different and cells that line the blood vessel. intellect, scientific creativity, totally unexpected.” Schulman’s strategy is to look drive, and maturity to flourish at cells in their entirety, with Schulman’s research centers independently, launch their own a focus on the membrane on the role of a protein called research careers, and bypass protein TF that starts the blood tissue factor (TF), which is the the traditional postdoctoral coagulation cascade process. primary initiator of the blood training period track. He utilizes functional genetics

28 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 29 Exceptional Mentorship and Career Development, Supporting Cutting-Edge Research

Through both the Franklin Epstein Society and Harvard Catalyst’s Grant Review and Support Program (GRASP), the Department of Medicine helps young physicians and investigators launch illustrious careers. Steven Freedman, MD, PhD, and Grace Huang, MD, explain how they are leading the way.

Dr. Steven Freedman describes “Such collaboration rarely Harvard Medical School in Medical Education at HMS. mentoring faculty: the Franklin the process of moving from happens anywhere else, (HMS). He also directs BIDMC’s She now serves as Vice Chair Epstein Society, Harvard a mentored research award he notes. “This really makes Pancreas Center and is a for Career Development and Catalyst’s GRASP program, toward independent grants us unique.” worldwide leading expert Mentoring in the Department and career development as akin to swimming through services within the Department. shark-infested waters. Luckily Franklin Epstein Society for young investigators and Co-founded by Mark Zeidel, physician-scientists at BIDMC, “The Franklin Epstein Society has been a MD, Chair of the Department Freedman and Dr. Grace of Medicine and led by Huang have assembled tremendous venue to connect with peers, Freedman, the Epstein Society a mentorship and career supports researchers from development submarine network about research and career residency through their mid- to navigate rough seas. development goals, and gain new friends.” career stages. The Society’s “At some places, a career in — Vaishali Moulton, MD, PhD monthly meetings are well research means that you’re on attended, by junior faculty your own and your lab is siloed. as well as established senior We want to do the opposite,” Both Freedman and Huang’s faculty who stay involved and in pancreatic diseases and of Medicine, Director of Freedman explains. “We want impressive credentials make use their own experiences Cystic Fibrosis. Academic Careers and Faculty to nurture you as much as them uniquely qualified to to provide support and Development, Director of the possible.” Career development guide younger colleagues Huang is a hospitalist by mentorship. Rabkin Fellowship in Medical and successful grant funding through the process of training and an Associate Education, and Co-Director of One of the primary goals of go hand in hand. Freedman advancing their academic Professor of Medicine at HMS. the Academy at BIDMC. the Epstein Society is to assist emphasized why working and research careers. After completing her residency investigators in obtaining a with Huang has not only in internal medicine at BIDMC, Their partnership between Freedman is the Chief of K-Grant from the National been impactful on his goals she went on to participate in research mentorship and the Division of Translational Institutes of Health (NIH). for grant funding, but also both the Rabkin Fellowship in overall career advancement Research within the Department These Mentored Research in making rising stars in the Medical Education at BIDMC led to the development of a of Medicine, as well as a Scientist Career Development Department successful. and the Academy Fellowship three-pronged approach to Professor of Medicine at Awards are an early step on

30 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 31 Current Department of Medicine K Grants the road to a career in clinical research award can transition GRASP relies on three accomplishment. However, or translational research. from the Epstein Society into distinct steps to best prepare other factors contribute to Aarti H. Zhenghui G. Eric A. Osborn, Chen S. Tan, MD Traditionally, approximately Harvard Catalyst’s GRASP investigators’ submission grant success as well – the Asnani, MD Jiang, MD MD, PhD Characterization of 20% of applicants for a K-Grant program, also led by Freedman. materials. First, Freedman reputation of the mentor CYP1 Inhibition as a Adenosine Intravascular Broadly Neutralizing receive the award. As Vaishali leads a three-day workshop— and co-investigators, invited New Therapeutic Deaminase 2 Molecular-structural Antibodies Against GRASP Strategy for Regulates Macro- Imaging of Coronary JC Virus Moulton, MD, PhD, explains, a bootcamp of sorts for presentations, and evidence Freedman developed GRASP Doxorubicin phage Phenotype Stent Pathobiology the Epstein Society is an mid-careers scientists. Then, that the investigator has built Cardiomyopathy and Liver Fibrosis in out of a desire to help Nonalcoholic Fatty important resource for any they begin to shape their on opportunities to innovate colleagues grasp the next Liver Disease young researcher. applications according to an and lead. stage of their careers. A large Elements of Grant Writing guide Pavan K. Bon Q. Trinh, PhD “The Franklin Epstein Society divide exists between the 20% Recognition of one’s unique Stephen P. Jon M. created by Freedman and Bendapudi, MD Juraschek, MD Resch, PhD has been a tremendous venue of applicants who receive a contribution to science through Enhancer RNA- other HMS colleagues. Lastly, The Role of mediated Tumor to connect with peers, network K-Grant and the approximately talks, funding, awards, and Improved Characte- Central Regulation colleagues use month-by- Coagulation Factor rization of Postural of Sodium Appetite Suppressor Gene about research and career 8% of applicants (only .1% on scholarship is the foundation XII in Hemostasis Blood Pressure Via Synergistic Action Expression in Normal month work plans over a five- and Thrombosis and Malignant development goals, and their first attempt) who receive of promotion at HMS, which Change in Older of Raas-sensitive year K-Grant. As he explains Adults Neurons Hematopoiesis gain new friends,” she says. a Research Project Grant (RO1). is important for professional their purpose, Freedman once growth. However, Huang again turns to metaphor. prefers to conceptualize Mark D. “If I asked you to build me career development as Sarah N. Mary B. Rice, MD Sarinnapha Benson, MD Kunz, MD Vasunilashorn, “ I like to focus more broadly a lunar command module, more than achieving the Air Pollution and the The Role of PPM1G in Quantification of Lung in Health and PhD you probably couldn’t do it,” next academic rank. Apolipoprotein E COPD: Obstructive, Neonatal Transport Shared Pathophysio- on what leads to professional Biology and Restrictive and Freedman says. “But if I said, Networks Through logy of Postoperative Atherosclerotic Vascular Pathways “When meeting with Network Analysis: A Delirium and every month: ‘put this screw Cardiovascular vitality, whose pillars are investigators and other faculty New Approach to Alzheimer’s Disease here and next month you’ll add Disease Studying Neonatal in the department, I like to and Related another piece over there,’ the Regionalization Dementias focus more broadly on what mentorship, reputation, module would come together.” leads to professional vitality, Katherine M. Jennifer H. Jennifer P. Rishi K. leadership, and skill-building.” With the work plans, GRASP has whose pillars are mentorship, Berg, MD Lee, MD Stevens, MD Wadhera, MD taken apart the mad dash of reputation, leadership, and skill- Thiamine V Placebo Effects of Palmitic A Multistakeholder Explaining Rising —Steven Freedman, MD, PhD preparing a grant application building,” she says. to Improve Oxygen Acid Esters of Examination of Heart Failure Consumption After Hydroxy Stearic Acids the Drivers and Mortality in Medicare and broken it down into In-hospital Cardiac (Pahsas) on Intestinal Value of Inpatient Huang conducts 1:1 CV methodical, manageable steps. Arrest Mucosal Biology Consultation “It’s a great way to engage R01s are the NIH’s original consultations with faculty in the for the Treatment of with people across divisions, grant mechanism, meant Then, Huang and Freedman Department of Medicine, which Type 2 Diabetes learn about their research, to fund specific projects for collaborate to optimize not only helps them prepare and help one another with independent investigators. Michael W. Ari L. Jordan B. Gloria Y. Yeh, investigators’ curriculum for promotion at HMS but also Donnino, MD Moskowitz, MD Strom, MD MD, MPH ideas, potential research vitae (CVs). allows them to identify short- In the GRASP program, Neuromuscular Thiamine as a Renal Identification of the Mentoring and collaborations, and other and long-term goals. however, the K to RO1 divide Blockade in Protective Agent in Components of Frailty Patient-oriented opportunities. Steve and Grace Career Development Post-cardiac Arrest Septic Shock Using Administrative Research in is almost nonexistent. Twenty are amazing mentors. They and Mentoring Looking down the list of active Data and Metabolite Mind-body Exercise percent of GRASP applicants Profiling have created an incredibly Freedman explains that grant K Grants in the Department, it receive grants on their first energized platform.” applications essentially come immediately becomes clear attempt (Moulton is among down to a simple question: are that Freedman’s and Huang’s The energy of that platform those who made the successful you a productive investigator? support is a key step along Di Feng, PhD Ruvandhi R. Ismail Syed, PhD Rebecca M. continues beyond the length of transition.) The program has the Publications and prior funding the way for nearly every The Interaction Nathavitharana, A Novel Class of Zash, MD a K-Grant. Senior investigators grant application process down Between Mechanical MD, MPH Lipids as Potential Decreasing Adverse demonstrate that investigators scientist at BIDMC. Forces and Optimizing Therapeutic Agents Birth Outcomes seeking their first independent to a science. have a strong track record of Cytoskeletal Diagnostic Strategies to Promote Among Hiv-infected Impairments in for TB Transmission Pancreatic Beta Cell Women on Podocyte Mediated Control in Health- Survival and Prevent Antiretroviral Therapy Kidney Disease care Facilities Type 1 Diabetes

32 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 33 chemotherapy side effects, If almost 100% of our they are a non-governmental assumptions. Governmental we’re talking about the toxicity of increased spending on body. I personally think that payors also have economic prices. We routinely hear stories brand name drugs comes governmental bodies can end incentives. They don’t want to of patients with cancer forgoing from year-on-year increases up in their own odd conflicts of assume a drug that breaks the Cutting-Edge treatment because they don’t that cannot be justified, interest. ICER can say what a budget will work. want to bankrupt their families. is there anything within fair price is, and we’ll talk about It’s very notable what happened the power of providers budget impact, but there’s DK: I’ve heard folks argue that Conversations David Rind, MD Dhruv Kazi, MD with PCSK9, as a preventative and patients to combat no reason for us to say the high drug prices in the US are drug. We know patients are these increases? evidence isn’t very good the result of a broken system. hesitant to take preventive when it is. I disagree. I think high drug treatments already, so when you prices reflect that our system On most Thursday mornings, the Department of Medicine can be found in Sherman Auditorium DK: A big chunk of our give them financial toxicity, they DK: I think ICER is doing a is working exactly as intended. gathering for Medical Grand Rounds, as speakers from BIDMC, Harvard Medical School, and annual increase in spending just won’t take the drug. fantastic job. I do think they’re We value innovation and want other esteemed institutions share their expertise on a range of timely and clinically important comes from year-on-year meeting a key societal need, to reward it, but we’ve lost sight topics. This year, a clear intersection of thought emerged in two lectures. David Rind, MD, the Chief DK: Now more than ever, we price increases on the exact at a time when we don’t of what represents meaningful need to reflect on what our same molecule, which is the appear to have the political innovation. We can argue about Medical Officer of the Institute for Clinical and Economic Review (ICER) spoke on “Medical Value stark healthcare disparities manufacturer saying ‘we know will to make this happen in an pricing and out-of-pocket costs Assessment in the United States,” diving into the complex model of value in healthcare. Additionally, say about the system we’ve you’re on this drug and it’s organized way. ICER provides but we need to go back to first Dhruv Kazi, MD, Director of the Cardiac Critical Care Unit at BIDMC, shared a high-level window created. We’ve got to push working for you, so we’re the information but relies on principles and think about what going to charge you 10% into the world of drug costs entitled “Breakthrough Innovation without Breaking the Bank.” We sat back against lazy arguments other stakeholders to act on this want from our health system in suggesting that regulating drug more.’ Rheumatological information to influence prices. terms of innovation and access. down with them to discuss the challenges of drug pricing and healthcare economics. prices would harm innovation anti-inflammatory drugs have Since our federal and state I think the PCSK9i experience and explore more nuanced had particularly egregious governments are the largest has shown that patients incentive mechanisms that increases in recent years, purchasers of drugs, it would In 2018, you worked together and an uncertainty about their medication. I think the As a society, we’ve created a lot and payors are becoming support innovation but ensure amounting to more than a seem natural for them to be when Dr. Kazi partnered where the price should go. combination of market forces of incentives for developing new increasingly sensitive to drug access. Drug pricing isn’t just doubling of the cost of each involved in negotiating prices. with ICER on a Just in Time Value-based pricing in this rare led to the price decrease, with drugs, but once those drugs prices, and we may finally have an economics issue, it’s a public drug over a decade. Analysis of PCSK9 Inhibitors. circumstance was appealing ICER providing some direction are on the market, consumers an opportunity for structural health issue. Prohibitively high Your joint analysis seems to the manufacturer because for how low the price needed can’t always afford them. Our DR: And ICER did a study where Dr. Rind, you remarked change. The onus will be on us out of pocket costs make no to have led to a significant it gave them a place to put the to go. The experience was analyses need to pay attention you look at MS drugs, and all that drug companies have to maintain this momentum, to clinical, economic, or ethical with market impact as after price. There was a win/win for illustrative that prices can to both total costs and out- the drugs are overpriced, but teams of smart people have the tough conversations sense to me, and yet they’re releasing an analysis that manufacturer and payor. In come down in the right set of of-pocket payments because if you looked 4-5 years back, designed to make pricing about how to best modify our pervasive in our system. prices needed to come down addition, a pricing war drove circumstances. the two don’t always travel they’re all fairly priced. decisions, but they’re tasked system to reflect our societal by 80%, they were quickly down the price. together. Our patients should DR: It’s one thing to use out of with making sure their in- priorities and to advocate for reduced by 60%. What do What areas should cost- not be asking, ‘can I really pocket costs when you have You both mentioned a l house analysis justifies the political reform needed Dhruv Kazi: I like your use of you think made the effective analyses focus afford this drug for the next seven ace inhibitors, the insurer ack of oversight and the cost they’re going to at federal and state levels to ‘rare circumstance.’ It was a difference in this instance? on in the future? 10 years?’ Those conversations has negotiated a great price on organization on the drug charge, not vice versa. ensure equitable access to perfect storm with pressure should be happening at one of them, and a patient likes pricing. In a perfect world, What power can ICER and effective therapies. from ICER and academic a societal level—What kind the ad for a specific one that you where would you hope academic groups exert in David Rind: ICER had groups providing strong DK: Cost-effectiveness of innovation and access make them pay more for. That’s to see that oversight come creating change? been heavily involved in the evidence the drug was analyses have, for the most do we value and do our very different from, ‘This is the from? Which would be PSCK9 space for a while, as overpriced, while patients part, focused on the total current frameworks reflect only drug you can take, yet we’re more effective: a had Dr. Kazi, and their drugs and payors were voting with cost of new therapies, but as DR: This is why we these priorities? going to make you pay 6,000 governmental or were clearly overpriced to the their feet. Prescriptions were drug prices skyrocket, so have conduct our own analyses. We dollars to get it.’ It’s not clear why independent body? point that no one was using either not getting approved or the copayments patients are DR: This has been a problem often analyze and think ‘how this would happen. them. As new data emerged, patients would show up to the responsible for. Copayments in oncology, to the point of did they come to that decision there was a combination of pharmacy saying, ‘Wait, how are distorting the market in talking about drugs’ “financial DR: I obviously have a or make that claim?’ and the the manufacturers’ recognition much do you want me to pay perverse ways, frequently toxicity.” This means instead conflict of interest in a way answer is, “because it got them they had charged too much for this?’ before leaving without putting new therapies out of of talking about the toxicity of and have to say, part of what just to the price they wanted.” and needed to lower the price reach for even insured patients. attracted me to ICER was We wouldn’t make those same

34 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 35 Medical Education Leadership Selected Publications

2018-2019 Academic Year ALLERGY & INFLAMMATION Popma JJ, et al. Transcatheter Aortic-Valve Syed I, Rubin de Celis MF, Mohan JF, Andersen MS, Lu S, Lopez GJ, Lassen Replacement with a Self-Expanding Valve Moraes-Vieira PM, Vijayakumar A, Nelson GASTROENTEROLOGY AT, Shapiro NI, Ghiran IC. A Novel Ciarán Kelley, MD in Low-Risk Patients. N Engl J Med 2019; AT, Siegel D, Saghatelian A, Mathis D, Kahn Sarah Flier, MD Implementation of Magnetic Levitation to 380(18): 1706-1715. BB. PAHSAs attenuate immune responses Quantify Leukocyte Size, Morphology, and and promote β cell survival in autoimmune Associate Director Robbins JM, Herzig M, Morningstar J, Magnetic Properties to Identify Patients diabetic mice. J Clin Invest 2019; 129. Sarzynski MA, Cruz DE, Wang TJ, Gao Y, ADVANCED ENDOSCOPY With Sepsis. Shock 2019; 51(2):147-152. Tyler Berzin, MD Wilson JG, Bouchard C, Rankinen T, GASTROENTEROLOGY, Ueki S, Miyabe Y, Yamamoto Y, Fukuchi M, Gerszten RE. Association of HEPATOLOGY AND NUTRITION CELIAC DISEASE Hirokawa M, Spencer LA, Weller PF. Ballou S, Katon J, Singh P, Rangan V, Lee Ciarán Kelley, MD Dimethylguanidino Valeric Acid With Correction to: Charcot-Leyden Crystals in Partial Resistance to Metabolic Health HN, McMahon C, Iturrino J, Lembo A, Nee J. HEPATOLOGY Eosinophilic Inflammation: Active Cytolysis Benefits of Regular Exercise. JAMA Cardiol Chronic Diarrhea and Constipation Are Michelle Lai, MD Leads to Crystal Formation. Curr Allergy 2019; 4(7):636-643. More Common in Depressed Individuals. Clin Gastroenterol Hepatol 2019; pii: S1542- INFLAMMATORY BOWEL DISEASE Asthma Rep 2019; 19(8):38. Wadhera RK, Joynt Maddox KE, Wasfy JH, 3565(19)30362-3. Sarah Flier, MD Giraldez MD, Spengler RM, Etheridge A, Haneuse S, Shen C, Yeh RW. Association of Bourlière M, Gordon SC, Schiff ER, Tran TT, Department of Medicine education leadership for the 2018-2019 Academic Year. MOTILITY Godoy PM, Barczak AJ, Srinivasan S, Hoff the Hospital Readmissions Reduction Anthony Lembo, MD PL, Tanriverdi K, Courtright A, Lu S, Khoory Program with Mortality Among Medicare Ravendhran N, Landis CS, Hyland RH, CHIEF MEDICAL RESIDENTS CORE II CLERKSHIP Vice Chairs J, Rubio R, Baxter D, Driedonks TAP, Beneficiaries Hospitalized for Heart Stamm LM, Zhang J, Dvory-Sobol H, Molly Brett, MD Pamela Hartzband, MD TRANSPLANT HEPATOLOGY Buermans HPJ, Hoen ENMN, Jiang H, Wang Failure, Acute Myocardial Infarction, and Subramanian GM, Brainard DM, VICE CHAIR FOR EDUCATION Josh Davis, MD Course Director Michelle Lai, MD McHutchison JG, Serfaty L, Thompson AJ, Eileen Reynolds, MD Jonathan Li, MD Alexander Carbo, MD K, Ghiran I, Wang YE, Keuren-Jensen KV, Pneumonia. JAMA 2018; 320(24): PANCREAS Freedman JE, WoodruffPG , Laurent LC, Sepe TE, Curry MP, Reddy KR, Manns MP. ASSOCIATE VICE Jim Parris, MD Course Director 2542-2552. Ritika Parris, MD Steven Freedman, MD, PhD Erle DJ, Galas DJ, Tewari M. Erratum: Deferred treatment with sofosbuvir- CHAIRS FOR EDUCATION Yeh RW, Valsdottir LR, Yeh MW, Shen C, C. Christopher Smith, MD Sarah Shannahan, MD PRACTICE OF Comprehensive multi-center assessment velpatasvir-voxilaprevir for patients with MEDICINE CLERKSHIP GENERAL MEDICINE Kramer DB, Strom JB, Secemsky EA, Healy Anjala Tess, MD AND PRIMARY CARE of small RNA-seq methods for quantitative chronic hepatitis C virus who were FIRM CHIEFS Anita Vanka, MD JL, Domeier RM, Kazi DS, Nallamothu BK. Christina Wee, MD, MPH previously treated with an NS5A inhibitor: Blumgart Firm Site Director miRNA profiling. Nat Biotechnol 2018; Residency Leadership Gloria Yeh, MD, MPH Parachute use to prevent death and major Wendy Stead, MD 36(9):899. an open-label substudy of POLARIS-1. PRIMARY CARE CLERKSHIP trauma when jumping from aircraft: RESIDENCY PROGRAM DIRECTOR William Aird, MD Lancet Gastroenterol Hepatol 2018; Susan Frankl, MD GERONTOLOGY Melo RCN, Weller PF. Contemporary randomized controlled trial. BMJ 2018; C. Christopher Smith, MD 3(8):559-65. Kurland Firm Site Director Sarah Berry, MD, MPH understanding of the secretory granules in 363:k5094. PRIMARY CARE James Heffernan, MD, MPH human eosinophils. J Leukoc Biol 2018; Danford CJ, Iriana S, Shen C, Curry MP, Lai GLOBAL HEALTH ENDOCRINOLOGY, DIABETES PROGRAM DIRECTOR Barbra Blair, MD Fellowship Program M. Evidence of bias during liver transplant Jonathan Crocker, MD 104(1):85-93. AND METABOLISM Kelly Graham, MD Directors evaluation of nonalcoholic steatohepatitis Robinson Firm Steinfeld J, Bradford ES, Brown J, Mallett S, Feit A, Levin N, McNamara EA, Sinha P, HEMATOLOGY/ONCOLOGY cirrhosis patients. Liver International 2019; ASSOCIATE PROGRAM DIRECTORS Shani Herzig, MD, MPH CARDIOVASCULAR MEDICINE Yancey SW, Akuthota P, Cid MC, Gleich GJ, Whittaker LG, Malabanan AO, Rosen Reed Drews, MD 39(6):1165-73. Neal Biddick, MD Zahir Kanjee-Khoja, MD, MPH Joseph Kannam, MD Jayne D, Khoury P, Langford CA, Merkel PA, HN. Effect of Positioning of the Region of Jonathan Crocker, MD HOSPICE AND Moosig F, Specks U, Weller PF, Wechsler Interest on Bone Density of the Hip. J Clin Huang J, Kelly CP, Bakirtzi K, Villafuerte Jason Freed, MD Tullis Firm ELECTROPHYSIOLOGY PALLIATIVE MEDICINE Densitom 2019; S1094-6950(19): 30030-7. Gálvez JA, Lyras D, Mileto SJ, Larcombe S, Molly Hayes, MD Deepa Rangachari, MD Alfred Buxton, MD Mary Buss, MD, MPH ME. Evaluation of clinical benefit from Kenneth Mukamal, MD, MPH Jeffrey William, MD treatment with mepolizumab for patients Xu H, Yang X, Shields KS, Zhu W, Zhang Y, INTERVENTIONAL CARDIOLOGY Huang H. Lee SW, Sousa-Lima I, Kim SS, Daniel Ricotta, MD INFECTIOUS DISEASES with eosinophilic granulomatosis with Goldsmith JD, Patel IJ, Hansen J, Huang M, Undergraduate Eric Osborne, MD, PhD Wendy Stead, MD Hwang WM, Dagon Y, Wang WM, Cho S, Elizabeth Targan, MD polyangiitis. J Allergy Clin Immunol 2019; Yla-Herttuala S, Moss AC, Paredes-Sabja Christopher Rowley, MD, MPH Kang MC, Seo JA, Shibata M, Cho H, Belew Anjala Tess, MD Education Leadership NON-INVASIVE CARDIOLOGY D, Pothoulakis C, Shah YM, Wang J, Chen X. Associate Director 143(6):2170-2177. GD, Bhin J, Desa BN, Ryu MJ, Shong M, Li P, Christina Wee, MD, MPH Warren Manning, MD Clostridium difficile toxins induce VEGF-A Julius Yang, MD, PhD CORE I CLERKSHIP CARDIOVASCULAR MEDICINE Meng H. Chung BH, Hwang D, Kim MS, NEPHROLOGY and vascular permeability to promote Amy Weinstein, MD, MPH CLINICAL INFORMATICS Gavin M, Landon B, Lu J, Ganjehei L, Ho Park KS, Macedo P, White M, Jone J, Kim EDUCATION MANAGER Course Director Stewart Lecker, MD disease pathogenesis. Nat Microbiol 2019; Charles Safran, MD K, Nathanson L, Ullman E, Grossman S, YB. Rho-kinase/AMPK axis regulates Ruth Colman Anita Vanka, MD 4(2):269-79. PULMONARY AND CRITICAL CARE Zimetbaum P. A combined care model hepatic lipogenesis during over-nutrition. J Course Co-Director ENDOCRINOLOGY, Asha Anandaiah, MD DIABETES AND METABOLISM using early access to specialists off-hours Clin Invest 2018; 128: 5335-5350. Peck-Radosavljevic M, Simon K, Iacobellis Alan Malabanan, MD A, Hassanein T, Kayali Z, Tran A, Makara M, SLEEP MEDICINE to reduce cardiac admissions. Intern Lowell BB. New neuroscience of Ben Ari Z, Braun M, Mitrut P, Yang SS, Eric Heckman, MD Emerg Med 2019; 14(6):973-979. homeostasis and drives for food, water, Akdogan M, Pirisi M, Duggal A,, Ochiai T RHEUMATOLOGY and salt. N Engl J Med 2019; 380:459-71. Vasileios Kyttaris, MD 36 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 37 Selected Publications (continued)

Motomiya T, Kano T, Nagata T, Afdhal N. Torres-Gonzalez M, Menetski JP, Correa- HEMATOLOGIC MALIGNANCIES INFECTIOUS DISEASES recipients receiving palivizumab. Leuk McDermott DF, Huseni MA, Atkins MB, Lusutrombopag for the Treatment of De-Araujo R, Bhasin S. Establishing the Link Abramson JS, Arnason JE, LaCasce AS, Leahey PA, LaSalvia MT, Rosenthal ES, Lymphoma 2019; 60(1):85-91. Motzer RJ, Rini BI, Escudier B, Fong L, Thrombocytopenia in Patients With Chronic Between Lean Mass and Grip Strength Redd R, Barnes JA, Sokol L, Joyce R, Karchmer AW, Rowley CF. High Morbidity Joseph RW, Pal SK, Reeves JA, Sznol M, Snyder GM, Wright SB. The epidemiology Liver Disease Undergoing Invasive Procedures Cut-points With Mobility Disability and Avigan D, Neuberg D, Takvorian RW, and Mortality Among Patients With Hainsworth J, Rathmell WK, Stadler WM, and prevention of Candida auris. Curr (L-PLUS 2). Hepatology 2019. Other Health Outcomes: Proceedings of the Hochberg EP, Bello CM. Brentuximab Sentinel Admission for Injection Drug Use- Hutson T, Gore ME, Ravaud A, Bracarda S, Infect Dis Rep 2019 ;21:19-33. Sarcopenia Definition and Outcomes vedotin, doxorubicin, vinblastine, and Related Infective Endocarditis. Open Suárez C, Danielli R, Gruenwald V, Choueiri GENERAL MEDICINE Consortium Conference. J Gerontol A Biol dacarbazine for nonbulky limited-stage Forum Infect Dis 2019; 6(4). Taylor JL, Rapoport AB, Rowley CF, TK, Nickles D, Jhunjhunwala S, Piault-Louis Basu S, Berkowitz SA, Philips Rl, Bitton Sci Med Sci 2019; pii: glz081. classical Hodgkin lymphoma. Blood 2019; Mukamal KJ, Stead W. An opioid overdose E, Thobhani A, Qiu J, Chen DS, Hegde PS, A, Landon BE, Phillips RS. Association Pericàs JM, Nathavitharana R, Garcia-de- 134(7):606-613 curriculum for medical residents: Impact Schiff C, Fine GD, Powles T. 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Endocarditis Caused by Highly Jorge SE, Lucena-Araujo AR, Yasuda H, Fernandez L, Fitzgerald P, Liao JM, Payne Intern Med 2019; 179: 383-391. Inhibition of CD47-SIRPα Requires Fc-FcγR Penicillin-Resistant Viridans Group Piotrowska Z, Oxnard GR, Rangachari Pennell NA, Neal JW, Chaft JE, Azzoli CG, TH, Delbanco T, Walker J. Patients Interactions to Maximize Activity in T-cell Streptococci: Still Room for Vancomycin- D, Huberman MS, Sequist LV, Kobayashi Jänne PA, Govindan R, Evans TL, Costa DB, Managing Medication and Reading Their Visit McLean RR, Kiel DP, Berry SD, Broe KE, Lymphomas. Blood 2019. Based Regimens. Antimicrob Agents SS, Costa DB. EGFR Exon 20 Insertion Wakelee HA, Heist RS, Shapiro MA, Notes: A Survey of OpenNotes Participants. Zhang X, Cupples LA, Hannan MT. Lower Chemother 2019 Jul; 63(8). Mutations Display Sensitivity to Hsp90 Ann Intern Med 2019; 171(1):69-71. 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BIDMC Department of Medicine 2019 Annual Report / 39 Selected Publications (continued)

Muzikansky A, Murthy S, Lanuti M, Rusch Germline Genetic Testing in Individuals Talbot BE, Vandorpe DH, Stotter BR, Alper and Tsokos, G. C. Pyruvate dehydrogenase Horng S, Greenbaum NR, Nathanson LA, EXPERIMENTAL MEDICINE VW, Kris MG, Sequist LV. SELECT: A Phase II with Pancreatic Ductal Adenocarcinoma SL, Schlondorff JS. Transmembrane phosphatase catalytic subunit 2 limits Th17 McClay JC, Goss FR, Nielson JA. Consensus Beigneux AP, Allan CM, Sandoval NP, Cho Trial of Adjuvant Erlotinib in Patients With (PDAC). Cancer 2019; 125: 2488-2496. insertases and N-glycosylation critically differentiation. Proc. Natl. Aca. Sci. USA Development of a Modern Ontology of GW, Heizer PJ, Jung RS, Stanhope KL, Havel Resected Epidermal Growth Factor determine synthesis, trafficking and activity 2018; 115 (37):9288-9293. Emergency Department Presenting PJ, Birrane G, Meiyappan M, Gill JE 4th, Tung NM, Garber JE. BRCA1/2 testing: Receptor-Mutant Non-Small-Cell Lung of the nonselective cation channel TRPC6. J Problems-The Hierarchical Presenting Murakami M, Miyashita K, Nakajima K, therapeutic implications for breast cancer Li, H., Tsokos, M. G., Bickerton, S., Moutlon, Cancer. J Clin Oncol 2019; 37(2):97-104. Biol Chem 2019; 294(34):12655-12669. Problem Ontology (HaPPy). Appl Clin Ploug M, Fong LG, Young SG. Lipoprotein management. Br J Cancer 2018; V.R., Fahmy, T, Kyttaris, V.C., Li, Y., Tsokos, M. Inform 2019; 10(3):409-420. lipase is active as a monomer. Proc Natl Peters ML, Stobie L, Dudley B, Karloski E, 119(2):141-152. PULMONARY, CRITICAL G., Sharabi, A., Li, Y., Mou.ton, V. R. Fahmy, Acad Sci U S A 2019; 116(13):6319-6328. Allen K, Speare V, Dolinsky J, Tian Yu, CARE & SLEEP MEDICINE T. M., Tsokos, G. C. Precision DNA Quintana Y, Fahy D, Crotty B, Gorenberg NEPHROLOGY DeLeonardis K, Krejdovsky J, Colvin A, Lim Baedorf Kassis E, Train S, MacNeil B, Loring demethylation ameliorates disease in M, Jain R, Kaldany E, Lipsitz L, Chen YP, Birrane G, Dassier AL, Romashko A, Albayram O, MacIver B, Mathai J, C, Borazanci E, Brand R, Tung N. Family SH, Talmor D. Monitoring of neuromuscular lupus-prone mice. J. Clin. Invest. (Insight) Henao J, Safran C. A Usability Evaluation of Lundberg D, Holmes K, Cottle T, Norton AW, Verstegen A, Baxley S, Qiu C, Bell C, Communication and Patient Distress after blockade: a comparison of train-of-four 2018; 3(16). pii: 120880. the InfoSAGE App for Family-Based Zhang B, Concino MF, Meiyappan M. Caldarone BJ, Zhou XZ, Lu KP, Zeidel M. and the Campbell diagram. Intensive Care Medication Management. Stud Health Structural characterization of the α-N- Traumatic Brain Injury-related voiding Maeda, K., Otomo, K., Yoshida, N., Abu- Med 2018; 44(12):2305-6. Technol Inform 2019; 257:352-357. acetylglucosaminidase, a key enzyme in dysfunction in mice is caused by damage Asab, A. S., Ichinose, K., Nishino, T., Kono, the pathogenesis of Sanfilippo syndrome to rostral pathways, altering inputs to the Majid A, de Lima A, Parikh M, Chee A, M., Ferretti, A., Maruyama, S., Bickerton, S., Torous J, Andersson G, Bertagnoli A, B. J Struct Biol 2019; 205(3):65-71. reflex pathways. Sci Rep 2019; 9(1):8646. Fernandez-Bussy S, Kheir F. Tunneled Fahmy, T. M., Tsokos, M. G., Tsokos, G. C. Christensen H, Cuijpers P, Firth J, Haim A, pleural catheters for patients with chronic Podocyte-specific delivery of calcium/ Hsin H, Hollis C, Lewis S, Mohr DC, Pratap Giessen TW, Orlando BJ, Verdegaal AA, Chun J, Zhang JY, Wilkins MS, pleural infection and nonexpandable lung. calmodulin kinase inhibitior prevents A, Roux S, Sherrill J, Arean PA. Towards a Chambers MG, Gardener J, Bell DC, SubramanianB, Riella C, Magraner JM, J Bronchology Interv Pulmonol 2019; autoimmune and drug-induced kidney consensus around standards for Birrane G, Liao M, Silver PA. Large protein Alper SL, Friedman DJ, Pollak MR. 26(2):132-6. damage. J. Clin. Invest 2018; smartphone apps and digital mental organelles form a new iron sequestration Recruitment of APOL1 kidney disease risk 128(8):3445-345. health. World Psychiatry 2019; 18(1):97-98. system with high storage capacity. Elife variants to lipid droplets attenuates cell Miller DC, Sullivan AM, Soffler M, 2019; 8. pii: e46070. toxicity. Proc Natl Acad Sci U S A 2019; Armstrong B, Anandaiah A, Rock L, Van Volenhoven, R., Hahn B. H., Tsokos, G. CLINICAL NUTRITION 116(9):3712-3721. McSparron JI, Schwartzstein RM, Hayes C., Wagner, C., Lipsky, P. E, Touma, Z., Alfaddagh A, Elajami TK, Saleh M, Young SG, Fong LG, Beigneux AP, Allan CM, MM. Teaching residents how to talk about Werth, V, Hsau, B., Chevrier, M., Gordon, R., Mohebali D, Bistrian BR, Welty FK. An He C, Jiang H, Nakajima K, Meiyappan M, Leeaphorn N, Garg N, Thamcharoen N, death and dying: a mixed-methods Zhou, B, Triebel, M., Rose, S. Efficacy and omega-3 fatty acid plasma index ≥4% Birrane G, Ploug M. GPIHBP1 and Khankin EV, Cardarelli F, Pavlakis M. analysis of barriers and randomized safety of ustekinumab, an interleukin 12 and prevents progression of coronary artery Lipoprotein Lipase, Partners in Plasma Cytomegalovirus mismatch still negatively educational intervention. Am J Hosp Palliat 23 inhibitor, in patients with active systemic plaque in patients with coronary artery Triglyceride Metabolism. Cell Metab 2019; affects patient and graft survival in the era Care 2018; 35(9):1221-6. lupus erythematosus: results of a disease on statin treatment. Atherosclerosis 30(1):51-65. of routine prophylactic and preemptive multicenter, double-blinded, phase 2, 2019; 285:153-162. therapy: A paired kidney analysis. Am J Schmickl CN, Heckman E, Owens RL, GENETICS randomized controlled study. Lancet 2017; Transplant 2019; 19(2):573-584. Thomas RJ. The respiratory signature: a Anez-Bustillos L, Dao DT, Fell GL, Baker Brubaker DK, Paulo JA, Sheth S, Poulin 392(10155):1330-1339. novel concept to leverage continuous MA, Gura KM, Bistrian BR, Puder M. EJ, Popow O, Joughin BA, Strasser SD, Lynch MR, Tran MT, Ralto KM, Zsengeller positive airway pressure therapy as an CLINICAL INFORMATICS Redefining essential fatty acids in the era Starchenko A, Gygi SP, Lauffenburger DA, ZK, Raman V, Bhasin SS, Sun N, Chen X, early warning system for exacerbations of Bajracharya AS, Crotty BH, Kowoloff HB, of novel intravenous lipid emulsions. Clin Haigis KM. Proteogenomic Network Brown D, Rovira II, Taguchi K, Brooks CR, common diseases such as heart failure. J Safran C, Slack WV. Patient experience with Nutr 2018; 37:784-789. Analysis of Context-Specific KRAS Signaling Stillman IE, Bhasin MK, Finkel T, Parikh SM. Clin Sleep Med 2019; 15(6):923-7. family history tool: analysis of patients’ In Mouse-to-Human Cross-Species TFEB-driven lysosomal biogenesis is Benotti PN, Wood GC, Still CD, Gerhard experience sharing their family health Translation. Cell Syst 2019; (3):258-270. pivotal for PGC1α-dependent renal stress Vukoja M, Riviello ED, Schultz MJ. Critical GS, Rolston DD, Bistrian BR. Metabolic history through patient-computer dialogue resistance. JCI Insight 2019; 5. pii: 126749. care outcomes in resource-limited settings. surgery and iron homeostasis. Obes Rev Gyuris A, Navarrete-Perea J, Jo A, Cristea S, in a patient portal. J Am Med Inform Assoc Curr Opin Crit Care 2018; 24(5):421-7. 2019; 20:612-620. Zhou S, Fraser K, Wei Z, Krichevsky AM, Rivera A, Vandorpe DH, Shmukler BE, 2019; 26(7):603-609. Weissleder R, Lee H, Gygi SP, Charest A. Andolfo I, Iolascon A, Archer NM, Shabani RHEUMATOLOGY AND CLINICAL IMMUNOLOGY Bistrian BR. Protein calorie malnutrition Bandeiras C, Cabral JMS, Gabbay RA, Physical and Molecular Landscapes of E, Auerbach M, Hamerschlak N, Morton J, Burns R, Smith, CC, Shmerling RH, Tess, A. and obesity: Nutritional collaboration from Finkelstein SN, Ferreira FC. Bringing Stem Mouse Glioma Extracellular Vesicles Define Wohlgemuth JG, Brugnara C, Snyder LM, How would you manage this patient with MIT to the bedside and clinic. Metabolism Cell-Based Therapies for Type 1 Diabetes to Heterogeneity. Cell Rep 2019; Alper SL. Erythrocyte ion content and gout? Grand Rounds Discussion from Beth 2018; 79:77-82. the Clinic: Early Insights from Bioprocess 27(13):3972-3987. dehydration modulate maximal Gardos Israel Deaconess Medical Center. Ann Economics and Cost-Effectiveness Analysis. McCracken E, Wood GC, Prichard W, channel activity in KCNN4 V282M/+ Intern Med 2018; 169:788-795. Lee YR, Chen M, Lee JD, Zhang J, Lin SY, Fu Biotechnol J 2019; 14(8):e1800563. Bistrian B, Still C, Gerhard G, Rolston D, Hereditary Xerocytosis (HX) red cells. Am J TM, Chen H, Ishikawa T, Chiang SY, Katon J, Kono, M., Yoshida, N., Maeda, K., Skinner. Benotti P. Severe anemia after Roux-en-Y Physiol Cell Physiol 2019; 317(2):C287-C302. Zhang Y, Shulga YV, Bester AC, Fung J, N.E., Pan, W., Kyttaris, V. C. Tsokos, M. G. gastric bypass: a cause for concern. Surg Obes Relat Dis 2018; 14:902-909.

40 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 41 Selected Publications (continued)

Monteleone E, Wan L, Shen C, Hsu CH, Zwicker JI, Muia J, Dolatshahi L, Westfield [SLAMF1] regulates Type I IFN production in Stevens J, Dawn Roche S, Reichheld A, Papa A, Clohessy JG, Teruya-Feldstein J, LA, Nieters P, Rodrigues A, Hamdan A, E.coli phagosomes. J Cell Biol 2018; Demosthenes N, Johansson A, Howell M, Jain S, Wu H, Matesic L, Chen RH, Wei W, Antun AG, Metjian A, Sadler JEE. Adjuvant 217(4):1411-1429. Cocchi M, Landon B. Measuring the Pandolfi, P. Reactivation of PTEN tumor low-dose rituximab and plasma exchange quality of inpatient specialist consultation INTERDISCIPLINARY MEDICINE suppressor for cancer treatment through for acquired TTP. Blood 2019; AND BIOTECHNOLOGY in the intensive care unit: Nursing and inhibition of a MYC-WWP1 inhibitory 134(13):1106-1109. Costa MD, Goldberger AL. Heart rate family experiences of communication. pathway. Science 2019; 364(6441). PLoS One 2019; 14(4). Zwicker JI, Schlechter BL, Stopa JD, fragmentation: using cardiac pacemaker Poulin EJ, Bera AK, Lu J, Lin Y-J, Strasser SD, Liebman H, Aggarwal A, Puligandla M, dynamics to probe the pace of biological Wyatt C, Stevens J, Patel D, Gallotto R, Paulo JA, Huang TQ, Morales C, Yan W, Caughey T, Bauer KA, Kuemmerle N, Wong aging. Am J Physiol Heart Circ Physiol 2019; Grujic D, Brown P, Freedman SD. controlled, phase 1/2a clinical trial Cook J, Nowak JA, Brubaker DK, Joughin BA, E, Wun T, McLaughlin M, Hidalgo M, 361:H1341-44. Absorption and Safety with Sustained Use (APPROACH) and in rhesus monkeys (NHP Johnson CW, DeStefanis RA, Ghazi PC, Neuberg D, Furie B, Flaumenhaft R. of RELiZORB Evaluation (ASSURE) Study in Daneshmandi S, Wegiel B, Seth P. 13-19). Lancet 2018; 392(10143):232-243. Gondi S, Wales TE, Iacob RE, Bogdanova L, Targeting protein disulfide isomerase with Blockade of lactate dehydrogenase-A Patients with Cystic Fibrosis Receiving Internal Medicine Residency Program. Gierut JJ, Li Y, Engen JR, Perez-Mancera PA, the flavonoid isoquercetin to improve (LDH-A) improves efficacy of anti- Enteral Feeding. J Pediatr Gastroenterol Borducchi EN, Liu J, Nkolola JP, Cadena AM, J Grad Med Educ 2019; 11(1):92-97. Braun BS, Gygi SP, Lauffenburger DA, hypercoagulability in advanced cancer. programmed cell death-1 (PD-1) therapy Nutr 2018; 67:527-532. Yu WH, Fischinger S, Broge T, Abbink P, Westover KD, Haigis KM. Tissue-specific JCI Insight 2019; 4(4): pii: e125851. Mercado NB, Chandrashekar A, Jetton D, . Become in melanoma. Cancers 2019; 11:450. Kothari D, Struyvenberg MR, Perillo MC, Hunter N, Smith CC, Reynolds E oncogenic activity of K-RasA146T. Cancer Peter L, McMahan K, Moseley ET, an effective resident teacher and team IMMUNOLOGY Hejblum BP, Weber GM, Liao KP, Palmer Ezaz G, Freedman SD, Sheth SG. Extra- Discov 2019; 9: 738-755. Bekerman E, Hesselgesser J, Li W, Lewis leader in 10 tried-and-true steps. JGME Chaudhary A, Kamischke C, Leite M, Altura NP, Churchill S, Shadick NA, Szolovits P, pancreatic complications, especially MG, Alter G, Geleziunas R, Barouch DH. 2018; 10(5):488-490. Zhang WC, Wells JM, Chow KH, Huang H, MA, Loren Kinman, Hemantha Kulasekara, hemodialysis predict mortality and length Murphy SN, Kohane IS, Cai T. Probabilistic Antibody and TLR7 agonist delay viral Yuan M, Saxena T, Melnick MA, Politi K, Marie-Pierre Blanc, Guoxing Wang, of stay, in ICU patients admitted with acute McSparron J, Vanka A, Smith C. The record linkage of de-identified research rebound in SHIV-infected monkeys. Nature Asara JM, Costa DB, Bult CJ, Slack FJ. Terhorst C & Samuel I. Miller. β-Barrel pancreatitis. Gastroenterol Rep (Oxf) 2018; Clinical Teacher’s Toolbox: Cognitive datasets with discrepancies using 2018; 563(7731):360-364. miR-147b-mediated TCA cycle dysfunction and Outer Membrane Proteins Induce diagnosis codes. Sci Data 2019; 6:180298. 6(3):202-209. Learning Theory for Clinical Teaching. The pseudohypoxia initiate drug tolerance mTORC2 Dephosphorylation and Hensley-McBain T, Berard AR, Manuzak JA, Clinical Teacher 2018; 15:1-5. Yang AC, Peng CK, Huang NE. Causal Singh P, Allemant PO, Brown J, Perides G, to EGFR inhibitors in lung adenocarcinoma. Autophagic Responses. Sci Signal 2018; Miller CJ, Zevin AS, Polacino P, Gile J, decomposition in the mutual causation Freedman SD, Martin CR. Effect of QUALITY IMPROVEMENT Nat Metab 2019; 460-474. 11(558). Agricola B, Cameron M, Hu SL, Estes JD, polyunsaturated fatty acids on postnatal Aronson MD. The Purpose of the Medical system. Nature Commun 2018; 9:3378. Reeves RK, Smedley J, Keele BF, Burgener HEMOSTASIS AND THROMBOSIS Herzog RW, Kuteyeva V, Saboungi R, ileum development using the fat-1 Record: Why Lawrence Weed Still Matters. SIGNAL TRANSDUCTION AD, Klatt NR. Intestinal damage precedes Bekendam RH, Iyu D, Passam F, Stopa JD, De Terhorst C, Biswas M. Reprogrammed transgenic mouse model. Pediatr Res 2019; Am J Med 2019; (19)30352-3. Clement E, Inuzuka H, Nihira NT, Wei W, mucosal immune dysfunction in SIV Ceunynck K, Muse O, Bendapudi PK, Garnier CD4+ T Cells That Express FoxP3+ 85(4):556-565. Toker A. Skp2-dependent reactivation of infection. Mucosal Immunol 2018; Kershaw C, Taylor JL, Horowitz G, CL, Gopal S, Crescence L, Panicot-Dubois L, Control Inhibitory Antibody Formation AKT drives resistance to PI3K inhibitors. Sci CENTER FOR VIROLOGY 11(5):1429-1440. Brockmeyer D, Libman H, Kriegel G, Ngo L. Hogg PJ, Dubois C, Flaumenhaft R. Protein in Hemophilia A Mice. Front Immunol Signal 2018; 11(521). AND VACCINE RESEARCH Use of an electronic medical record disulfide isomerase regulation by nitric 2019; 10:274. Osuna CE, Lim SY, Kublin JL, Apps R, Chen Barouch DH, Tomaka FL, Wegmann F, Stieh reminder improves HIV screening. BMC oxide maintains vascular quiescence and Toker A, Dibble CC. PI 3-Kinase Signaling: E, Mota TM, Huang SH, Ren Y, Bachtel ND, Wang N, Yigit, B, van der Poel CE, Cuenca DJ, Alter G, Robb ML, Michael NL, Peter L, Health Serv Res 2018; 18(1):14. controls thrombus formation. J Thromb AKTing up inside the Cell. Mol Cell 2018; Tsibris AM, Ackerman ME, Jones RB, Nixon M, Carroll MC, Herzog RW, Engel P & Nkolola JP, Borducchi EN, Chandrashekar Haemost 2018; 16(11):2322-2335. 71(6):875-876. DF, Whitney JB. Evidence that CD32a does Latifi N, Kriegel G, Herskovits AZ. Point-of- Terhorst C. The Checkpoint Regulator A, Jetton D, Stephenson KE, Li W, Korber B, not mark the HIV-1 latent reservoir. Nature Care Urine Pregnancy Tests. JAMA 2019. Eriksson O, Chiu J, Hogg P, Atkinson JP, SLAMF3 Preferentially Prevents Expansion Yuan M, Kremer DM, Huang H, Breitkopf Tomaras GD, Montefiori DC, Gray G, 2018; 561(7723):E20-E28. Liszewski MK, Flaumenhaft R, Furie B. 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42 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 43 Research Funding: Academic Year 2018-2019 In Memoriam

Division Funding Source Direct Award Indirect Award Direct Award This year marked the passing of a beloved member of BIDMC and the Department of Medicine. Allergy and Inflammation Federal $1,072,074 $676,008 $396,065 Non-Federal $109,290 $107,712 $1,577 Joanne Casella, MS, served the medical center and New England Deaconess Cardiovascular Medicine Federal $12,419,091 $8,031,719 $4,387,372 Non-Federal $9,720,284 $8,198,758 $1,521,526 Hospital for 52 years. For 20 of those years, she was the administrative leader of the Department, which she ran with consummate diplomatic skill, a keen business Clinical Informatics Federal $504,948 $409,592 $95,355 Non-Federal $69,543 $60,472 $9,070 sense, and a quiet, passionate devotion to our patient care, teaching, and Endocrinology, Diabetes and Metabolism Federal $10,471,867 $7,039,497 $3,432,369 research missions. Non-Federal $3,608,613 $3,150,381 $458,232 Experimental Medicine Federal $389,894 $219,537 $170,356 Raised in the Back Bay, Joanne attended the Boston public schools and Non-Federal $1,146,172 $ 1,014,240 $131,932 began her career as a Northeastern University co-op student in the Gastroenterology Federal $6,541,616 $4,303,626 $2,237,990 Deaconess clinical pathology laboratory, transitioning to part-time work Non-Federal $3,589,143 $2,850,274 $738,869 as a medical technologist on the evening shift for five years when her Federal $3,995,788 $2,611,876 $1,383,912 General Medicine daughter was young. A gifted technologist and manager, Joanne worked Non-Federal $5,909,658 $5,260,753 $648,905 her way up from Chief Medical Technologist to Vice President of the Genetics Federal $6,865,005 $4,143,804 $2,721,201 Non-Federal $5,597,621 $4,975,609 $622,012 Pathology Department before moving to the Department of Medicine in 1993. She was one of the first women to hold a departmental Gerontology Federal $700,624 $520,492 $180,132 Non-Federal $220,184 $204,638 $15,545 leadership role at the medical center. Hematology Oncology Federal $17,673,193 $12,076,381 $5,596,812 Non-Federal $17,564,681 $15,230,187 $ 2,334,493 She guided the Department steadily and effectively through the Hemostasis and Thrombosis Federal $3,479,313 $2,555,266 $924,047 tenures of Drs. Robert Glickman, Robert Moellering, and Mark Non-Federal $741,980 $528,570 $213,409 Zeidel as Chairs. She developed a superb team of division Immunology Federal $1,168,372 $667,622 $500,749 administrators, many of whom went on to major leadership Non-Federal $54,831 $54,831 $ roles within the institution. Her colleagues remember her Federal $1,958,845 $1,490,274 $468,571 Infectious Diseases sound judgement and integrity, and knew that at all times Non-Federal $236,624 $174,765 $61,859 she put our mission first. Interdisciplinary Medicine and Biotechnology Federal $2,635,551 $1,526,105 $1,109,445 Non-Federal $838,995 $736,034 $102,960 Nephrology Federal $4,833,117 $2,927,059 $1,906,058 Non-Federal $5,387,882 $3,739,510 $1,648,372 Pulmonary, Critical Care and Sleep Medicine Federal $714,588 $674,719 $39,869 Non-Federal $948,788 $906,473 $42,314 Rheumatology and Clinical Immunology Federal $1,796,356 $1,004,576 $791,779 Non-Federal $955,511 $781,947 $173,563 Signal Transduction Federal $295,361 $160,430 $134,930 Non-Federal $4,845 $3,656 $1,188 Translational Research and Technology Innovation Federal $1,042 $602 $439 Non-Federal $1,293,134 $1,108,566 $184,568 Transplant Immunology Federal $ $ $ Non-Federal $2,000 $1,739 $260 Virology and Vaccine Research Federal $40,343,678 $33,640,731 $6,702,946 Non-Federal $8,819,249 $7,628,904 $1,190,345 Total Federal $117,860,331 $84,679,925 $33,180,406 Total Non-Federal $66,819,036 $56,718,026 $10,101,009

GRAND TOTAL $184,679,367 $141,397,951 $43,281,416

44 / BIDMC Department of Medicine 2019 Annual Report BIDMC Department of Medicine 2019 Annual Report / 45 Beth Israel Deaconess Medical Center is a patient care, teaching, and research affiliate of Department of Medicine Harvard Medical School and consistently ranks as a national leader among independent Beth Israel Deaconess Medical Center hospitals in National Institutes of Health funding. 330 Brookline Avenue, Boston, MA 02215 617-667-7000 BIDMC is part of Beth Israel Lahey Health, a new health care system that brings together Follow us on Twitter academic medical centers and teaching hospitals, community and specialty hospitals, more @BIDMC_Medicine than 4,000 physicians, and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education. BILH is the largest provider of healthcare in Massachusetts. BIDMC is also clinically affiliated with the Joslin Diabetes Center and Hebrew SeniorLife and is a research partner of Dana-Farber/Harvard Cancer Center and The Jackson Laboratory. BIDMC is the official hospital of the Boston Red Sox.