ighty first-year students were of medical school is going to be quite welcomed into the medical different from anything you’ve done artmouth Medical School has Eprofession with the white coat before. It’s not going to be like high received an $11.6 million ceremony October 26, which intro- school and it’s not going to be like Daward from the National duced the new students to the privi- college.” He characterized this period Institutes of Health (NIH) to establish leges and responsibilities associated as an important transition in the stu- a nationally recognized center of bio- with becoming a physician. dents’ lives, an experience that is not medical research excellence in only intellectual but also profoundly immunology and inflammation.The emotional.“It’s an attitudinal transi- five-year grant will support collabora- tion,” he said,“for you will notice a tive projects at DMS in conjunction change in the way you study and a with the University of New change in the way you think about Hampshire (UNH), promoting people.” research opportunities for biomedical Baldwin said that medical training investigators in New Hampshire with prepares physicians to perform two broad potential for understanding and basic tasks: relieve suffering and pro- treating diseases of the immune sys- long life. Physicians, therefore, have tem and cancer. Flying SquirrelFlying Graphics limited expertise and are not meant to The funds are awarded through a Dean John C. Baldwin, MD, welcomes MD/PhD be judges, policemen or moral guides special program called COBRE, an candidate Hai Sun into medicine. for their patients.“Be grateful to your acronym for centers of biomedical Associate Dean for Medical patients,” Baldwin said,“because research excellence that NIH Education, David Nierenberg, MD, patients give meaning, purpose and designed to cultivate research expert- expounded on the symbolism of a gratification to the physicians’ lives.” ise among junior faculty and strength- white coat, stating that they stood for He concluded by saying,“That is why en the research infrastructure of states “the uniform of a profession, a med- this is such a great profession, symbol- that do not receive as much NIH ical caregiver, cleanliness, skill, train- ized by putting on a white coat.” funding as some large states. ing, expertise and qualities of profes- White coats were presented along “This award enables the medical sionalism.” Wearing a white coat with a pin from the Arnold P.Gold school to build on its productivity and should express professionalism, he Foundation, dedicated to fostering leadership in an area of far-reaching said, such as “subordination of one’s humanism in medicine. importance for health and disease. self-interests, response to society’s —Tanisha Keshava, Dartmouth ’05 And as importantly, it affords an needs, adherence to high ethical and opportunity to forge alliances in a moral standards and demonstration of consortium with life scientists at core humanistic values of empathy, UNH,” says DMS Dean John C. integrity and altruism.” He did, how- Baldwin, MD. ever, warn against possible negative The program encompasses five connotations to a white coat, such as integrated research projects, under the formality, authority, arrogance, superi- umbrella of “immune mechanisms ority, power and condescension. controlling inflammation and cancer.” DMS Dean John C. Baldwin, SquirrelFlying Graphics The projects are “multidisciplinary in MD, commented that “the experience Katrina Mitchell '05 accepts her white coat. breadth, characteristic of a center of (continued on page 6) 2 DMS Digest November/December 2001 n this country, as or some proteins made deep step is getting into a vesicle.That’s of last summer, within a cell, those that work called sorting,” says Barlowe. He Imore than 50 mil- Felsewhere in the body have a makes the analogy of a bus.“If there is lion people had no complex journey aboard carrier ves- a bus to carry passengers and the pas- health insurance, and sels with many possible stops before sengers need seats, then if we look at at least 30 million they exit the cell and reach their des- the bus carefully we should be able to more were underin- tination. DMS biochemists have dis- find some seats.” sured.According to the US Census covered a key receptor for sorting Using baker’s yeast as a model Bureau, at least 75 percent of the which proteins stay and which leave, system, Barlowe found a seat on the uninsured people were actually work- documenting for the first time what cellular bus. He discovered a “trans- ing. Still, in the absence of a right to many scientists theorized but had not port receptor,” the first of its kind to healthcare in this country, they were confirmed about how proteins travel select a soluble protein and help ferry uninsured and relegated to the “safety through cells for export. it out of its compartment. net” of struggling inner city hospitals, The results, published November Yeast, like many animals, gives off free clinics, emergency wards and 16 in Science, by Charles Barlowe, pheromones when mating. Barlowe teaching hospitals. Clearly, those with- PhD, associate professor of biochem- found that one little yeast pheromone out jobs have no hope of obtaining istry and William J. Belden, a graduate binds to a protein, Erv29p, for its traditional insurance, and they fare student, help resolve a major piece of journey through the cell, and that even more poorly in accessing the the cell traffic puzzle.They pave the without that receptor protein, the health system.This serious problem way for further understanding of how pheromone is not secreted. “If you clearly demands attention if America hormones such as insulin and other knock out Erv29p, you still make the is to move into the new century important factors are conveyed bus and it still goes to the right place. remaining the most powerful nation through cells for secretion into the But it’s missing the seat for this pas- in the world.We must recognize that bloodstream. senger to get on, so the passenger the uninsured are vitally important to Transporting proteins that need to stays off.” The vehicle moves along, the healthcare system as a whole, for leave the cell to function is essential. but it can’t carry passengers. their costs must, in the long run, be After they are manufactured on mem- The Erv29p receptor may have borne by us all as their lack of treat- branes in the cell interior, the proteins parallels in higher cells or there may ment negatively affects society. It is are captured in little vesicles that take be other receptors as well, and diseases our moral duty to see that every per- them to the cell boundary for dis- related to faulty secretion could be son in this great nation has access to charge. Packaging the proteins to linked to flawed receptors. In humans, this basic human right. board the vesicles takes a series of evidence suggests that a protein simi- At DMS, we are working actively steps not yet well delineated. lar to Erv29p is required to get a to combat this problem.Through our “Internal membranes have thou- blood clotting factor out of cells, so Center for Evaluative Clinical sands of proteins in them and some of genetic mutation that causes a form of Sciences, and in concert with the those proteins depend on vesicles to hemophilia is linked to a protein like Rockefeller Center at Dartmouth, we travel to another location. But the first the one documented in yeast. are actively pursuing new solutions to this crisis, and are working with oth- ers around the nation to implement changes in public policy. I am very proud that DMS is a national leader in this area, and I strongly encourage each one of you to think about ways in which you might become involved with this important cause. John C. Baldwin, MD Dean, Dartmouth Medical School Flying SquirrelFlying Graphics Vice President for Health Affairs, Dartmouth College Charles Barlowe, PhD November/December 2001 DMS Digest 3 hat would you do if you associate professor of psychiatry and management, giving educational sup- were stuck in a small room of community and family medicine, port for crew-members-turned-care Wwith half a dozen people an expert on problem-solving treat- providers, pre-mission training sup- for two and one-half years? Would ment for depression, and Albert W. port, and providing a resource to you be exasperated? Would you func- Holland, PhD, chief psychologist at ground personnel. tion efficiently? This is the dilemma NASA-Johnson Space Center. A mission to Mars would take facing the National Aeronautics & The prototype will be a comput- two and one-half to three years, Space Administration (NASA) as it er-based system to assist astronauts in including the travel time and the time plans for a long-distance space trip to preventing, diagnosing and managing spent on Mars waiting for a suitable Mars.The foundation for such a mis- psychological and social problems that exit window. Buckey, a former astro- sion rests on more than designing and could arise on a long-duration space naut who was a member of a 16-day building a sophisticated spacecraft mission.This project will merge the space shuttle mission in April 1998 capable of getting to Mars. Just as fields of psychotherapy and multime- says,“What we are dealing with is not important is the need to make sure dia to develop self-help programs for people who have psychological prob- that the astronauts on board remain prevention and treatment of psy- lems; really quite the opposite.We mentally fit. chosocial problems.A completed want to help people who are psycho- The National Space Biomedical Smart Medical System for logically strong, but are put in sur- Research Institute (funded by NASA) Psychosocial Support (SMS-PS) will roundings that are very demanding.” recently funded a research team at contain diagnostic, treatment and edu- Carter said that they would also Dartmouth to come up with a solu- cational programs geared toward every shoot video segments with screen tion for this unique problem—to foreseeable psychosocial problem, par- actors in the space station simulator at develop a prototype of computer soft- ticularly conflict resolution and NASA-Johnson Space Center in ware that could someday diagnose depression.