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Biomedical break- throughs, the explosion of the field of Student Roundtable: 'I Can Handle Anything' 4 genetics, distance-learning, new forms MCG students contemplate health care in the 21st century. of health care delivery, an unprecedent- a Positive . 7 ed shift to outpatient care, managed care Faculty Roundtable: 'We've Seen Lot of Changes'. MCG faculty weigh in on past and future changes in health care. and a host of other factors have com- bined to virtually transform the field. Alumni Roundtable: Will the progress—and headaches—of 'We Have the Best Health Care System in the World' 11 health care continue unabated into the A1CG alumni discuss their careers and the evolution of health care. 21st century? Will we finally conquer problems, such as skyrocketing costs and Alum News 16 disproportionate access to care, that have News from MCG's fire alumni associations. vexed our society for so long? Who better to weigh in on these Medical College of Georgia Hospital and Clinics issues than those who will serve on the Annual Report 28 front lines of health care in the 2 1 st century? Medical College of Georgia Today Plan Your Giving 33 editor Christine Hurley Deriso asked Leave a legacy. several MCG students, residents, faculty and alumni about their thoughts on Thank You, Donors 35 health care in the next millennium. Their responses—forthright, impassioned and reflective—are featured inside. This edition of MCG Today also rec- ognizes those whose generous support MCG President: Francis Tedesco, M.D. Editor: Christine Hurley Deriso has advanced the research, educational J. Executive Editor: fames B. Osborne, Ed.D. Art Director: Breiii D. Burch and clinical missions of MCG. The list Director of Marketing Photographer: Philjones gets bigger every year. Your support is and Public Relations: Dale Crail overwhelming, and we are more grate- ©1999, Medical College of Georgia. The Medical College of Georgia is the health sciences university of ful than we can say. We embark on a the University System of Georgia. Focusing on health-care education, research and patient care, the new millennium knowing our dreams Augusta-based institution consists of MCG Hospital, more than 811 support clinics, statewide outreach are within reach. With your support, programs and the Schools of Allied Health Sciences, Dentistry. Graduate Studies. Medicine and Nursing. Medical College of Georgia Today is sponsored by grants from MCG Foundation, Inc. and the MCG there's no limit to what we can do. School of Medicine Alumni Association. It is produced by the Division of Institutional Relations; Sincerely, Medical College of Georgia; Augusta, Georgia 3091 2. Advertising inquiries should be directed to Augusta Magazine, (706) 722-5833, P. O. Box 1405, Augusta. Georgia 30903. Published quarterly, MCG Today is furnished to alumni and friends of MCG without charge. The appearance of advertisements in this publication does not constitute an endorsement by the Medical College ot Georgia ot the products or Francis J. Tede^o, M.D. services advertised. AT A GLANCE Hard to Swallow When Dr. Mercado-Deane joined the CMC in 1993, she suspected that children with chronic res- piratory problems might not completely close off 2 months old, Julianna Badke cooed, their airway when swallowing. The result is chronic Atsmiled, sucked her fingers, rolled over in her coughing—or worse, desensitization to the dis- crib In short, she did everything a baby comfort of swallowing into the airway. Children is supposed to do. Everything except eat. who become desensitized may fail to cough, which "She would scream and chew her knuckles can result in problems s-uch as pneumonia or chok- when I tried to feed her," her mother, Ann, ing. Some children with swallowing difficulty go recalled. "It took one and a half hours for her to to the other extreme; rather than ignoring the dis- finish a bottle. She was so miserable that eventually comfort, they avoid it altogether by refusing to eat. she stopped eating completely." She was also Dr. Mercado-Deane suspected that Julianna fit into chronically congested, compounding her misery. the latter category. Julianna w as referred to Dr. Maria-Gisela Despite the potential of swallowing problems to Mercado-Deane, a pediatric radiologist at the create such havoc, children with such difficulty Medical College of Georgia Children's Medical often surfer for years before the problem is uncov- Center. Based on her studies of more than 2,000 ered. Yet the disorder is diagnosable and treatable, children with similar symptoms, Dr. Mercado- assuming radiologists know what to look for. Deane immediately suspected the cause of Children with respiratory problems are often Julianna's problem. referred to radiologists for X-rays of their upper- gastrointestinal functioning. Radiologists are have no effect on the endometrium, the lining of trained to look for signs of reflux—stomach con- the uterus, although, as with tamoxifen, an tents flowing back to the esophagus, which is a increased risk of clots in the large veins and lungs common cause of respiratory problems. Dr. was noted. Mercado-Deane decided to seize the opportunity The raloxifene studies were limited to post- to also check the child's swallowing function. menopausal women who were not necessarily at "I thought it was important when doing these high risk for breast cancer. The FDA approved X-rays to pay more attention to the swallowing raloxifene to prevent osteoporosis in post- mechanism," she said. "I think swallowing, along menopausal women in December 1997. with reflux, contributes to respiratory symptoms, The new study will compare the efficacy and so we're trying to diagnose and treat them togeth- safety of these two similar anti-estrogens in post- er. It only adds an extra minute or two to the pro- menopausal women age 35 and older who are at cedure," she said. increased risk of developing invasive breast cancer As suspected, Dr. Mercado-Deane found that over the next five years, Dr. Dalton said. Julianna was swallowing into her lungs rather than esophagus. "As babies grow, their oral-motor skills will The Countdown's On improve, but in the meantime, they may need thicker food," said CMC speech language patholo- gist Andrea Glover. Dwain Shaw's voice mail and you'll get Mrs. Badke was instructed to thicken Julianna's Callthe gist of his preoccupation: "This is formula with rice cereal, a consistency she could Dwain Shaw," his voice intones. "There are much easier tolerate. Julianna immediately redis- 128 days remaining until the year 2000." covered her appetite. "It was so simple—all we did Why the countdown? Mr. Shaw, Medical was thicken her food and lift her head higher College of Georgia director of Information when she ate—but it made all the difference," Mrs. Services and Year 2000 project director, is in charge Badke said. "She's 100 percent better." of ensuring that Jan. 1, 2000 is as smooth-running and uneventful on campus as the day before. The trick is to make sure every piece of computerized Breast Cancer Study equipment that recognizes the date is Y2K-compli- ant—modified to recognize the year 2000. This is a monumental task, but MCG is in excellent shape. Whether raloxifene can match or beat About three years ago, MCG began moderniz- tamoxifen's ability to reduce the risk of ing its mainframe applications, controlling func- breast cancer in high-risk women is tions such as the payroll and budget. Dale being studied at the Medical College Chernich, MCG's chief information officer, had of Georgia. the foresight to say, "While we're at it, let's make Both anti-estrogens appear to bind to estrogen sure we're Y2K-compliant." receptors in early breast cancer cells and essentially "Our good fortune is we've had people with destroy the cells. Tamoxifen has been shown to vision, like Dale, and we've had excellent adminis- halve the risk of invasive and non-invasive breast trative support," Mr. Shaw said. in cancer high-risk women, but has side effects MCG President Francis J. Tedesco has appointed including an increased incidence of endometrial a Year 2000 Task Force with representatives cancer, blood clots and possibly stroke. MCG is throughout the campus to work with Information participating in a study supported by the National Services toward Y2K compliance. The task force is Cancer Institute that will follow 22,000 post- going building by building, checking and modify- menopausal women over five years to determine if ing, if necessary, every piece of relevant equipment. raloxifene matches tamoxifen's effectiveness with The division wants no surprises.