rochestermedicine roche stermedicine rochester · gloria s. pryhuber,m.d., a neonatologist and the...

ROCHESTERMEDICINE

OsteotoxicologyAn advocate for the study of the environment’srole in bone diseases, Edward Puzas chaseshis primary and persistent culprit, lead.

ROCHESTERMEDICINE

Eastman’s directiveMedical Center’s community health missionreaches across the institution and deep intocommunity and homes.

UNIVERSITY OF ROCHESTER MEDICAL CENTER • SCHOOL OF MEDICINE AND DENTISTRY • FALL / WINTER 2011

ROCHESTERMEDICINEROCHESTERMEDICINEUNIVERSITY OF ROCHESTER MEDICAL CENTER • SCHOOL OF MEDICINE AND DENTISTRY • VOL. 3 of 3 • 2012

Focus on AgingA psychiatrist and a new Medical Center programtake on the challenges of health care for thegrowing population of older adults.

AMan of Many HatsDavid Topham chases pathogens, talkscomputerese, and has a quest of his own.

On the coverYeates Conwell, M.D.director of the Officefor Aging Research and Health Services

The University of RochesterSchool of Medicine andDentistry Alumni Councilrecognizes the achievementsof SMD alumni through thealumni awards program.The Alumni Council relieson its fellow alumni tonominate their peers forthese prestigious awards.

Alumni AwardsCall for Nominations

All graduates of the MD, PhD, MS, and MPH programs, and former residents, are invited to submit nominations for the following awards:

The Distinguished Alumnus(a) Award recognizes achievement that hashad an impact on a national and global scale by individuals whose livesand work exemplify the standards and objectives of the School.

The Alumni Service Award recognizes outstanding support, commitment, and service which have furthered the interests of the School.

The Humanitarian Award recognizes an alumnus of the school whohas provided unique, compassionate care to patients who have specialneeds because of specific afflictions, poverty, or living conditions that lack resources.

The Alumni Achievement Award recognizes an outstanding alumnus who has excelled in teaching, community service, research, clinical and/orhealth policy, who completed their training at SMD within the last 25 years.

For a complete description of award criteria and nomination instructions, please visit www.urmc.rochester.edu/smd/alumni/alumniawards.cfm.

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- hether seeking to predict stormpaths, optimize web searches, or under-stand complex human biologicalprocesses, scientists must be able tocapture and make sense of massivequantities of information, that is,manage “big data.”

Today’s teams of biomedical scien-tists require computational andmathematical approaches to deal withthe explosion of data being generatedby sensors, electronic medical records,devices, and genomics. With powerfulnew supercomputers, investigators arecreating simulations that model humanresponses, much more quickly and safelythan traditional clinical trials.

This summer, as part of a partnershipbetween the University, New YorkState, and IBM, Rochester acquiredIBM’s Blue Gene/Q, one of the mostdynamic and efficient computer systemsin the world. Adding to our existingportfolio of supercomputers, the BlueGene/Q will provide extra musclefor the Health Sciences Center forComputational Innovation (HSCCI).Already 500 University of Rochesterscientists use high-performance super-computing in their research and thecenter has helped to attract at least$107 million in new funding. The newaddition makes Rochester one of thefive most powerful university-basedsupercomputing sites in the country.

In this issue, you will meet biologistDavid J. Topham, Ph.D., the executive

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Bradford C. Berk, M.D., Ph.D. (MD ’81,PhD ’81), CEO, University of RochesterMedical Center; Senior Vice Presidentfor Health Sciences

director of the HSCCI. David is usingthe supercomputer to build highlysophisticated mathematical modelsthat simulate the immune response toinfluenza and vaccination. You’ll alsoread about how he’s encouraging theuse of the computer to marry the datasets of teams of investigators. We canonly begin to imagine what discoverieslie ahead, as the Blue Gene/Q helps usto spot patterns in mountains of data.

And, it’s not just biomedical researchthat stands to benefit. Bioinformatics isa prerequisite for practicing personalizedmedicine, population health manage-ment, for controlling quality and costs,and more. Supercomputing holds enor-mous promise across our missions.

Watch for our next issue of RochesterMedicine, in which Rochester’s new chairof Biostatistics and ComputationalBiology, Robert J. Strawderman, III,Sc.D., talks about his vision for a focusedand thriving role in academic medicine.Statisticians are not only critical forinterpreting data in a sensible way,but they’re helping us at the front endto carefully design trials that allow usto see meaningful results and applythem broadly, and to discover patternsin big data that set the stage for futureinvestigations. Yes, mining andmanaging big data is the next big fron-tier — and we look forward to beingable to report our significant progressin the months and years to come.

ROCHESTER MEDICINE2 Vol. 3 – 20122

t’s no secret that research moneyfrom the National Institutes of Healthhas tightened, primarily because of thefederal budget and the slow pace ofthe economic recovery, and competi-tion for the available money is fierce.

The School of Medicine andDentistry has 435 grants and contractsfrom NIH, and almost 1,200 when youinclude research grants and contractsfrom all sponsors. These support about3,300 people who are directly involvedin the science or who support ourresearch enterprise.

So you can see there is much at stakeas we face one of the most challengingresearch environments in a decade. Overthe last two federal fiscal years, half of thetop 50 research schools have seen grantsupport from the NIH decline. Like mostof our peers, the School of Medicine andDentistry’s funding from grants andcontracts in fiscal 2012 was flat comparedto the past year.

While we might have done betterthan some of our peers, the cost ofscience is increasing at a higher ratethan the cost of living. Our scientistsand our research enterprise are beingseverely stressed.

We are working to develop moresupport for research on several fronts.But one of the most important is devel-oping more endowed chairs andprofessorships.

Endowments, as I say frequently,are very important for the future ofthe School. Endowments help us retainthe faculty we treasure and also recruitexcellence for the future. Endowments

also help us continue or expandresearch, teaching and clinical care.

Since we started our campaign –The Meliora Challenge: The Campaignfor the University of Rochester – wehave received gifts that have estab-lished 25 new endowed chairs orprofessorships.

This issue of Rochester Medicineincludes a report on Georgia Gosnell,and her late husband, Thomas, whohave been generous and long-timesupporters of the University and theMedical Center. Mrs. Gosnell hasdecided to use $3.1 million from theirprevious philanthropy to establishtwo permanent endowed professorships:Timothy E. Quill, M.D. (M ’76, R ’79),receives the Georgia and ThomasGosnell Distinguished Professorship inPalliative Care, while Robert J. Panzer,M.D. (R ’80, FLW ’82), receives theGeorgia and Thomas GosnellProfessorship in Quality and Safety.

At convocation in August, I tookpart in awarding 11 endowed chairs andprofessorships, seven of which are new.This is a tremendous boost for ourSchool. As you will read in this issue,we have new endowed positions innephrology, anesthesiology, pediatrics,neuromedicine, orthopaedics, neuro-muscular research and family medicine.

This is just the beginning, a veryimportant beginning. Before we beganthe campaign, we had 39 endowedprofessorships. Our goal is to doublethat number by June 30, 2016. We’reclosing in on our goal, but I’m thinkingwe can surpass it.

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Mark B. Taubman, M.D.Dean of the School of Medicineand Dentistry, Vice Presidentfor Health Sciences

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CONTENTS

FEATURES

DEPARTMENTS

ROCHESTER MEDICINE

Rochester Medicine is published by: The University of Rochester Medical Center,Department of Public Relations and Communications, in conjunction with theDepartment of Alumni Relations & Advancement for the School of Medicine & Dentistry.Associate Vice President forPublic Relations andCommunications Teri D’AgostinoEditor Michael WentzelContributing Writers Lori Barrette, Emily Boynton, Heather Hare,

Mark Michaud, Leslie Orr, Tom Rickey,and Leslie White

Art Director Mitchell ChristensenPhotographer Ken HuthFor questions or comments, contact: Department of Alumni Relations andAdvancement for the School of Medicine and Dentistry300 East River Road, Rochester, NY 14627800–333–4428 585–273–5954 Fax 585–461–2081Comments on this issue, e-mail: [email protected]

4 A Man of Many Hats: David Topham chases pathogens,talks computerese, and has a quest of his own.

12 Focus on Aging: A psychiatrist and a new Medical Centerprogram take on the challenges of health care for the growingpopulation of older adults.

20 Medical Center Rounds28 Philanthropy32 Alumni News34 Student Life36 Class Notes

444 In Memoriam

Find the School of Medicine and Dentistry on Facebook at:www.facebook.com/urmc.education

Write to us!Rochester Medicine welcomes letters fromreaders. The editor reserves the right to selectletters for publication and to edit for style andspace. Brief letters are encouraged. Please send to:

[email protected]

Rochester Medicine Magazine601 Elmwood Avenue, Box 643,Rochester, NY 14642.


Virus infected lung airway stained for CD4T Cells (blue) and CD8 T Cells (red)

A Man of

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By Michael Wentzel

Ask biologist and influenza researcher

David J.Topham, Ph.D., what he does

at the University of Rochester Medical

Center and you could get a long answer.

Topham is a University vice provost and executive director ofthe Health Sciences Center for Computational Innovation.

He is director of the National Institute of Allergy andInfectious Diseases (NIAID) Respiratory Pathogens ResearchCenter, which is based at the Medical Center.

He is co-director of the New York Influenza Center ofExcellence (NYICE), also at the Medical Center.

A professor of microbiology and immunology in theDavid H. Smith Center for Vaccine Biology and Immunology,Topham also oversees his research lab and mentors scientists.

“I do wear a lot of hats,” he said.Topham has so many jobs that he has to use two business

cards because he can’t fit all his titles on one card.“David Topham is a productive and insightful scientist.

His leadership and his versatility are essential for our research

utilizing high-performance computers,” said Mark B. Taubman,M.D., dean of the School of Medicine and Dentistry.We’re aiming high and we have confidence the potentialwill become results.”

A biologist by inclination and by training, Topham hasconcentrated his research on immune responses to virus infec-tions, with an emphasis on respiratory infections and influenza.His early career work produced a series of significant and influ-ential papers establishing the relative importance of CD4and CD8 T cells, B cells and cytolytic pathways in controllinginfluenza in the respiratory tract. After joining the MedicalCenter faculty, he shifted his research to secondary immunityand mechanisms of cross-reactive immune responses toinfluenza.

He and his team discovered that the collagen IV-bindingalpha-1 integrin is essential for establishing and maintainingmemory CD4 and CD8 T cells in the respiratory tract.In the absence of these tissue-memory T cells, protection fromsecondary infection is severely diminished in spite of substan-tial memory in the lymphoid organs. These studiesdemonstrate the critical role of tissue-localized memory forimmune protection in non-lymphoid peripheral tissues.

Topham has moved into clinical and translational studies

DavidTopham chases pathogens,talks computerese and hasa quest of his own.

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Many HatsA


of human immune responses to natural infection and experi-mental vaccines, with a major emphasis continuing to becross-reactive T and B cells. Working with computationalbiologists, he has developed highly sophisticated mathematicalmodels that simulate the adaptive immune response toinfluenza.

His newest hat is as director of the Respiratory PathogensResearch Center (RPRC) that NIAID views as a resourceto do research on respiratory infections, targeting most otherfungal, bacterial and viral pathogens, but excluding mycobac-terium tuberculosis.

“It surpasses anything we’ve ever done in ambition andcomplexity,” Topham said. “I’m called the director but I’m onlya ringleader. This is the work of many people. We had to havea very substantial infrastructure to do the studies they want usto do. I can’t take credit for winning the award. We’re relyingon expertise in Rochester, which is substantial.”

Ann R. Falsey, M.D. (R ’86, FLW ’91), professor of medicineat the Medical Center and an infectious disease specialist atRochester General Hospital, helps direct the RPRC. She isan internationally known expert on respiratory syncytial virus(RSV) and leads the team’s efforts to understand the virus andany future trials of vaccines and treatments.

More than a dozen researchers are involved in the RPRC.Edward E. Walsh, M.D. (R ’77, FLW ’82), a professor of medicineat the Medical Center and also an infectious disease specialistat Rochester General, for example, is investigating severeRSV disease in children younger than one year of age.Gloria S. Pryhuber, M.D., a neonatologist and the GeorgeWashington Goler Professor of Pediatrics at the MedicalCenter, is building on her well-established work in inflamma-tory lung disease in children.

The RPRC establishes a new model for the way researchwill be conducted in the future, Topham said. The New YorkInfluenza Center of Excellence, for example, follows a tradi-tional model in which individual investigators conductindividual projects in their own research domain.

“It’s all focused on influenza, but it is not necessarilya coordinated effort where all the resources of the center focuson a small number of problems,” he said. “The RPRC isdifferent. We research questions that could come from NIAIDor from clinical faculty. We build an infrastructure to addressthe questions that involves many different technologies.For one investigator to do all these together is a lot. By havinginvestigators each take a piece, we can address some big ques-tions and do it in a coordinated fashion. The idea is tointegrate data sets once they have been generated by thedifferent investigators. We’re pulling in new investigators andnew resources from across the University. This is how researchis going to be done down the road.”

Topham envisions a project on lung infection that notonly involves a study of gene expression, but also investiga-tions of microbes present in the gut and the respiratory tractduring infections and how that conditions the immune system.This data would be combined with disease information andmedical histories from subjects themselves to better determinehow the disease works and how vaccination works.

“It’s pretty ambitious,” he said. “It requires multiple inves-tigators. You have to be able to organize them, keep themfocused and keep them happy.”

Blue Gene musclesThese days, Topham also often finds himself knee-deepin the world of high-performance supercomputers with hiswork in the Health Sciences Center for ComputationalInnovation (HSCCI).

For the last seven years, he has been involved in a projectutilizing mathematical modeling of immune responses toinfluenza. It has transformed into an informatics approach,studying gene expression, proteomics, cellular parametersand clinical parameters to try to develop a multi-level modelto identify the key control points of the immune responsesto flu vaccination. This project in the Center for BiodefenseImmune Modeling at the Medical Center, directed by MartinZand, M.D., Ph.D., and Hulin Wu, Ph.D., demonstrates thepossibilities of biomedical informatics, Topham said.

This summer, as part of a partnership between theUniversity and IBM, the University received IBM’s BlueGene/Q, one of the most powerful and efficient computersystems in the world. The Blue Gene/Q will provide additionalmuscle for the HSCCI that Topham leads.

In 2008, the University created the HSCCI in partnershipwith IBM. In the same year, IBM gave an earlier generationBlue Gene supercomputer system – the Blue Gene/P – to theUniversity. Since that time, more than 500 scientists at theUniversity have used high-performance computing in their

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We build an infrastructure to address the questions that involves manydifferent technologies. For one investigator to do all these together is a lot.By having investigators each take a piece, we can address some big questionsand do it in a coordinated fashion.”

Virus-infected trachea stained for ICAMantibody

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Virus-infected trachea with CD8 T Cellsstained red and CD 31 T Cells stained green

Topham has moved into clinical and translational studies of human immuneresponses to natural infection and experimental vaccines, with a majoremphasis continuing to be cross-reactive T and B cells.

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research and the center has helped attract at least $107l;million in new funding.

“I’m not an IT whiz and some of this goes way beyondmy personal comfort zone,” Topham said. “But one of thethings I am realizing is that I am good at is getting people towork together. I’m good at setting up collaborations, good atidentifying scientific direction for different projects. It’s not myskills in computing or modeling or even immunology that werereasons they wanted me to lead the center, but becauseI could communicate with computational biologists and ourresearchers. I know enough about both domains to at least getthe conversation started. I can identify who should be talkingto one another and facilitate those collaborations.”

Falsey agreed with Topham’s self-assessment, saying he isquite adept at identifying good people and bringing themtogether for productive collaborative research.”

“He has a unique ability to understand the science ofrespiratory research on a very deep level yet also has the visionto imagine what a center should be and how to grow aprogram,” she said.

The HSCCI should move to expand more deeply intocomputational biology, Topham said.

“I am encouraging everyone to move in that direction.I am looking at investigators across the University who haveinformatics or computational needs but don’t know how toaccess the technology,” Topham said. “I view one of my rolesas opening up these tools to those investigators. There areopportunities all over the place for others to benefit.”

At meetings with high-performance computer scientists,Topham admits, he finds it difficult to “talk the talk.”

“But that isn’t what they need,” he said. “What we need

are translators. When you have computational biologists,mathematicians, statisticians and basic immunologists, biolo-gists and clinicians come together, they talk differentlanguages. They can work together, but they find it very hardto communicate. We have a data problem. We need to buildthe translators who work at the interface of molecular biolo-gists, the cellular biologists and clinicians and people who usecomputational and mathematical approaches to deal with thedata that is generated. We now can generate far more datathan we can ever analyze or interpret, so we have to createtools and methods and hardware and software to really makethe most of the studies we are doing and data we generate.”

Topham and others at the University are discussinga training path for “translators” that could develop intoan undergraduate and graduate program.

Part of a grand planKristin M. Scheible, M.D. (M ’04, R ’07, FLW ’10), assistantprofessor of pediatrics at the Medical Center, found herself inTopham’s lab as a neonatology fellow. She had little laboratorytraining, but was interested in a research career.

“I soon learned that Dave’s willingness to take on thetraining of novices is not a common trait in competitiveacademic research,” Scheible said. “It is a characteristic,however, that defines him as a scientist. Dave is consistentlyable to identify potential in his trainees as future scientistsmoving the field forward, potential in his colleagues as futurecollaborators, potential in new technology to advancediscovery, and potential in ideas to enrich scientific under-standing. He approaches other perspectives, whether clinically

“


or laboratory-oriented, with a positive attitude, providinga fertile environment for novel ideas and connections.No idea or individual is ever dismissed.”

Although Topham’s lab focuses on influenza research,he provided guidance and resources to Scheible so she couldpursue her own research interest in neonatal T cells. For sometime, Scheible said she could not envision how her work wouldbenefit the lab’s mission. After several years, Scheible said shesaw the grand plan.

“One of the priority projects for the Respiratory ResearchPathogens Center addresses infant immune development,specifically how an infant’s T cell responses are shaped by theviruses and bacteria to which they are exposed,” Scheible said.Partly through his investment in my tangential project,he was able to build collaborations and experience thatresulted in a fundable translational study. This was one moreexample of Dave’s ability to focus beyond the present and hiscommitment to a bigger vision that moves science forward.”

Topham’s Tcell questSince he was a post-doctoral fellow more than a dozen yearsago, Topham has maintained a personal quest as a scientist.

“I always have wanted to understand how cytotoxic T cellsfunction in the airways,” he said. “Influenza is an infection thatonly takes place in the epithelial cells that line the respiratorytract. Immune cells have to get from the lymph nodes throughthe blood to the tissue and then exit to the epithelial layerwhere they seek out infected cells and kill them. That meansthey have to move a lot. We don’t know how this is regulated.We have some ideas of what molecules and receptors might beimportant, but no one has been able to directly test at the siteof the infection in tissue to see how these cells work.”

The technology now exists to make site visits possible.Using a multiphoton microscope, scientists can image the cellsin real time in live animals.

“We can watch the cells migrate. We can interfere withthem. We can see the target cells,” Topham said. “We’re tryingto study the environment of the tissue, the proteins that formthe structure of the tissue, because the T cells have to interactwith those structures. I want to see this project developbecause it is important. This is where we will find new waysto combat infection. Having virus-specific T cells in theairways at the time you encounter a new infection means youcan resist an infection more effectively. If we can immunizein a way to place those cells in those locations, we would havebetter vaccines. First, we have to understand how they getthere, how they stay there, and how they move around beforewe can figure out how to immunize in a way that promotesthose cells.”

His work with the New York Influenza Center ofExcellence (NYICE), which is directed by John J. Treanor, M.D.(M ’79, FLW ’85), has echoes of his personal research target.

“Our main question is: How does an influenza infectionor vaccination affect the immune system?” Topham said.

How did the virus or vaccine modify someone’s immune status?Were more antibodies elicited or different kinds of antibodiesthat could neutralize the virus or cross-react with other viruses?Would the virus or the vaccine modify T cells, what theirspecific functions are?”

A better understanding of the immune response toinfluenza could result in the ability to design a way to immu-nize so the immune system would cross-react to manyinfluenzas.

“Some people call it a universal vaccine. I hesitate to saythat. It is almost a cliché,” Topham said. “We know cross-protection exists, but we don’t know enough about how itworks. So, we have a lot of projects focused on it. The jury isstill out on this but we (the NYICE investigators) found that,with CD4 T cells, the immune system predominantly respondsagainst pieces of the influenza virus that it has seen in the past.

“With the CD8 response, we actually found the nearopposite. When the immune system sees a new virus, not onlydoes it respond with T cells that have seen the influenzabefore, it also mounts new responses to the virus to things thatare unique to the new infection. That is a pretty fundamental,new piece of information. We now know the immune system,at least in healthy young-to-middle-age adults, remains plasticand mounts new responses. That is important if you want todesign a vaccine. If you can’t respond to new things, you wantthe vaccine to contain a lot of the old things that areconserved among many viruses. If they can see new thingsyou can immunize and tailor it to what is circulating today.”

Topham’s enthusiastic commitment to his work is infec-tious too, Treanor said.

“I think David has a remarkable ability to remain opti-mistic in the face of daunting challenges, and to see theopportunities in situations that may not be obvious to others,”Treanor said. “Both of the two large projects that I aminvolved in with David, NYICE and the RPRC, were reallyintense competitions with other groups, most of which wereconsiderably larger and probably more accomplished than wewere. But David has this vision of ways that we can contributesomething that others can’t and this real knack for figuring outthe pathway for bringing a lot of people together in uniquecollaborations.

“Obviously, it’s driven by a very broad understandingof scientific topics from multiple points of view, but it’s alsoa product of a very engaging personality and this sort ofcan-do” perspective towards problem solving. David isextremely passionate about his work, and I think that rubs offon others also.”

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Vol. 2 – 2012 11

“I’m not an IT whiz…but one of the things I am realizing is that I am good atis getting people to work together. I’m good at setting up collaborations,good at identifying scientific direction for different projects. It’s not my skillsin computing or modeling or even immunology that were reasons theywanted me to lead the center, but because I could communicate withcomputational biologists and our researchers…. I can identify who should betalking to one another and facilitate those collaborations.”

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By Michael WentzelEmmy Award-winning producer and director ManvilleJennings never shows a sign of deep depression or anger in aUniversity of Rochester Medical Center video during which hediscusses the impact Alzheimer’s disease is having on his life.

He can no longer drive, he says, but then Jennings stopstalking, becomes lost in his thoughts and cannot describe howother aspects of his life have changed. No cure to the diseasethat is erasing his memory will be found in his lifetime but,Jennings says, he considers himself lucky to have nearbydoctors and others who are conducting research on Alzheimer’sand also providing excellent care.

Jennings is a patient in the Medical Center’s MemoryCare Program, through which patients and their familiesreceive services from a multi-disciplinary team of clinicians,including specialists in neurology, psychiatry, geriatrics,neuropsychology, social work, nurse practice, and marriage andfamily therapy.

The Memory Care Program provides much-needed care tomany like Manville Jennings, but its effectiveness and successare threatened. An estimated 30,000 people in the Rochester

region have Alzheimer’s disease or a related dementia.The program is overwhelmed with requests for care.

The Memory Care Program is one of the first targets forthe Office for Aging Research and Health Services (OARHS),which was created by the Medical Center this year to investi-gate, test and develop novel, more efficient and lower costways to provide health care to the elderly that are coordinatedwith community and regional services and partners.

“The Memory Care Program is world class,” said YeatesConwell, M.D., the director of OARHS. “But, based ona traditional clinic approach to care and constrained bycurrent reimbursement schemes, it is not a sustainable model.They can care for only a fraction of the enormous and rapidlygrowing number of people who need the services.

“We’re still operating in a fee-for-service reimbursementsystem through a hospital program that is very constrainedby what the Centers for Medicare and Medicaid Services willallow providers to bill for. It’s components of comprehensivecare that are not now reimbursed – care management andsocial work services, for example – that will impact cost and

A psychiatrist and a new Medical Centerprogram take on the challenges of health carefor the growing population of older adults.

Focus onAging


quality and outcomes. Alzheimer’s is a quintessential chronicdisease. How do we provide better care, a better experience ofcare and at a lower cost? The answer lies in innovativeapproaches that fully integrate and pay for both medical andpsychosocial services.”

As a professor of psychiatry at the Medical Center andan internationally known researcher in suicide prevention,Conwell might seem like an unlikely person to direct an officeaimed at redesigning health care systems.

But Conwell has helped develop successful programs withcommunity partners that improve mental health care for theelderly. And, earlier this year, he was selected as one of73 people from across the country, and the only psychiatrist,to serve in the Centers for Medicare and Medicaid Services’(CMS) Innovation Advisors Program.

The initiative, launched by the CMS Innovation Center,aims to develop a cadre of professionals with the skills to driveimprovements to patient care and reduce costs nationwide.Among other duties, the advisors support the Innovation

Center in testing new models of care delivery and also formpartnerships with local organizations to drive delivery systemreform, and improve their own health systems so their commu-nities have better health and better care at a lower cost.

“The advisors program is a wonderful educational experi-ence for me,” Conwell said. “I’m gaining insights into what thelarge national priorities are for health system redesign andbringing them back to the Medical Center. Through OARHS,we can shape the resources we have here in ways that make usa highly innovative institution as it relates to health care forolder people. Over the years I’ve been at the Medical Center,it’s been clear that the University has tremendous strengths inregard to aging, from basic science right up through the designand delivery of health services.

“The Medical Center is a health system that aspires totake on new responsibilities for a large population of olderpeople throughout our region. I see the role of OARHS ashelping faculty and staff across our mission areas-clinical care,education, research and community service-to understand

”I’m gaining insights into what the large national priorities are forhealth system redesign and bringing them back to the MedicalCenter.Through OARHS, we can shape the resources we havehere in ways that make us a highly innovative institution as itrelates to health care for older people.”—Yeates Conwell, M.D.

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the challenges and opportunities, to think creatively and drawon resources across traditional boundaries to achieve betterhealth, better-quality care and lower cost for older adults.This is about facilitation, collaboration, connecting the dots.”

The rewards of collaborationClinical depression is common in later life and often leads toother problems, including poor health outcomes, higher costsfor health care and institutionalization, and premature deathdue to suicide or other causes.

Identifying elders at risk and providing care can improvehealth and hold down costs, as well as prevent self-destructiveacts. Because social factors are so prominent in depressiveillness, engaging social service agencies in its recognition andmanagement is a promising strategy. In 2006, Conwell receiveda National Institute of Mental Health grant of $2.57 million fora project that established a unique partnership with Rochesterarea aging services agencies, Eldersource Care Management

Services, Lifespan and Catholic Family Center. The partner-ship became known as the Senior Health and ResearchAlliance, or the SHARE Alliance.

SHARE Alliance activities have included: training agencycare managers in the detection and basic management of late-life mental illness and the assessment and management ofsuicide risk, adopting a routine of screening for mental disor-ders in agency clients, revising the data management systemsof the agencies to support research, and conducting researchstudies. Thousands of people in the Rochester region havebeen assessed for depression and other issues and receivedinterventions from SHARE Alliance partners.

In 2010, the Centers for Disease Control (CDC) awardedConwell and the Medical Center $2 million for another projectdesigned to test whether linking lonely and socially discon-nected seniors with other caring older adult volunteers reducesthe risk of suicide. The volunteers have been recruited, trainedand supervised by Lifespan Inc., the largest aging servicesagency in the Rochester region and the Medical Center’s


partner in the research.These projects demonstrated to Conwell and others the

rewards to older adult health of linking an academic medicalcenter with community-based social service agencies in collab-orative projects

“The nature of the work we do as care providers willchange a lot over the coming few years,” Conwell said. “Healthcare inevitably is moving farther afield. We need to beproviding support for the delivery of care to older adults inprimary care offices and other sites beyond the walls of theMedical Center.

Conwell and his colleqgues at URMC recognize that tomeet the Institute for Health Care Improvement’s Triple Aim– improving the patient experience, improving the healthstatus of populations, and reducing the cost of care – willrequire approaches that are both multidisciplinary and highlycoordinated. “We have to raise awareness of people in ourcommunity about the challenges we face and the importanceof working together to come up with creative solutions.

I don’t believe you can give cost-effective health care, forexample, to someone with a complex disorder that has socialimplications without engaging social services in the care ofthat person.”

Among other goals, OARHS aims to obtain grants fromthe Center for Medicare & Medicaid Innovation (CMMI),the federal Patient Centered Outcomes Research Initiative(PCORI) and other sources to support the study of newapproaches to care from health care systems and communityorganizations.

“Calls for proposal come out and suddenly you havepeople sitting around the table who have never sat togetherbefore and they are coming up with ideas and generating caremodels that show we can get better outcomes and for lessmoney,” Conwell said. “Now that these discussions havestarted, OARHS has a responsibility to nurture them andto help ensure they yield fruit.”

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A map for patientsAnother OARHS activity is the recently inaugurated, “Agingin Context Project,” a geospatial mapping and database linkageproject that will build a foundation for future regional healthand services initiatives.

“The objective is to make a comprehensive repository ofdata that is useful to patient-centered medical homes, the servicesystem, policy makers and others for personalizing care andtailoring the array of resources to what the community needs,”Conwell said. “In addition to the health and service utilizationinformation available from the medical record, we’re collectinginformation, for example, on the location of parks, bus lines, side-walks, shopping malls, types of housing. There are data on crime,outlets where alcohol is available, but also places where freshproduce is available.”

With such a set of linked databases, a physician could askspecific questions about an individual patient. Say you wanted todefine the risk of an elderly patient being hospitalized orrequiring readmission after discharge. In addition to the usual risk

stratification metrics, put in the addresses of the patient, theprimary care office and of the patient’s caregivers and relatives,and information about the means by which they interact. Addinformation about access to exercise options and proper nutri-tion, or the closeness of a bar or place to buy alcohol.

“With the necessary research and sophisticated computermodeling, we might get much better at determining who needswhat kinds of extra services to remain safe and well in thecommunity after discharge,” Conwell said. “With new financialpenalties to hospitals for readmission of Medicare patients withina month of discharge, there is a strong financial incentive to dothis kind of work as well.”

At the practice level, the database could give a patient-centered medical home a portrait of its population of patientsand how that population related to community-based servicesmost needed by patients. At the system level, policy makerscould see utilization of services, the needs of patients and theavailability of services that could result, for example, in a deci-sion to relocate bus lines.

I see the role of OARHS as helping faculty and staffacross our mission areas-clinical care, education, researchand community service-to understand the challengesand opportunities, to think creatively and draw on resourcesacross traditional boundaries to achieve better health,better-quality care and lower cost for older adults.”

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Another OARHS target is mobility. Falls account for a largeproportion of costs of emergency room visits and hospitalizations,as well as mortality, of older people.

The Geriatric Fracture Center at Highland Hospitalhas taken a lead in management of fall-related injuriesand in the prevention of falls. Conwell wants to find waysto coordinate Highland’s expertise with that of other centersof excellence in the Medical Center that are relevant to fallsprevention – orthopaedics, physical rehabilitation, neurologyand ophthalmology – to create a more complete continuumof care that excels not only in the treatment of fractured hipsfollowing a fall, but the prevention of falls and injuries as well.

The SilverTsunamiThe Memory Care Program project showcases what Conwellhopes to accomplish with OARHS.

“People with memory disorders are more than two timeslikely to end up in the hospital, where care is often chaotic,”

he said. “Take them out of their familiar environment and putthem in a noisy, fast-paced, scary place like a hospital andthey don’t do well. So, they take a lot of hospital resources.The hospital experience is bad for them and expensive andthe outcomes are not very good.

“Dementia is a complex illness, a long process that unfoldsin variable ways over time. At each stage, there is need forservices that under current payment schemes are unreimbursedor poorly reimbursed. Without attention to these elementsof care, patients utilize greater amounts of expensive servicesto their detriment. We think we can prevent some of thatby redesigning a system upfront that cares for more peoplein better ways. And we think that by doing things differentlywe can ultimately save the Medical Center money.”

Conwell is working on the pilot project with CarolPodgorski, Ph.D., M.P.H., associate professor of psychiatry,Lisa Boyle, M.D, M.P.H., assistant professor of psychiatry,and Frederick J. Marshall, M.D., associate professor ofneurology and director of the program. It targets a segment


By improving our interface with primary care practices andsupporting providers’ ability to diagnose and manage the mostcommon forms of dementia, our goal is to extend the highestlevel of care to the community.”— Frederick J. Marshall, M.D.

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of the program’s patients by adapting elements of a dementiacollaborative care model developed at Indiana UniversityWishard Health Aging Brain Center.The key element of the model, according to Boyle, is usinga team-based approach for assessment and management ofboth the patient with mild cognitive impairment or dementiaand family caregivers. The pilot incorporates the use of adementia care coordinator, who works along with specialistsat the Memory Care Program, and the patient’s primary carephysician.

The dementia care coordinator’s role includes conductingsystematic screening for common problems associated withdementia and caregiver-related stress, coordinating the recom-mended treatment for the patient and family caregiver withthe providers, and linking the patient and family to commu-nity resources.

“By improving our interface with primary care practicesand supporting providers’ ability to diagnose and managethe most common forms of dementia, our goal is to extend

the highest level of care to the community,” said Marshall.In so doing, our hope is to create systems of care that decreasethe rates of potentially avoidable hospitalizations for thesepatients, and that buttress the supports available to care-givers.

OARHS will have results from the pilot project sometimein 2013.

“Older people are the fastest growing segment of our popu-lation,” Conwell said. “Whether you call it the Silver Tsunamior the Golden Wave, the challenge is real. This is a large groupof people that consumes a tremendous amount of health careservices and a lot of health care dollars and we are notprepared for their care. The challenge is local, regional andnational. We have a set of resources in the Rochester area thatare very strong in relation to issues of aging and health butthey haven’t really been knit together in a way that allows usto optimally meet this challenge. This has to go forward.We can’t stand still. OARHS gives us a framework to do so.”

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medical center rounds

existing board. The Medical Center also willappoint representatives from Thompson Healthto its existing board of directors.

The Thompson Health parent corporationwill retain its own local President/CEO. MichaelStapleton, who had been Thompson’s executivevice president and chief operating officer,became president and chief executive officer inJuly when Farchione retired.

Following months of strategic planning betweenthe University of Rochester Medical Center andThompson Health in Canandaigua, N.Y., leadersfrom both organizations officially agreed tomake Thompson Health an affiliate of theMedical Center.

The Thompson Health affiliation, which wasannounced in June, came after several monthsof discussions, due diligence, and boardapprovals involving administrative leaders,physicians, and board members among the twohealth systems.

“This affiliation between Thompson Healthand the University of Rochester Medical Centeroffers a great opportunity to bring a truly inte-grated delivery system to the Finger Lakesregion,” Linda Farchione, then-president andchief executive officer of Thompson Health,said in June. “It will allow for coordinatedservice delivery of all levels of health care closeto home.”

“Thompson Health is unquestionably one ofthe most progressive, well-run, and medicallyrobust health systems in our region, so it isa natural fit with the Medical Center’s familyof providers,” said Medical Center CEO BradfordC. Berk, M.D., Ph.D. (M ’81, PhD ’81). “Workingtogether, we have enormous potential toimprove the health of our region.”

Berk said that by partnering, a seamlessnetwork of health care delivery will be createdallowing patients to access many differentlevels of care at a variety of locations. Bothview the affiliation as an extension ofsuccessful partnerships that already existbetween the two health systems within manymedical and surgical specialties, includingcardiology, neurosurgery, oncology, imaging andmore.

Another community benefit of this collabora-tion will be that hundreds of Ontario Countyresidents who are admitted to Rochester’sStrong Memorial Hospital each year will be ableto receive the health care they need muchcloser to home at Thompson. This not onlybenefits Ontario County patients, but also freesup specialty and sub-specialty care beds,

only available at Strong Memorial Hospital,for patients throughout upstate New York.

The parent corporation, Thompson Health,will remain intact and will continue to overseeand govern Thompson’s subsidiary corpora-tions including F.F. Thompson Hospital, theM.M. Ewing Continuing Care Center, FFTHProperties, F.F.T. Senior Communities (FerrisHills and Clark Meadows) and the F.F.Thompson Foundation.

Thompson Health will continue to operateunder the guidance and leadership of its existingboard of directors comprised of members of thelocal community. Thompson will add new repre-sentatives from the Medical Center to the

Canandaigua hospital formallyaffiliates with Medical Center

Thompson Health is unquestionably one of the most progressive,well-run, and medically robust health systems in our region,so it is a natural fit with the Medical Center’s family ofproviders.”— Bradford C. Berk, M.D., Ph.D., Medical Center CEO

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State fundsmedical trainingat Rochester

The University of Rochester Medical Center hasreceived a $344,000 New York state grant for athree-year project to expand and improvetraining and education of School of Medicineand Dentistry medical students and residentswho deliver primary care at Culver MedicalGroup.

Residents will use mannequins and othertools to learn how to perform common officeprocedures such as injections to knees andankles, skin biopsies, and tracheotomy care.The program will focus on the management ofcomplex, chronic diseases that originate inchildhood (cystic fibrosis and sickle cell disease,for example), but require well-coordinated careinto adulthood.

The Culver Medical Group is a freestandingprimary care center owned by the MedicalCenter. Its mission is to care for medicallyunderserved people who live in Rochester, byusing fresh ideas and innovative, evidence-based approaches to care.

The grant was awarded through the Doctors

Across New York Ambulatory Training Program,which is designed to defray the costs of clinicaltraining and placement of physicians. StateHealth Commissioner Nirav R. Shah, M.D.,M.P.H., announced the awards to train 1,000medical residents and students at 43 commu-nity-based sites.

“This project is a great opportunity to rein-vigorate the outpatient training experience,with both case-based teaching sessions andhands-on procedural curriculum,” said RobertFortuna, M.D., M.P.H., co-director of the traininggrant and an assistant professor of medicineand pediatrics at the Medical Center.

Brett W. Robbins, M.D. (R ’97), serves asprogram director of the Internal Medicine-Pediatrics residency, and Tiffany Pulcino, M.D.,M.P.H. (R ’08), is a co-director of the grant.All three provide full-time care at CulverMedical Group.

Since 2001 the Culver Medical Group hasbeen involved in training medical residents whowant to learn about primary care in an outpa-tient setting. Twenty eight residents work underthe supervision of seven Internal Medicine-Pediatrics faculty members. Local and nationalmedical students also rotate through theprogram.

The Medical Center’s grant is among$10.6 million in total funding awarded to17 New York health care institutions.

Pluta CancerCenter mergerproposed

The Medical Center has announced a Memor-andum of Understanding with the Pluta CancerCenter that could lead to an eventual merger ofthe two organizations.

Pluta, which is located in Henrietta, N.Y.,sought a community partner, largely in responseto the rapidly changing healthcare environment.

Founded in 1975 through a generous gift ofthe Pluta family, the Pluta Cancer Center has astaff of 42, including two radiation oncologistsand three medical oncologists. The Center seesapproximately 500 new patients each year,yielding about 19,000 patient visits.

“Bringing together the scope of servicesprovided at our Wilmot Cancer Center and thePluta Cancer Center makes good sense for anumber of reasons,” Berk said when the memo-randum was announced in July. “Pluta hasa rich, well-deserved reputation within ourcommunity for providing high quality, patient-centered care, much in line with our owninitiatives.

We are leveraging the strengths of bothorganizations and raising the bar even higheron the quality of care we can provide to patientsin our region.”

Pluta would provide the Medical Center anoff-site location that offers additional conven-iences for some patients and add a larger poolof candidates for clinical trials. The ability toprovide service at a second location also offersthe Wilmot Cancer Center added flexibility, withthe possibility of relocating some services toPluta to provide room for future growth inprograms at Wilmot.

The process leading to an actual merger ofURMC and Pluta is expected to be complete byearly 2013.



“For 20 years we studiedmyotonic dystrophy, hopingthat someday we would learnenough to spot its Achillesheel. This work comes closeto doing that.”— Charles Thorton, M.D.

Antisense’could lead toa treatmentfor musculardystrophy

By Tom RickeyScientists have reversed symptoms of myotonicmuscular dystrophy in mice by eliminating abuildup of toxic RNA in muscle cells.

After experimental antisense compoundswere administered to mice twice a week forfour weeks, symptoms of the disease werereduced for up to one year, a significant portionof a mouse’s lifespan.

The investigators say that while the work isan encouraging step forward against myotonicdystrophy, one of the most common forms ofmuscular dystrophy, it’s too soon to knowwhether the approach will work in patients.But they are cautiously optimistic, noting thatthe compound is extremely effective atreversing the disease in a mouse model.

The work, carried out by scientists at theUniversity of Rochester Medical Center,

Isis Pharmaceuticals Inc. and Genzyme, waspublished in August in Nature.

“These results give us strong encourage-ment about the possibility of developing atreatment that could fundamentally alter thedisease. It’s an important step on a long path,”said senior author Charles Thornton, M.D.,a neurologist at the Medical Center who hasbeen pursuing new treatments for the diseasefor more than two decades.

“But, it’s too early to know if this treatmentwill work as well in people as it did in the labo-ratory. Unfortunately, in biomedical researchthere are previous examples of compounds thatworked in mice but not in people,” addedThornton, the Saunders Family DistinguishedProfessor in Neuromuscular Research.

The recent progress comes about a decadeafter several scientists, including Thornton,discovered that the genetic defect that causesthe disease works quite differently than mostother inherited diseases. In many diseases,a genetic flaw means that an important proteinis not made correctly, or not made at all.

But in myotonic dystrophy, the defect resultsin the creation of an abnormal messenger RNA,which accumulates in the nucleus, getting in theway and stopping other proteins from doingtheir jobs. One of those proteins is MBNL1,which helps create chloride channels that areimportant for electrical control of muscles.When that process is thwarted, muscles senderrant electrical signals, causing symptoms.

The approach outlined in the Nature paperexploits the roots of the defect, harnessing anenzymewhose usual job is to cut RNA into pieces.Working closely with the Rochester and Genzymeteams, scientists at Isis created syntheticcompounds-short snippets of chemically modifiedDNA-that bind to the toxic RNA, modifying it insuch a way that it was targeted for destruction by

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By Mark MichaudComplex, multi-system diseases like myotonicdystrophy require physicians and patients toidentify which symptoms impact quality of lifeand, consequently, what treatments should takepriority.

However, a study published in July in thejournal Neurology reveals that there is oftena disconnect between physician and patientover which symptoms are more important, aphenomenon that not only impacts care but alsothe direction of research into new therapies.

“In order to design better therapies we mustfirst develop a clear understanding of whatpatients think are the key mental and physicalburdens of this disease,” said University ofRochester Medical Center neurologist ChadHeatwole, M.D. (R ’05, FLW ’06), lead author ofthe study. “It is clear from this study that, in thecase of myotonic dystrophy, researchers havenot always been concentrating on the symp-toms that are most important to the patient.”

Myotonic dystrophy has been characterizedas one of the most diverse and complex geneticdiseases with a wide range of symptomsranging from fatigue, muscle weakness, cogni-tive impairment, depression, difficulty sleeping,impaired vision, pain, difficulty swallowing,gastrointestinal problems, and myotonia, theinability to relax muscles after contraction thatis the hallmark of the disease.

As a result, physicians and patients areoften confronted with a bewildering array oftreatment options and researchers have previ-ously had no comprehensive method to measurethe meaningful impact of experimental thera-pies. Further impetus for a patient-centeredapproach has come from a recent push by thefederal Food and Drug Administration to requirethat new drugs take into account whatoutcomes patients feel are important.

Using a national database of musculardystrophy patients developed by the MedicalCenter, Heatwole and his colleagues surveyed278 people with myotonic dystrophy type-1. Theyasked them not only which symptoms they wereexperiencing, but which ones have the mostimpact on their lives. Answers were cross refer-

enced with the respondent’s age and a geneticmeasure, called CTG repeat length that roughlycorrelates with the severity of the disease.

The study revealed that certain symptoms likemyotonia, which are experienced by more than90 percent of individuals with the disease, areless important to patients than symptoms such assuch as fatigue, limited mobility, and sleep prob-lems. Respondents also identified specificsymptoms that have the greatest impact on theirlives. These included difficulty having children, notbeing able to stay in the standing position, anddifficulty holding down a job.

“One of the more surprising results is thatmyotonia – the condition that gives the diseaseits name – is down the list of things thatpatients feel most affect their daily lives,” saidHeatwole. “These insights will not only haveimportant implications for how patients aretreated, but also how new therapies for thedisease are evaluated by building betteroutcome measures.”

Heatwole and his colleagues have devel-oped a questionnaire for myotonic dystrophypatients that weights patient responses basedon their study findings. The questionnaire,called a disease-specific patient reportedoutcome measure is one of many being devel-oped for neuromuscular diseases at the MedicalCenter by Heatwole and his team. They willenable researchers to more precisely measurewhether the impact of experimental therapies ismeaningful to patients.

one of the body’s own enzymes, RNase H.With the team’s most effective compounds,

symptoms in the mice were reversed. The levelof toxic RNA was reduced by more than80 percent; stiffness in muscles eased dramati-cally; the microscopic structure of muscle wasimproved; and electrical signaling in musclesreturned to normal.

The possibility of targeting “toxic RNA”–a buildup of abnormal RNA causing cellularprocesses to go awry-makes myotonicdystrophy an excellent target for antisensedrugs, said Thornton.

The compounds are called “antisense”because their genetic code is the mirror imageof the target RNA strand, known in scientificparlance as the “sense” molecule. The anti-sense compound will only stick to the preciseRNA that is part of the myotonic dystrophy gene,leaving thousands of other vitally importantRNA s alone.

While antisense technology has been indevelopment for a couple of decades, it has notbeen effective at eliminating RNA in musclecells until now.

“For 20 years we studied myotonic dys-trophy, hoping that someday we would learnenough to spot its Achilles heel,” said Thornton.This work comes close to doing that … I knowit is unscientific for me to think so, but I can’thelp but see a little glimmer of ’medical justice’in this approach. For the same reason that thetoxic RNA makes people sick, by hanging aroundtoo long in the nucleus and gumming up theworks, it also becomes more susceptible to anti-sense drugs, because these drugs seem to workextraordinarily well against RNA in thenucleus.”

Now scientists at Isis and the Universityof Rochester are working to improve thecompound further, developing antisensecompounds with stronger activity against thetoxic RNA, but with minimal effects on the restof the body. An unknown factor at this point,Thornton says, is whether the compounds willalso improve the muscle-wasting aspect of thedisease. That symptom, which causes greatdifficulty for patients, has been hard for scien-tists to create in mice, and so it’s difficult topredict how it might respond to antisenseknockdown technology.

The first author of the paper is ThurmanWheeler, M.D., assistant professor of Neurologyat the University of Rochester Medical Center,who conducted many of the experiments.

In Muscular Dystrophy, what mattersto patients and doctors can differ

“It is clear from this study that,in the case of myotonicdystrophy, researchers havenot always been concen-trating on the symptoms thatare most important to thepatient.”— Chad Heatwole, M.D.

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Without PSAtesting, moremen would die,study concludes

By Leslie OrrEliminating the PSA test to screen for prostatecancer would be taking a big step backwards andwould likely result in rising numbers of men withmetastatic cancer at the time of diagnosis,predicted a University of Rochester MedicalCenter analysis published in the journal, Cancer.

The Medical Center study suggests that theprostate-specific antigen (PSA) test and earlydetection may prevent up to 17,000 cases ofmetastatic prostate cancer a year. Data shows, infact, that if age-specific pre-PSA era incidencerates were to occur in the present day, the numberof men whose cancer had already spread at diag-nosis would be three times greater.

“Our findings are very important in lightof the recent controversy over PSA testing,”said Edward M. Messing, M.D., study co-author,chair of the Department of Urology, and presi-dent of the Society of Urologic Oncology.Yes, there are trade-offs associated with thePSA test and many factors influence the diseaseoutcome. And yet our data are very clear: notdoing the PSA test will result in many menpresenting with far more advanced prostatecancer. And almost all men with metastasis atdiagnosis will die from prostate cancer.”

In 2011 the U.S. Preventive Services TaskForce recommended against PSA screening inall men, prompting criticism from the medicalcommunity. The government panel reviewedscientific evidence and concluded thatscreening has little or no benefit, or that the

harms of early detection outweigh the benefits.One major concern, for example, was thatdoctors are screening for, finding, and treatingnon-aggressive cancers that might haveremained quiet, causing patients to needlesslysuffer from serious treatment side effects suchas incontinence or erectile dysfunction.

The U.S. Task Force recommendationsagainst screening caused some confusion, andin response, a special panel of experts from theAmerican Society of Clinical Oncology decidedthat for men with a life expectancy of less than10 years, general screening with the PSA testshould be discouraged. For men with a longerlife expectancy, though, it is recommended thatphysicians discuss with patients whether thePSA test is appropriate for them.

Messing’s study looked back at the era priorto 1986, when no one was routinely screenedfor prostate cancer with a PSA test. To analyzethe effect of screening on stage of diseaseat initial diagnosis, Messing and EmelianScosyrev, Ph.D., assistant professor of urology,reviewed data from 1983 to 2008 kept by thenation’s largest cancer registry, Surveillance,Epidemiology and End-Results or SEER. They

Edward M. Messing, M.D.

compared SEER data from the pre-PSA era (1983to ’85) to the current era of widespread PSA use(2006 to 2008), and adjusted for age, race, andgeographic variations in the United Statespopulation.

Approximately 8,000 cases of prostate cancerwith metastases at initial presentation occurred inthe U.S. in 2008. Using a mathematical model toestimate the number of metastatic cases thatwould be expected to occur in 2008 in the absenceof PSA screening, Scosyrev and Messing pre-dicted the number would be 25,000.

The authors emphasized the study was obser-vational and has some limitations. In particular itis impossible to know if the PSA test and earlydetection is solely responsible for the fewer casesof metastasis at diagnosis in 2008.

The potential lead-time of screening alsoshould be considered when interpreting the studyfindings, Scosyrev said. For some people anearlier stage of cancer at diagnosis may notalways translate into better survival. This mayhappen, for example, in cases when the cancerhad already metastasized at the time ofscreening, but the metastasis remained unde-tected.

In general, however, the study concludedthat massive screening and PSA awarenessefforts during the 1990s and early 2000sresulted in substantial shifts toward earlier-stage disease and fewer cases of metastases atdiagnosis.

In the United States over the most recent20 years, Messing said, prostate cancer deathrates have been reduced by close to 40%. Thisoccurred without substantial changes in howmen were treated (via surgery and radiationtherapy). Other models published in the scien-tific literature have suggested that more than50% of this reduction is due to early detection.

The Ashley Family Foundation funded theMedical Center research.

Our findings are very important in light of the recent controversy overPSA testing. Yes, there are trade-offs associated with the PSA test andmany factors influence the disease outcome. And yet our data are very clear:not doing the PSA test will result in many men presenting with far moreadvanced prostate cancer.”

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Scientists findprotein control-ling developmentof treatment-resistantprostate cancer

By Emily BoyntonScientists have identified what may be the PeytonManning of prostate cancer. It’s a protein that’sessential for the disease to execute its game plan:Grow and spread throughout the body.

Like any good quarterback, this protein hascommand over the entire field; not only does itcontrol cell growth in tumors that are sensitiveto hormone therapy, a common treatment formen with advanced disease, but also in tumorsthat grow resistant to such treatment, a devel-opment that leaves men and their doctors withno good options to turn to.

In a study published in July in the Journal ofClinical Investigation, a team led by scientistsfrom the University of Rochester Medical Centerfound that the protein paxillin is a major playerin prostate cancer. Though in the very earlystages, the discovery is an important first steptowards developing a treatment for men whosecancer prevails even after the most aggressivetreatment.

“The holy grail in prostate cancer is to figureout why cells stop responding to hormone

therapy,” said senior study author Stephen R.Hammes, M.D., Ph.D., chief of the Division ofEndocrinology and Metabolism at the MedicalCenter.

Initially, hormone therapy, which starvestumors of the hormones that fuel their growth,works well and may lead to remission. But,nearly all prostate cancers treated withhormone therapy become resistant over aperiod of months or years and the cancer makesan unwelcome comeback.

“Somehow, tumors find a way to grow evenwhen their main power source is choked off,”said Hammes, also the Louis S. WolkDistinguished Professor in Medicine. “Our workis exciting because we’ve identified a proteinpathway that controls growth even in theabsence of hormones and provides a completelynew treatment target for the disease.”

Hammes and first author Aritro Sen, Ph.D.,research assistant professor in the Division ofEndocrinology and Metabolism, knew from theirprevious research that paxillin is important inprostate cancer, but they didn’t know why or how.

Under certain conditions, they found that theprotein, which normally hangs out in the cyto-plasm or gel-like substance that fills a cell,actually goes into the nucleus. There, it’s anextremely commanding force, regulating signalsthat lead to the creation of cancer cells.

“This is the first time anyone’s shown thatpaxillin goes into the nucleus and controls geneexpression,” said Sen. “When we eliminatedthis protein from prostate cancer cells theirgrowth was significantly arrested, but whatsurprised us most was that this effect was iden-tical in both hormone therapy-dependent aswell as resistant prostate cancer cells.”

In typical tumors stimulated by male

hormones called androgens, paxillin partnerswith the hormones to turn on genes that lead tothe creation of more cancer cells. Such tumorsshrink, at least for a time, when subject tohormone therapy.

But for tumors that continue to grow despitehormone therapy, Hammes’ team found thatpaxillin takes another route and connects withnaturally occurring substances called growthfactors to activate genes that produce morecancer cells. Take paxillin out of the nucleus andgrowth comes to a halt: Without it, genesdirected by androgens don’t get turned on, nordo genes directed by growth factors.

“Lots of pathways are being examined asscientists look for what makes a prostate cancercell become castration resistant, but ours is acompletely novel approach,” said Hammes ofthe paxillin-mediated pathway.

Sen added: “We have now found a commonfactor that regulates both hormone-dependentand castration-resistant prostate cancer cells.”

The team found that paxillin is ramped up intissue from human tumors, much more so thanin normal cells. And in mice with humanprostate cancer cells, getting rid of paxillincaused the tumors to grow more slowly.

The next step is to figure out how to stoppaxillin from getting into the nucleus, or toinhibit its activity once it’s in the nucleus.“Paxillin has important functions in the cyto-plasm, like helping cells communicate witheach other to form organs and other structures,”Hammes noted. “If we can target paxillin in thenucleus where it mediates cancer cell growth,but leave it intact in the cytoplasm so it cancontinue to do the important work it does there,that would be the goal.”

Cancerous prostate Normal prostate



Scientists findpreviouslyunrecognizedcleansingsystem in brain

By Tom RickeyA previously unrecognized system that drainswaste from the brain at a rapid clip has beendiscovered by neuroscientists at the Universityof Rochester Medical Center.

URMC scientists are hopeful that these find-ings have implications for many conditions thatinvolve the brain, such as traumatic brain injury,Alzheimer’s disease, stroke, and Parkinson’sdisease.

The highly organized system acts like aseries of pipes that piggyback on the brain’sblood vessels, sort of a shadow plumbing

system that seems to serve much the samefunction in the brain as the lymph system doesin the rest of the body-to drain away wasteproducts.

“Waste clearance is of central importance toevery organ, and there have been long-standingquestions about how the brain gets rid of itswaste,” said Maiken Nedergaard, M.D., D. M.Sc.,senior author of the paper, Frank P. SmithProfessor of Neurosurgery and co-director of theUniversity’s Center for Translational Nuero-medicine. “This work shows that the brain iscleansing itself in a more organized way and ona much larger scale than has been realizedpreviously.

The findings were published online inAugust in Science Translational Medicine.

Nedergaard’s team has dubbed the newsystem “the glymphatic system,” since it actsmuch like the lymphatic system but is managedby brain cells known as glial cells. The teammade the findings in mice, whose brains areremarkably similar to the human brain.

Scientists have known that cerebrospinalfluid or CSF plays an important role cleansing

brain tissue, carrying away waste products andcarrying nutrients to brain tissue through a processknown as diffusion. The newly discovered systemcirculates CSF to every corner of the brain muchmore efficiently, through what scientists call bulkflow or convection.

“It’s as if the brain has two garbage haulers–a slow one that we’ve known about, and a fast onethat we’ve just met,” said Nedergaard. “Given thehigh rate of metabolism in the brain, and its exqui-site sensitivity, it’s not surprising that itsmechanisms to rid itself of waste are more special-ized and extensive than previously realized.”

The glymphatic system is like a layer of pipingthat surrounds the brain’s existing blood vessels.The team found that glial cells called astrocytesuse projections known as “end feet” to form anetwork of conduits around the outsides of arteriesand veins inside the brain.

Those end feet are filled with structures knownas water channels or aquaporins, which move CSFthrough the brain. The team found that CSF ispumped into the brain along the channels thatsurround arteries, and then washes through braintissue before collecting in channels around veinsand draining from the brain.

The scientists say the system operates onlywhen it’s intact and operating in the living brain,making it very difficult to study for earlier scientistswho could not directly visualize CSF flow in a liveanimal, and often had to study sections of braintissue that had already died. To study the living,whole brain, the team used a technology known astwo-photon microscopy, which allows scientists tolook at the flow of blood, CSF and other substancesin the brain of a living animal.

First author Jeffrey Iliff, Ph.D., a research assis-tant professor in the Nedergaard lab, took anin-depth look at amyloid beta, the protein that accu-mulates in the brain of patients with Alzheimer’sdisease. He found that more than half the amyloidremoved from the brain of a mouse under normalconditions is removed via the glymphatic system.

“If the glymphatic system fails to cleanse thebrain as it is meant to, either as a consequence ofnormal aging, or in response to brain injury, wastemay begin to accumulate in the brain.” Iliff said.This may be what is happening with amyloiddeposits in Alzheimer’s disease. Perhaps increasingthe activity of the glymphatic system might helpprevent amyloid deposition from building up orcould offer a new way to clean out buildups of thematerial in established Alzheimer’s disease.”

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The green shows cerebrospinal fluid ina channel anlong the outside of an arteryin the brain of a mouse.

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School ofMedicine andDentistry namesnew endowedchairs andprofessorshipsAt convocation in August, the University ofRochester School of Medicine and Dentistryawarded 11 endowed chairs and professor-ships. At last year’s convocation, the Schoolawarded 10.

Increasing the number of endowed profes-sorships is a major goal of the School ofMedicine and Dentistry and the Medical Centerin The Meliora Challenge: The Campaign forthe University of Rochester, the $1.2 billionfundraising effort.

This year’s recipients are:

David A. Bushinsky, M.D.

John J. Kuiper Distinguished ProfessorEstablished in 2012, this new professorshipsupports the work of an outstanding facultymember in the Division of Nephrology in theDepartment of Medicine. Bushinsky is aprofessor of medicine in the NephrologyDivision, a position he has held since October,1992. He has been a member of the School ofMedicine and Dentistry faculty since 1989.

Thomas L. Campbell, M.D.

William Rocktaschel Chair in FamilyMedicineThis professorship, a part of the Department ofFamily Medicine and Highland Hospital sincethe early 1990s, is new to the School ofMedicine and Dentistry. It is to be held by theChair of the Department of Family Medicine.Campbell was appointed department chair in2004 and is currently professor of family medi-cine, a position he has held since 1998. He hasbeen a member of the faculty since 1983.

Yuhchyau Chen, M.D., Ph.D.

Philip Rubin Professorship in RadiationOncologyEstablished in 1995, this professorship is heldby the chair of the Department of RadiationOncology. Chen was appointed chair in January,2012, and is a professor of radiation oncology,a position she has held since 2006. She hasbeen a member of the faculty since 1995.

Michael P. Eaton, M.D.

Denham S. Ward, M.D., Ph.D. ProfessorshipThis is a new professorship, established in2011, and is to be held by the chair of theDepartment of Anesthesiology. Eaton wasappointed chair in January, 2012, and isprofessor of anesthesiology, a position he hasheld since 2011. He has been a member of thefaculty since 1995.

Richard E. Kreipe, M.D. (FLW ’81)

Dr. Elizabeth R. McAnarney Professorshipin Pediatrics Funded by Roger and CarolynFriedlanderThis new professorship honors Elizabeth R.McAnarney, M.D., for her service to children inthe Rochester region and for inspiring volunteerinvolvement with the University. Kreipe isprofessor of pediatrics in the AdolescentMedicine Division, a position he has held since1999. He has been a member of the faculty since1981.

Maiken Nedergaard, M.D., D. M.Sc.

Frank P. Smith Professor of NeurosurgeryThis professorship was established in 1981 tohelp an outstanding member of the Departmentof Neurosurgery so that he or she can devotetime to teaching and research. Nedergaardwas appointed co-director of the Center forTranslational Neuromedicine in 2007. She isprofessor of neurosurgery, first in the Center forAging and Developmental Biology (2003–2007)and then in the Center for TranslationalNeuromedicine (2007 to present). She has beena member of the faculty since 2003.

Webster H. Pilcher, M.D., Ph.D. (M ’83, PhD ’83,

R ’89)

Ernest and Thelma Del Monte DistinguishedProfessorship in NeuromedicineThis new professorship was created in gratefulappreciation to the University of RochesterMedical Center and Webster H. Pilcher, inparticular, for health care provided for theRochester community and for its broadermission of education and research. Pilcher ischair of the Department of Neurosurgery andprofessor of neurosurgery, positions he has heldsince 2002. He has been a member of the facultysince 1990.

Edward M. Schwarz, Ph.D.Richard and Margaret Burton DistinguishedProfessorship in OrthopaedicsThis is a new professorship, created to supporta tenured faculty member with a primaryappointment in the Department of Orthopaedicsin the Center for Musculoskeletal Research.Schwarz was appointed director of the Center in2012 and is professor of orthopaedics in theCenter for Musculoskeletal Research, a positionhe has held since 2006. He has been a memberof the faculty since 1997.

Robert L. Strawderman, III, Sc.D.Dean’s ProfessorshipDean’s Professorships were established in 1983to be assigned to individuals of outstandingresearch excellence, usually, but not limited to,newly appointed faculty to the School ofMedicine and Dentistry and designated by thedean of the School. Strawderman is the newchair and professor of biostatistics and compu-tational biology.

Charles A. Thornton, M.D. (FLW ’90, ’92),

Saunders Family DistinguishedProfessorship in Neuromuscular ResearchEstablished in 2012, this professorship providestransformational support for efforts in clinicaland translational science in neuromuscularresearch. Thornton is a professor of neurology,a position he has held since 2006. He has beena member of the faculty since 1991.

Hulin Wu, Ph.D.Dean’s ProfessorshipWu is a professor of biostatistics and computa-tional biology, a position he has held since 2003when he joined the faculty.


philanthropy

Created to foster an outstanding healthcare environment dedicated to supportingpatients and their families, the new$145-million tower, located on CrittendenBoulevard and attached to the MedicalCenter and Strong Memorial Hospital,will be eight floors with approximately245,000 square feet of space. It is slatedto open in 2015.

Plans for the new Golisano Children’sHospital at the University of RochesterMedical Center were unveiled in March,revealing a space that is special in designand spirit. A groundbreaking ceremonywas held in September.

Children’s hospital designed for best health care

and support of patients and families

Private patient rooms will provide acomforting experience that reduces stressand anxiety, while enhancing confiden-tiality. Amenities include a new hospitalitysuite that parents can use to shower, eathome-cooked meals as a family or evenrun a load of laundry.

Continued on page 55

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A toddler playroom and a new two-storyplaydeck will be located on the seventhfloor, and a school room and a teen roomthat will overlook the playdeck will belocated on the eighth floor. An outdoorrooftop playspace and a healing gardenare also planned.

The new pediatric operating rooms andthe new Pediatric Cardiac Intensive CareUnit/Pediatric Intensive Care Unit willopen in the new building in 2016. In a laterphase of construction, the RonaldMcDonald House within the hospital alsowill be relocated.

Golisano Children’s Hospital’s $100-millioncampaign supports both a new children’shospital and major enhancements to pedi-atric programs. A $20 million lead gift fromentrepreneur and philanthropist B. ThomasGolisano, for whom the hospital is named,bolstered plans to build the new facility.The campaign is part of the University ofRochester Medical Center’s $650 millioncampaign and the overall $1.2 billion goalof The Meliora Challenge: The Campaignfor the University of Rochester.

For a virtual tour of the building, go to:www.givetokids.urmc.edu


philanthropy

Gosnell giftssupport newNICU andtwo endowedprofessorshipsGeorgia Gosnell, who, with her late husband,Thomas, has a long history of giving in theRochester area, has committed $5 million toname the Neonatal Intensive Care Unit in thenew Golisano Children’s Hospital at theUniversity of Rochester Medical Center.

Mrs. Gosnell also has created two profes-sorships in the School of Medicine andDentistry in Quality and Safety and PalliativeCare.

“Georgia and Thomas have been greatfriends of the University-and countless otherRochester institutions-for many years. This giftand the new professorships they have createdare part of their incredible philanthropiclegacy,” said University President JoelSeligman.

The $5 million commitment will help fundthe hospital’s new Gosnell Neonatal IntensiveCare Unit (NICU), which will include 60 bedsboth in the new building, and in the currentNICU space on the third floor of StrongMemorial Hospital. The Gosnell NICU in thenew building will provide intensive care to theregion’s sickest babies in private rooms.Renovations will be made to the current NICUspace to deliver highly specialized care forbabies who need less acute treatment.

“There are few ways to make a greaterimpact on a community’s future health than byensuring babies the best start they can have inlife, and the Gosnells’ gift is going to help us dojust that,” said Bradford C. Berk, M.D., Ph.D.,CEO of the Medical Center.

Mrs. Gosnell’s gift is one of the largestthe Golisano Children’s Hospital $100 millioncampaign has received since its public launch inOctober 2011.

“Without forward-thinking philanthropistslike Georgia and Tom Gosnell, we wouldn’t bebreaking ground on a new children’s hospitaltailored to the needs of families of today andtomorrow,” said Nina F. Schor, M.D., Ph.D,William H. Eilinger Chair of Pediatrics and pedi-

Trustee andneurosciencesbenefactorErnest J. DelMonte diesFirst Del MonteDistinguishedProfessor installedErnest J. Del Monte, visionary, philanthropistand University of Rochester Trustee from 1998to the time of his death, died April 21, 2012.He was 87.

With a $10 million gift to the University in2009, Del Monte and his late wife, Thelma,made a commitment to support the study ofsome of the most progressive researchprograms in the field of neurosciences to trans-late neurobiological discoveries into betterhealth for all.

The Ernest J. Del Monte NeuromedicineInstitute was named in his honor.

Among Del Monte’s many business achieve-ments is pioneering the construction of hotelsusing modular units. This approach, for whichhe received more than 20 patents, has sincebeen used to construct hotels around the world.In 1972, Del Monte developed a relationshipwith the Marriott Corporation, and today thecompany owns and operates 17 Marriott hotelsthroughout New York.

In addition to his support of the Institute,Del Monte established the Ernest and ThelmaDel Monte Distinguished Professorship inNeuromedicine, to show his appreciation for theMedical Center’s health care services and itsbroad mission of education and research.

Webster H. Pilcher, M.D., Ph.D. (MD ’83, PhD’83, R ’89) was installed in March as the firstdistinguished professor for his outstandingcontributions to the Department of Neuro-surgery and vision for the Del Monte Institute.Pilcher was appointed chair of the departmentin 2002.

School of Medicine and Dentistry Dean,Mark Taubman, M.D., explained that Pilcher’sgoal is to bring a large group of scientists,working among eight departments and withindifferent centers, into one state-of-the-artresearch building.

Endowed professorships are a key initiativefor the School as part of The Meliora Challenge:The Campaign for the University of Rochester.

Webster H. Pilcher, M.D., Ph.D. with the Del Monte family during his installation as chair.

The late Ernest J. Del Monte (left)with UR president, Joel Seligman.

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atrician-in-chief of Golisano Children’s Hospital.‘Grateful’ doesn’t begin to describe how we feelabout Georgia’s generosity to our region’s mostfragile babies.”

The Gosnell family is one of Rochester’smost generous families, having supported theMedical Center, Rochester Institute of Tech-nology (RIT), Rochester Museum & ScienceCenter, Rochester Philharmonic Orchestra,Al Sigl Center, Genesee Land Trust, and theMemorial Art Gallery, among other importantRochester institutions. The Gosnells wereinstrumental in the restoration of the GeorgeEastman House and the wing-footed Mercurystatue on the top of the Aqueduct Buildingalong the river in downtown Rochester.

Mr. Gosnell, who died three years ago, waschairman emeritus of RIT’s Board of Trusteesand was a major force behind that school’sAccess to the Future fundraising campaign thatraised more than $120 million. He served in theU.S. Navy during World War II and earned manyhonors during his service, including a PurpleHeart. He then went on to earn his bachelor’sdegree from Yale and worked his way up in theLawyers Co-Op publishing firm from elevatoroperator to become the fourth generation of hisfamily to run the company.

Over the years, the couple’s ongoing givingto the Medical Center has exceeded$3 million. Mrs. Gosnell has decided to usethese endowed funds to establish two perma-nent endowed professorships: the Georgia andThomas Gosnell Distinguished Professorship inPalliative Care and The Georgia and ThomasGosnell Professorship in Quality and Safety.

The Georgia and Thomas Gosnell Dis-tinguished Professorship in Palliative Careenhances a program that recently became oneof the first nationwide-and the first at anacademic medical center-to earn advancedcertification from the Joint Commission, thenation’s predominant standards-setting andaccrediting body in health care. The Palliative

Care program celebrated its 10th anniversaryin 2011 and continues to grow, providing morethan 1,000 new inpatient consultations andabout 400 new outpatient and home consulta-tions, annually.

“Our program is now among just a handfulnationally that enjoy such endowed support,which will help fuel our mission of providing,studying and teaching about comprehensive,multidisciplinary, evidence-based palliative carefor our seriously ill patients and their families,”said Timothy Quill, M.D. (M ’76, R ’79), the inau-gural Gosnell Professor in Palliative Care, aswell as professor of Medicine, Psychiatry, andMedical Humanities, and director of the Centerfor Ethics, Humanities, and Palliative Care.

Patient safety and patient-centered care arecornerstones of high-quality health care andmajor priorities at the Medical Center.Supporting this vision, the Georgia and ThomasGosnell Professorship in Quality and Safety willbolster innovative quality and safety initiativesat the Medical Center and ensure an optimal

patient experience. By helping providers andstaff learn about and incorporate “best-prac-tices” for safe and high quality care, theendowed professor will promote better patientoutcomes and reduce the risk of complications.

“Taking quality and safety at the MedicalCenter to the highest level requires more thanindividual projects,” said Robert Panzer, M.D.(R ’80, FLW ’82), the first Gosnell Professor inQuality and Safety, Chief Quality Officer andassociate vice president of patient care qualityand safety. “It requires a long-term commitmentto create highly reliable care where patients getthe right care at the right time from the entireteam-consistently and safely. This professorshipwill ensure that this work will continue to besupported well into the future.”

“

Timothy Quill, M.D. Robert Panzer, M.D.

Georgia Gosnell


alumni news

When Eric Topol, M.D., (M ’79) wrote

his address for the University of

Rochester School of Medicine and

Dentistry’s Class of 2011 commence-

ment ceremonies, he intended to title

his speech “The Creative Destruction

of Medicine.”

But Mark B. Taubman, M.D., dean of the Schoolof Medicine and Dentistry, told Topol his titlewould “scare everyone” and urged him tochange the title. Topol’s wife and his daughteragreed with the dean, so he changed the title ofhis address to “Medicine Rebooted.”

But Topol did not relinquish the title or theconcept. Earlier this year, he published a booktitled, The Creative Destruction of Medicine,and he is shaking up people, if not scaring them,and trying to get them to join the digital revolu-tion he believes will make health care better.

“I’m trying to get my colleagues and thepublic to realize there is a new exciting oppor-tunity to change medicine by embracingnew technology and tools-such as genomesequencing and wireless wearable sensors-thatcan bring a new height of precision to medi-cine,” Topol said in an interview. “I’ve beenseeing things that can change the practice ofmedicine dramatically. I can see where this isall headed. It is happening in the digital world,but just hasn’t invaded the medical cocoon.”

Like a preacher on a mission, Topol is takinghis message to the public, reiterating his pointsin interviews and lectures. A number of his talksare available on YouTube. And he is not beingmild-mannered.

“This will be a consumer health revolution.People will drive it,” Topol said. “This is the

Author of more than 1,000 original peer-reviewed publications, Topol has edited morethan 30 books, including major textbooks oninterventional cardiology and cardiovascularmedicine. He has been elected to the Instituteof Medicine of the National Academy ofSciences. And he was voted the number-onemost influential physician executive of 2012 ina national poll run by Modern Physician andModern Healthcare.

Topol is not only challenging his colleaguesin medicine, he is participating in the revolution.

“I haven’t used a stethoscope in more thantwo years to listen to the heart,” he said. “I usea portable high-resolution ultrasound. I’mshowing the patient what I see in real time.If they went for an echo, they never would seeit. They would be sent to a lab. The person whoadministers the ultrasound can’t tell the patientanything. They have to call their doctor to get areport. I’m talking to the patient as I examinethe heart. I can show a valve that is not movingproperly. That is powerful and intimate. Toolsused properly can heighten the relationshipbetween doctor and patient. Ultimately, GeorgeEngel would celebrate this change.”

Topol has tried a glucose monitor that linksto an app on a smartphone.

“It was an education for me discoveringwhat I ate that sent my glucose way up. It haschanged my lifestyle,” he said. “Sensors are notonly for the gym, for counting our steps ortracking our heart rate when we exercise. Whensensors get into the medical space, everyonewill realize the opportunities.”

Topol is leading a study of whether a newtechnology called the Zio Patch, a wirelessmonitor that is applied to the chest like an adhe-sive bandage, does a better job detectingarrhythmias than the Holter monitor. The Zio canmonitor the heart for up to 14 days. After theprescribed time, the patient removes the patchand mails it for analysis.

“It is amazing how simple it is,” Topol said.

Creative destructionEric Topol advocates a digital revolution in medicine.

printing press and the Gutenberg Bible thatstarted opening up reading and knowledge tothe people. Doctors have had all the informationuntil now. That is changing. With the smart-phone, sensors and other tools, we can build asocial medical health network and create a levelplaying field of information … This is not just amini-disruption; it’s a mega-disruption. It is thebiggest shake-up in medicine ever.”

Topol has the credentials to support hispredictions of significant change.

Known as one of the nation’s top medicalresearchers, he is the director of the ScrippsTranslational Science Institute in California,which focuses on individualized medicine. Healso is the chief academic officer of ScrippsHealth, a senior consultant cardiologist practi-tioner at Scripps Clinic, professor of genomicsat The Scripps Research Institute and co-founder and vice chairman of West WirelessHealth Institute, which develops wirelesshealth technology as a means to loweringhealth care costs.

33

We are using the Holter, an invention from 1949with wires that won’t allow you to shower orexercise. You can only use it for a day and it isvery expensive. You have to go to a hospital toget hooked up and back to a hospital to have itremoved. This trial will show whether this patchcan deliver better diagnostic information thanthe Holter. This is symbolic of creative destruc-tion. We’ve been using the same technology foralmost 70 years. This could be a better idea.We can do better.”

A wireless monitor that can track heartrhythms and report by smartphone will helpphysicians mange patients remotely and reducevisits to hospital emergency departments andunnecessary admissions, Topol said. Sensorscan pick up conditions that could cause anasthma attack, warn the patient and preemptthe attack. Sensors can monitor sleep patternsin the home.

“These technologies and these changes willnot increase health care costs. They are ways tocut costs,” Topol said. “We’re spending $300billion a year for prescription drugs and $100billion is waste or the wrong drug or wrong dosefor the person. We can do genomic screeningsto match up the patient with a drug and dosethat works and avoid serious side effects. Therewill be enormous savings every year.”

Why don’t we do many office visits withSkype? he asks.

“It would make in-person appointments lessfrequent and reduce costs,” Topol said. “For thepatient, it would eliminate an hour’s wait aftergoing through the hassle of driving and parking.With the use of sensors, all the data could begathered in advance of the Skype call or in realtime. You can have 10 minutes on a video linkwith streaming information. It is intimate andwill increase the interaction. If widely used andproperly reimbursed, it will make it easier forpatients to have access to their doctors and itwill give doctors a reach that is amplified.

“One study has shown that 62 percent ofdoctors refuse to communicate with patients bye-mail. I’ve been e-mailing my patients sincethe 90s. We have to get over this stuff. Studiesby organizations like Kaiser have showncommunication between doctors and patientsimproves efficiency and reduces need for officevisits.”

Consumers have reacted strongly and posi-tively to his message of “creative destruction,”Topol said.

“Whether we’re talking about the genomeor blood pressure sensors or glucose readingson a smartphone, they want to be there. Theywant to consult with their doctor. They wanta partnership,” he said. “These changes canmake medicine so much more efficient andscientifically sound. We will have informationand data on each individual patient we never

had before. The data belongs to patients andthey should own it. They should be our partner.The role of the doctor is changing and it meansempathy and compassion are more critical nowthan ever.”

In an interview published by the websiteMedscape, Topol said the rise of technology andpersonalized medicine is inevitable.

“It’s just a matter of when. The question is:what is the plasticity of the medical community?What are the willingness and initiatives thatcould be taken on the physician’s side, or is thisgoing to have to all be driven from theconsumer’s side?,” Topol said. “It has to happenbecause we are in a situation that’s untenableand unsustainable in health care today. We canmove to a whole new plateau where we have somuch more data on each individual that wedidn’t have before. Whether it’s high blood pres-sure or trying to prevent the progression fromprediabetes to diabetes, we have new tools;there should be a new day in medicine if we arewilling to accept that and try to catalyze thisopportunity.”

“

This is the printing press and the Gutenberg Bible that started opening upreading and knowledge to the people. Doctors have had all the informationuntil now. That is changing.”

With the smartphone, sensors and other tools, we can build a social medicalhealth network and create a level playing field of information… This is notjust a mini-disruption; it’s a mega-disruption.”

It is the biggest shake-up in medicine ever.”

”

”

”


student life

John T. Hansen, Ph.D., the University ofRochester School of Medicine and Dentistry’sassociate dean for admissions since 1996,has seen thousands of applicants to the Schoolover the years and he knows what they want.A professor in the Department of Neurobiologyand Anatomy and a former chair of the depart-ment, Hansen maintains a special interest in therole of anatomy in medical education. He was amember of the committee that designed theSchool’s Double Helix curriculum that weavesbasic science and clinical work throughout allfour years of medical school. Hansen, who cameto Rochester in 1985 from the University ofTexas Health Center at San Antonio to direct thecourse in anatomy, has authored severalmedical textbooks, including Netter’s Atlas ofHuman Physiology, Essential Anatomy Dissectorand Netter’s Clinical Anatomy. He also is co-author with Philip Rubin, M.D., of TNM StagingAtlas.

Q&A: John T.

Hansen, Ph.D.

Admissions deandiscusses the art andscience of medicineand anatomy labQ: About a dozen years ago, you helped designthe Human Structure and Function course. Whatis different about this course?A: At most medical schools, anatomy andhistology are first semester courses and physi-ology is second semester. As a result, studentshave to wait four to six months to learn how thekidney or the heart works physiologically.For example, in our course, students learn theembryology, the gross anatomy, microscopicstructure and cardiovascular and renal physi-ology all in the same contiguous time slots sothey can think across disciplinary boundariesthe way they are going to as physicians, insteadof thinking in disciplinary silos. This approachtakes away the artificial boundaries of anatomy,histology and physiology. It makes eminentsense. It’s really a natural way to relate functionand structure.

How can you look at a nephron under amicroscope and dissect a kidney in the anatomylab and then have to wait four months to findout what a nephron and a tubule or collectingduct does physiologically? It’s the same thingwith the heart. You look at the heart and it’s awonder, but unless you understand the physio-logical dynamics going on in each heartchamber and all the pressure changes associ-ated with systole and diastole during thecardiac cycle, how can you appreciate thecomplexity of the cardiovascular system? Ourstudents get to understand this dynamic fromthe development level all the way up to theadult anatomy and physiology.

Q: What is valuable in designing the HumanStructure and Function course the way you did?A: Everything microscopic or macroscopic startsto make sense once you understand the func-tion. These elements of embryology, histology,

anatomy and physiology all play out in theobjectives of the weekly problem-basedlearning classes so students can think acrossboundaries and across those disciplinary linesand see them as the whole, not as parts pastedtogether artificially.

It is wonderful in anatomy lab to hold a heartor kidney, or any other organ in your hand, andknow the students understand the functionalrelationship. Or for a physiologist to talk aboutwhat goes on in the stomach or the heart, andknow the students have already seen theseorgans and looked at them microscopically,often within just the past day or two. It’s anatural extension of learning for them, not aleap of faith.

No one learns this material on the first pass.You keep coming back in later courses and inmore advanced ways throughout medical schooland graduate training. There are planned redun-dancies that help you begin to understand andretain important material. You review for theboard exams and then you’re in the clinic andyou start thinking about basic science in adifferent way. Patients are people with realsymptoms of things going on and often exhibitmulti-system diseases. Even with our first-yearstudents working with preceptors in thecommunity, it drives home the importance oflearning and using basic science in this context.They think of the heart not only as an evolu-tionary wonder, which it is, but they also thinkof it in relation to hypertension and how thisdisease process changes the morphology andthe physiology of the system. They start thinkingdynamically about interrelationships as first-year students. The science is not theoretical.Students see their patients and the medicationsthey are taking and start putting it all togetherin a way that is more natural and relevant thanwhen the disciplines were relegated to sepa-rate silos. The way it happens at Rochester isspectacular and our students are evidence ofthat. Our students can’t imagine that it is nottaught this way everywhere. Fortunately, thetrend is catching on, but it is nice to be at thevanguard.

Q: Rochester stands out in this integratedapproach to teaching anatomy, histology andphysiology. Why is that?A: A lot of anatomy programs try to integrateanatomy with histology, but very few in thecountry integrate anatomy and histology withmedical physiology. The reason it doesn’t

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Emma Lo, a third-year student at the Universityof Rochester School of Medicine and Dentistry,has spent a lot of time in city parks, underbridges and wandering city streets, settings notusually recommended for students.

But the neighborhoods and the people therehold great interest for her and are the target ofthe School’s UR Street Outreach, a street medi-cine program she helped launch last year toimprove access to quality health care forRochester’s homeless population.

“You realize that these people, who superfi-cially seem so different, could really be you,”Lo said. “They are some of the most challengingpatients, which makes every small successso rewarding. Our goals are two-fold, both toimprove access to health care and resourcesfor the street homeless and to break downbarriers between the medical world and thisvery misunderstood population. This projectembodies the values of the biopsychosocialmodel and is necessary for my education asa physician.”

UR Street Outreach is one of severalprograms supported by the School ofMedicine’s and Dentistry’s Center for Advocacy,Community Health, Education and Diversity(CACHED), through which medical studentsvolunteer at clinics, schools and other commu-nity organizations.

In 2010, Lo put together a detailed proposalto Adrienne Morgan, senior director of CACHED,

happen at most schools is because it meanstwo or three departments have to coordinatetheir efforts. They have to give and take. Theyhave to work together and usually those depart-ments have different research and teachingapproaches. Anatomy is largely qualitative andvisual while physiology is much more quantita-tive. Merging these disciplines can be a toughact to pull off.

It has worked well here because our facultyare inherently very collaborative. We have alot of common research interests among phar-macology, physiology and neurobiology, andanatomy. The fact that we have research collab-orations, that we respected each other’s areasof investigation even though we had differentapproaches to teaching, has helped make itwork out beautifully. Some schools try to mergeanatomy and histology, and that’s a major taskfor them, but they aren’t even thinking aboutincluding physiology, and that’s a shame.

Q: Is this course a selling point for choosingRochester?A: Students want to come here because theylike the curriculum. They see the medicalstudents here are happy with the curriculum.The faculty who teach are very devoted and areexcellent teachers who are learning-centered.Now, integrate the basic science with theclinical experience that happens in the after-noons-the two strands of the Double Helixbasic-it is a natural for them.

Rochester has the Double Helix and thebiopscychosocial model, which means a holisticand open-ended approach to medicine and thepatient. The applicants sit outside our admis-sions office and see a portrait of George Engel,and they know we’re the home of the biopsy-chosocial model. The students know they willlearn the science of medicine in Rochester, butthey also will learn the art of medicine. We’refondly known, and I wear this as a badge ofhonor, as the liberal arts of medical schoolsbecause this is the place where the art andscience of medicine come together from dayone. Our students start thinking holisticallyabout the patient, all the factors that surround apatient’s life; everything is placed in a muchlarger context and they get a broader view.Collegiality is an offshoot of the biopsychoso-cial model. The research collaborations of JohnRomano and George Engel had a halo effectthat can be seen in many of our teaching andContinued on page 47

for UR Street Outreach. Lo modeled herproposal, in part, on Operation Safety Net,a street medicine program founded by JimWithers, M.D., 20 years ago that is now part ofthe Pittsburgh Mercy Health System. Lo spenta year in AmeriCorps, working with OperationSafety Net.

In UR Street Outreach, at least one nighta week, one or two medical students and aphysician or nurse join a former homelessperson, who acts as a liaison, for visits to siteswhere the homeless gather to sleep, to camp orto get a free meal.

In the first months of the program, Lo andothers worked to build trust and relationshipswith the wary people they encountered, simplytalking with them or providing them with cleansocks. The UR Street Outreach volunteers nowcarry over-the-counter medications and antibi-otics they give to those in need.

The volunteers have found people withfrostbite, high blood pressure, chronic asthma,fractures and even seizures.

“We start by building relationships and trust,trying not to have an agenda. We address theirimmediate needs; only after some time will theyconsider going to a clinic or the hospital,” Lo said.

About 25 medical students participate in URStreet Outreach, some of whom have taken overleadership of the program as Lo is involved inthe busy schedule of a third-year medicalstudent.

Go to www.rochester-medicine.urmc.eduto see the first of several on-line video reportson-line exclusive

Students take medicine and careout of the hospital into the streets


class notes

If you see any alumni whom you wouldlike to contact, use the Online Directory atwww.alumniconnections.com/URMC to findaddress information.

Submit your class notes to your classagent or to [email protected].

Note: MD Alumni are listed alphabetically byclass, Resident and Fellow alumni follow inalphabetical order, and Graduate Alumni arelisted separately in alphabetical order.

MD AlumniClass of 1947William L. Parry is a professor emeritus at theUniversity of Oklahoma College of Medicineafter serving 32 years as its first academic full-time chairman of the Department of Urology.At the 2012 meeting of the American Assoc-iation of Genito-Urinary Surgeons, Parry wasappointed historian. He is a former presidentand one of eight honorary members. He also hasstarted his tenure as historian of the Society ofUniversity Urologists, of which he is a foundingmember, the first Secretary-Treasurer and presi-dent. He is recipient of the first SUU PresidentialAward.

Class of 1955David L. Rogers retired July 1, 2012 from hisposition as health officer for Calvert County,Maryland, a post that he has held for the past39 years. The Maryland State Medical Societyrecently presented Rogers with its Dr. Henry P. &M. Page Laughlin Award for his “long and dis-tinguished service to physicians and patients inMaryland and his commitment to improvingpublic health in Calvert County.”

Class of 1960William E. Powell (BA ’56) writes: “I have beenworking as physician oversight for theUniversity of Houston Downtown student healthclinic. I also am teaching physical assessmentto the University of Texas Health Science CenterSchool of Nursing in Houston. I function asfeature editor for the Harris County MedicalSociety Retired Physician Organization, singingbass in the Houston Symphony-Bay AreaLeague chorus “Noteables”; Maestro theMagnificent hand puppeteer, teaching all first

An eye for the camera

Gary D. Paige, M.D., Ph. D., chair of the Department of Neurobiology and Anatomy and the Kilian J.and Caroline F. Schmitt Professor of Neurobiology and Anatomy, was introduced to photographyat the age of 7. Photography has remained one of his passions since then. He sees a common threadin medicine, science and photography in “a foundation of knowledge, creative innovation andimprovisation.” His research and his photography have taken him to many places around the world.Paige provided a few of his photos to Rochester Medicine.

To view more of his photos, go to: http://frontpaige.smugmug.com/

Balloon flight at Letchworth State Park

37

graders in the Clear Creek Independent SchoolDistrict the four families of a symphonyorchestra for the Houston Symphony; usheringat the Alley Theater and doing all those retiredthings forbidden by a busy obstetrical practicewhich I left 10 years ago.”

Class of 1961Hechmat (Heshy) Tabechian (R ’64) retired inJuly after 10 years as the executive director ofthe Rochester Academy of Medicine. Formerly,he served as chief of the Nephrology Division atthe then Genesee Hospital in Rochester. Heremains active with the School of Medicine andDentistry as a clinical professor of medicine,preceptor in the Introduction to ClinicalMedicine course, and interviewer of first-yearstudent applicants. Tabechian also serves asthe class agent for the Class of 1961 and main-tains a close relationship with the School’sAlumni Relations Office.

Class of 1962Jerry Moress writes: “After 43 years of neuro-logical practice, I retired in September, 2011.The last 11 years were spent in Ketchum, Idaho,where having a BMI over 23 is a punishableoffense. Due to health issues, I was unable toattend my 50th reunion. Best to all my class-mates.”Robert Newman has been awarded theEUROPAD Chimera Award by the EuropeanOpiate Addiction Treatment Association; theaward recognizes those most committed to“realizing their dream of helping drug addicts.”He is only the second non-European (amongsome 20 awardees) to be a recipient.

Class of 1966President Barack Obama has appointedWarrenM. Zapol to a second term on the ArcticResearch Commission. Zapol, who was firstappointed in 2008, is director of the AnesthesiaCenter for Critical Care Research at Mass-achusetts General Hospital. From 1994 to 2008,he served as the Anesthetist-in-Chief. He also isthe Reginald Jenney Professor of Anesthesia atHarvard Medical School in Boston. He alsoserved on the Polar Research Board of theNational Academy of Sciences from 2003 to2006. In 2006, the United States Board on Geo-graphic Names named a glacier after him.He has also been part of nine expeditions toAntarctica since 1974 to study the diving physi-ology of the Weddell Seal.

Class of 1967Kenneth J. Maiocco has been named to TopDoctors in Connecticut, Best Doctors in Americain U.S. News and World Report and again asBest Doctors in America, Top Docs in the NewYork Metropolitan Area and Top 128 Physiciansin Fairfield County as a dermatologist.

Class of 1969Richard Peer (R ’75) was elected chairman ofthe Medical Society of the State of New Yorkboard of trustees at its 206th annual House ofDelegates (HOD) meeting in Saratoga Springs inApril. He is in private practice with the BuffaloMedical Group and is the medical director of

two health care facilities and a consultant forRoswell Park Cancer Center. Peer also is anassociate clinical professor of surgery at theState University of new York at Buffalo, wherehe has taught since 1977.

Class of 1970Ron Worland (R ’77) writes: “I have recentlyretired from the active practice of plastic andreconstructive surgery after 35 years inMedford, Oregon. I plan on continuing mymedical practice as an international humani-tarian surgeon. I have completed 26 inter-national missions to India, China, the DominicanRepublic, Venezuela, and many missions to

Dolphins at Baja’s Los Islotes

Oaxaca, Mexico. Thus, I am only retired fromactive private practice.”

Class of 1974Robert F. Ozols (BS ’66 PhD ’71) received theDistinguished Achievement Award from theAmerican Society of Clinical Oncology (ASCO)this year for his leadership in the field ofoncology. Ozols is an internationally knownexpert in ovarian cancer and a leader inadvancing chemotherapy research. His researchhas focused on how cancer cells develop drugresistance and on strategies for overcomingresistance. Ozols has chaired ASCO’s CancerResearch Committee and Cancer Com-munications Committee. He has served on theboard of directors of the American Associationof Cancer Institutes and ASCO. He is a fellow ofthe American Society of Clinical Oncology.

Class of 1977William Y. Hoffman is chief of the Division ofPlastic and Reconstructive Surgery and vice-

chair of the Department of Surgery at Universityof California at San Francisco.

Class of 1978Jeffrey Charen (R ’80) writes: “My son, DanielCharen, is attending the University of RochesterSchool of Medicine and Dentistry. He just grad-uated from Cornell University. I graduated fromthe U. of Rochester School of Medicine in 1978and did two years of general surgery residencyat Strong Memorial Hospital. I subsequently didan orthopedic surgery residency at Tufts-NewEngland Medical Center. I currently practice ina four-man orthopedic group in Edison andOld Bridge N.J., specializing in the hip and knee.I am married to Karen Charen, a physical thera-pist and have a daughter Rebecca who is ajunior at the U. of Michigan.”Leslie Scoutt has been inducted as a fellow inthe American College of Radiology (ACR). Scouttis medical director of the non-invasive vascularlab at Yale University School of Medicine andchief of the ultrasound section at Yale-New

Vol. 3 – 2012ROCHESTER MEDICINE38

class notes

Haven Hospital. She is a member of the ACR, amember of the board of trustees of theAmerican Registry of Radiologic Technologistsand a member of the board of governors of theAmerican Institute of Ultrasound in Medicine.Alan G. Palestine writes: “After 30 years ofpracticing ophthalmology in the Washington,D.C. area, I have retired to Colorado to ski, hike,shoot shotgun sports and spend more timeenjoying the outdoors. I may return to part-timepractice, but am really enjoying retirement.”

Class of 1982Mark Adams (R ’84 MBA ’93) was elected to thecouncil steering committee of the AmericanCollege of Radiology.Robert A. Herbstman (BA ’78) was elected tothe executive board of the New Jersey Societyof Plastic Surgeons.Harold L. Paz (BA ’77), Penn State Milton S.Hershey Medical Center CEO, Penn State’ssenior vice dean for health affairs, and dean,Penn State College of Medicine, has been

Takeoff at Mendon Ponds, N.Y.

39

named to Becker’s Hospital Review’s recentlyreleased “100 Physician Leaders of Hospitalsand Health Systems” list, which features someof the top physician leaders in health care.Paz has held the top position at Penn StateHershey since April 2006.Joseph Serletti (R ’88) has been electeda member of the American Surgical Association.Serletti is the Henry Royster-William MaulMeasey Professor of Surgery and chief ofplastic surgery at the University of Penn-sylvania. He also is a director of the AmericanBoard of Plastic Surgery.

Class of 1985Dennis Kraus (BA ’81) writes: “After 22 years atMemorial Sloan-Kettering Cancer Center, I havejoined the Northshore Health Care System asthe director of the head and neck oncologyprogram. My clinical practice is located at theLenox Hill Hospital in Manhattan. My positionincludes responsibility for the clinical andresearch efforts for head and neck oncology

across the 15 hospital health care system.”

Class of 1986Robert McGowen has joined SouthcoastPhysicians Group as the chief of primary careservices for the Wareham, Mass., region.McGowen also practices internal medicine atSouthcoast Health System at Rosebrook inWareham.

Class of 1988Jeffrey M. Lyness (BA ’83), professor of psychi-atry, has become the senior associate dean foracademic affairs for the University of RochesterSchool of Medicine and Dentistry. Lyness, whowas appointed associate dean for AcademicAffairs a year ago, has been director ofcurriculum for medical student education since2008 and medical director of continuing medicaleducation since 2010.David L. Waldman (MS ’83, PhD ’88, R ’90) hasbeen inducted as a fellow in the AmericanCollege of Radiology (ACR). Approximately

10 percent of ACR members achieve this distinc-tion. Waldman is a professor and chair ofradiology at the University of Rochester MedicalCenter.

Class of 1989Peter Hotvedt writes: "I sent my daughter toRochester. She started as an undergrad this fall."

Class of 1994Joseph E. Losee (R ’99) currently serves as theprogram director for the University of Pitts-burgh’s plastic surgery residency program andchief of plastic surgery at the PittsburghChildren’s Hospital. Losee recently was electeda director of the American Board of PlasticSurgery.

Class of 1995Dwight Heron has been inducted as a fellow inthe American College of Radiology (ACR). Heronis a professor and vice-chairman of clinical

Grazing near the Mount Tabor-Weston Road in Vermont.


student life

affairs in the department of radiation oncologyat the University of Pittsburgh School of Med-icine (UPMC), where he also is a professor ofotolaryngology, head and neck surgery; deputydirector of the University of Pittsburgh CancerInstitute; and the director of radiation servicesat UPMC Cancer Centers.Manish Vig (BA ’91 BS ’91) writes: “The familyand I recently moved from Massachusettswhere I served as medical director and chief ofthe emergency department at the HolyokeMedical Center. I led a turnaround of a depart-ment in demise and managed to recruit afull-time team of 14 physicians and eight mid-level providers in the midst of 33 percent growthin the annual population we served. I alsoimplemented best-practice processes andaltered the various systems that lead to efficientand safe patient care, particularly in the areasof acute stroke and coronary disease, andmanaged to do all of this as we adapted to statehealth care reform.

“More importantly, during this time, wewelcomed our daughter, Sofia Rani Vig, whowas born in July 2010, and has quickly becomebest friends with her big brother Rohan. Thekids are now learning to settle in the metroAtlanta area as I assume a new role with theSchumacher Group as its State of Georgia AreaMedical Officer. The company provides leader-ship and staffing solutions at over 200emergency departments and hospitalist depart-ments nationwide, and my territory willeventually expand to providing oversight at our18 sites in the state … The support I get frommy wife and kids along with the ongoing friend-ships from medical school has been somethingto cherish as I continue to find novel ways tointegrate clinical excellence, operational over-sight and business development in medicine.”

Class of 1998Robert Whorf (R ’01) writes: “On a personalnote I, my wife, Patty, and two sons are living inSouthwest Florida on the Gulf of Mexico.We are having fun kayaking, jet skiing andsailing and continuing my tradition of damaginglocal golf courses.” Whorf is director ofresearch operations at Florida Cancer Special-ists and Research Institute. In addition to thegoal of increasing participation in clinical trials,he helps oversee the expansion of the drugdevelopment unit. He has served as principaland sub-investigator on almost 60 clinicalresearch trials. He has been named by U.S.

News and World Report as one of the TopDoctors in the United States in their 2011 and2012 Rankings Guides.

Class of 2000Christopher Ellis, assistant professor ofcardiac electrophysiology at Vanderbilt Heart

and Vascular Institute, and his wife WendyDrew Ellis M.D. (pediatric radiologist, VanderbiltChildren’s Hospital), announce the birth of theirfirst child, a girl, Parker Josephine.

Class of 2006Cara Agerstrand has accepted the position of

Sunset at Elk Lake in the Adirondacks.

41

assistant professor for clinical medicine in theDivision of Pulmonary, Allergy, and Critical CareMedicine at Columbia University MedicalCenter, New York-Presbyterian Hospital, in NewYork City. She is specializing in critical care andextracorporeal membrane oxygenation (ECMO).She completed her residency in internal medi-cine and a fellowship in pulmonary and criticalcare medicine at Columbia University MedicalCenter.Ryan Anthony recently completed a cardiologyfellowship at Vanderbilt University MedicalCenter in Nashville and has joined MountCarmel Columbus Cardiology Consultants inColumbus, Ohio.Tracey Henderson writes: “My husband,Joe Henderson (M ’05) and I welcomed our firstchild, Elizabeth Violet, on Jan. 24, 2012.I completed my chief residency in pediatrics andhave joined Bay Creek Pediatrics inWebster, N.Y.”Lenny Lesser finished a research fellowship atUCLA and has taken a research physician job atthe Palo Alto Medical Foundation, where he will

be working on obesity and nutrition research.He continues to enjoy the California lifestyle,and is in his second season of amateur bikeracing.Benjamin Petre writes: The Petre family ismoving again. Kristen and Ben with their twodaughters, Grace (3) and Hannah (1), have finallyfinished his orthopedic training at JohnsHopkins Hospital and subspecialty training insports medicine at The Steadman Clinic in Vail,Colo. Ben is excited to be joining an orthopedicpractice in Annapolis, M.D.

Class of 2007Gregg Lawrence Chesney (BA ’03) and TaylorBlake Lubitz were married at the WoodmereClub in Woodmere, N.Y. Rabbi Debra M. Bennetofficiated. Chesney was a chief resident inemergency and internal medicine at Long IslandJewish Medical Center in New Hyde Park, N.Y.He recently began a fellowship in critical caremedicine at Stanford University Medical Centerin Stanford, Calif.

Class of 2008Vasanth Kainkaryam completed a combinedinternal medicine and pediatrics residency atBaystate Medical Center. He joined HartfordMedical Group in Connecticut. He and his wife,Pranjali, had their first baby, a daughter, VihanaPrishti Kainkaryam, in April, 2012.

Class of 2009Alexis Weymann (M ’09) and David Perlmutter(M ’10) were married in Shelburne, Vermont, onMay 26, 2012. They write that Dr. Chin-To Fong(genetics, pediatrics at URMC) was the weddingofficiant. Many MDs from the classes of 2009and 2010 were in attendance. David is a third-year Wills Eye ophthalmology resident, andAlex is just finishing up her pediatrics residencyat Children’s Hospital of Philadelphia. She willbe working for a year at CHOP and then willstart a dermatology residency at Geisinger withplans to pursue pediatric dermatology.

Elk Lake in the Adirondacks, just before dawn.

Like the tools of our profession,

medical education must also evolve

over time.

Today, Rochester is known for innovative approaches to medical education. However, innovation is the product of generosity, and we would not be where we are today if not for the annual support of alumni and friends.

You are an important part of the School of Medicine and Dentistry’s past and present successes.

Be a part of our futureevolution by making a gi� today.

Visit Rochester.edu/giving/innovate or call 800.598.1330.All gifts count toward The Meliora Challenge, a University-wide fundraising Campaign that was launched in 2011 and runs through June 30, 2016.


class notes

Class of 2010Brian Jenssen writes: “I’m finishing up mypediatric residency at Children’s Hospital ofPhiladelphia this next year, where I’ll be chiefresident for the academic year of 2013–2014.More importantly, I’m recently engaged to oneof my co-residents, Kate Henry, and we’re plan-ning to marry the summer after residency.”David Perlmutter (M ’10) and Alexis Weymann(M ’09) got married in Shelburne, Vermont, onMay 26, 2012. They write that Dr. Chin-To Fong(genetics, pediatrics at URMC) was the weddingofficiant. Many MDs from the classes of 2009and 2010 were in attendance. David is a third-year Wills Eye ophthalmology resident, andAlex is just finishing up her pediatrics residencyat Children’s Hospital of Philadelphia. She willbe working for a year at CHOP and then willstart a dermatology residency at Geisinger withplans to pursue pediatric dermatology.

Resident/Fellow AlumniMark J. Adams (MD ’82, R ’84, MBA ’93) –See MD Class of 1982.Teresa Ainsworth (R ’97) is an emergencymedicine staff physician for Finger Lakes Healthin Geneva, N.Y. She is pursuing internationalmedicine and is engaging a part-time appoint-ment in Guam. Her husband David Ainsworth isa system analyst for Summit Federal CreditUnion. They reside in Honeoye Falls, N.Y. Theirdaughter, Aspen Ainsworth, is completing herthird year clerkships at State University of NewYork at Buffalo School of Medicine. Their son,Austin, will be a sophomore at Honeoye Falls-Lima High School, with emphasis in Latin andinstrumental music.Scott Bissell (R ’02) has joined the medicalstaff of St. Francis Hospital and Medical Center.He is practicing as a member of ConnecticutOrthopedic Associates.Vladimir Bogin (R ’01) is chairman of the board

at Medistem Inc. Medistem is a clinical stageadult stem cell company that has discoveredEndometrial Regenerative Cell, a universaldonor cell that has potent vasculogenic proper-ties. The company has received approval forphase Ib study in patients with critical limbischemia from the FDA and is conducting aphase IIa study in patients with congestiveheart failure.Jeffrey H. Charen (MD’78, R ’80) – See MDClass of 1978.Joseph Edward Losee (MD ’94, R ’99) – SeeMD Class of 1994.Navin C. Nanda (FLW ’73) is DistinguishedProfessor of Medicine and CardiovascularDisease, and director of Heart Station/Echo-cardiography Laboratories at the University ofAlabama at Birmingham.

In May, 2011, Nanda was presented the“Father of Modern Echocardiography” award bythe Chinese Ultrasound Doctors Association inWuhan, People’s Republic of China. In February,2012, he also received “The Father of Modern

43

Echocardiography” award from the IndianAssociation of Cardiovascular and ThoracicAnesthesiologists for his pioneering contribu-tions in all fields of cardiac ultrasound, includingperioperative echocardiography. Among severalother awards, Nanda was presented a LifetimeAchievement Award from the Indian HeartRhythm Society. He was the first in the world toimage cardiac catheters and pacemakers byechocardiography and assess pacemaker func-tion including detection of complications, suchas pacemaker perforation and thrombosis.He was the first to show increase in strokevolume by Doppler with sequential pacingcompared to regular ventricular pacing anddeveloped the Doppler technique to maximizestroke volume and minimize mitral regurgitationduring cardiac pacing.Richard Peer (MD ’69, R ’75) – See MD Class of1969.Lance Rodewald (FLW ’87) received the Dis-tinguished Alumni Award for 2012 fromSouthern Illinois University School of Medicine.Rodewald is the director of the immunizationservices division in the National Center forImmunization and Respiratory Diseases at theCenter for Disease Control and Prevention(CDC). The awards from the School’s AlumniSociety board of governors recognize out-standing contributions to medicine anddistinguished service to humankind. Rodewaldsupervises 215 personnel stationed both at CDCheadquarters in Atlanta as well as throughoutthe United States and oversees a budget of$4.4 billion. Record or near-record highs inimmunization coverage and record or near-record lows in incidence of vaccine-preventablediseases have been achieved since Rodewaldwas named director in 2000.AnnRosenthal (R ’86) has been appointed chief ofthe division of rheumatology at the MedicalCollege of Wisconsin. Rosenthal also is the newWill and Cava Ross Professor of Medicine, andassumes the new position of vice chair for facultydevelopment in the Department of Medicine. Sheheads the rheumatology practice at FroedtertHospital, and practices at the Clement Zablocki VAMedical Center. Rosenthal is internationallyknown as an innovative laboratory investigator inthe fields of crystal-related arthritis and cartilagedegeneration. Her research program has beencontinuously funded from the VA and/orNational Institutes of Health since 1992.Joseph Serletti (MD’82, R ’88) – See MD Classof 1982.

David L. Waldman (MS ’83, MD ’88, PhD ’88,R ’90) – See MD Class of 1988.Robert Whorf (R ’01) – See MD Class of 1998.Ron Worland (MD ’70, R ’77) – See MD Class of1970.

Graduate AlumniJoseph G. Brand (PhD ’72) has retired after39 years and more than 110 publications, fromMonell Chemical Senses Center in Philadelphia.He served as associate director of Monell from1991 until his retirement.Mary Fox (MPH ’89), an assistant professor inthe Health Policy and Management Departmentof the Johns Hopkins Bloomberg School ofPublic Health, has been selected to serve onthe Environmental Protection Agency’s (EPA)Science Advisory Board Ad-hoc Panel. Fox andothers on the Ad-hoc panel will focus on devel-oping advice based on current informationabout perchlorate, a naturally occurring andprocessed chemical found in drinking water.Steven Gilbert (BS ’73, MS ’83, PhD ’86) writes:The second edition of my book A Small Dose ofToxicology: The Health Effects of CommonChemicals was just launched as a free e-bookfor downloading for an iPad, kindle or PDF.It is published by Healthy World Press(www.healthyworldpress.org). All the chapterswere updated and several new chapters addedwith links into Toxipedia (www.toxipedia.org)and free PowerPoint presentations for eachchapter (www.asmalldoseof.org). A Small Doseof Toxicology is an introductory toxicology text-book that examines the health effects ofcommon chemical agents and places toxicologywithin the framework of everyday life. Agentscovered include not only obvious candidatessuch as lead, mercury, and solvents, but familiarcompounds such as caffeine, alcohol, and nico-tine. Additional chapters cover basic toxicology,targets of toxic agents, risk assessment, history,and ethics.Kelly Goonan (MPH ’97) is the director of carecoordination for Cornerstone Health Care inHigh Point, N.C.John Joseph Karijolich (MS ’08, PhD ’11) andKatie Michelle Lovria were married Jan. 28,2012, at Casa Larga Vineyards in Fairport, N.Y.The couple lives in New Jersey.Heather Lankes (MS ’03, MPH ’06, PhD ’06) andAmit Lugade (MS ’03. PhD ’06) were married on

June 6, 2012.Carol Warren Nichols (BA ’72, MS ’75) hasbeen certified by IYNAUS (Iyengar Yoga NationalAssociation the United States) as an Intro-ductory II Iyengar Yoga Teacher. Thiscertification is approved and signed by B.K.S.Iyengar of the Ramamani Iyengar MemorialYoga Institute, Pune, IndiaRobert Felix Ozols (BS ’66, PhD ’71, MD ’74) –See MD Class of 1974.Rachel Lee Roper (MS ’90, PhD ’92) was issueda patent covering discovery and characterizationof the A35 pox virus gene. If this gene isremoved from vaccine strains the vaccines aremuch safer. In addition, since this gene encodesan immunosuppressive protein, removal of thegene from vaccine strains yields a vaccine thatgives improved immune responses. This tech-nology can be used for vaccines against anumber of diseases and for cancer treatment.The patent also covers the potential future useof this gene, or its cognate protein, to clinicallysuppress undesirable immune responses, suchas in organ transplantation and autoimmunediseases. Also covered is the detection of theA35 gene or protein in pathogens carrying thegene.Marcia Joslyn Scherer (MPH ’86, PhD ’86) haspublished two books, Assistive Technologiesand Other Supports for People with BrainImpairment (Springer Publishing Company) andAssistive Technology Assessment Handbook(CRC Press). She is president of the Institute forMatching Person & Technology in Webster, N.Y.David L. Waldman (MS ’83, MD ’88, PhD ’88, R’90) – See MD Class of 1988.Deborah Warner, Ph.D. (PDC ’80), ran for theNew Hampshire Senate District 1, the northernmost area in the state, which includes Mt.Washington. She says: “All are welcome to visitthe North Country and enjoy its mountains,lakes, rivers and people.”Stephanie Wragg (PhD ’96) was appointedassociate dean for academic affairs for theCollege of Medicine of the University of Illinoisat Urbana-Champaign. She is also associateprofessor of biochemistry.

“

Vol. 3 – 2012

in memoriam

ROCHESTER MEDICINE44

In memoriam

Bruce Larry Brown (MD ’47)James G. Brown (R ’46)Anthony J. Capone (MD ’57, R ’61)Carlo C. Davis (MD ’51)Robert Morgan Fink (PhD ’42)Hilliard E. Firschein (PhD ’58)John B. Flick (MD ’45)Alice Foster (BA ’45, MD ’48)William L. Greer (MD ’43)Lewis Hogg (MD ’45)Richard A. Isay (MD ’61)Walter “Worth” E. Linaweaver (MD ’55)Charles C. Lobeck Jr. (MD ’52)Martha R. Lumpkin (R ’52)Thomas M. Mettee (MD ’68)Robert P. Perry (MD ’76)Stephen R. Pope (MD ’53)William D. Salmon (R ’52)Richard H. Saunders Jr. (MD ’43)Thomas D. Smith (R ’74)Clifford W. Skinner (R ’57)Elizabeth Anna Werner (PhD ’68)Joel Jacob Widelitz (MD ’71)

Continued from page 37Hansen Q&A

research faculty. It’s an attitude. It’s aboutlooking at things in the largest context possible.If you approach education that way, in a liberalarts mode, there is no limit to what you canlearn. You open your mind. You meet newpeople, and experience new ideas andapproaches. It all builds upon itself.

Q: Do you think the traditional anatomy courseand dissection lab will disappear from medicalschool curriculums because of advancements indigital technology?A: I don’t think we’ll see changes, at least in theimmediate future. I don’t know what thefinances are going to be for any medical schoolin the future, but schools are not abandoningtraditional anatomy. Most schools still adhereto a good dissection course and have a viableanatomical gift program to support it.

Yes, things are digitized and online and theyare wonderful adjuncts, but they are no replace-ment for a cadaver. I think most clinicians wouldtell you the same thing. Anatomy plays a keyrole in the mindset of a beginning medicalstudent. It is the one thing they are thinkingabout as they start as a first-year student. Howwill I react? How will I deal with this? It is oneof the most lasting memories of their under-graduate medical education.

Anatomy traditionally has been taught by adevoted group of faculty who value excellencein teaching. You have to be a committedteacher. It is the most time intensive basic

science course. It is physically demanding to bein anatomy lab. It is emotionally draining forstudents and faculty, but it is such a richlearning experience. Students don’t just learnanatomy. They learn resilience. They learnabout physical and emotional stamina. Theylearn to work as a team, perhaps for the firsttime. They have to work together and supportone another. It’s an intensive learning environ-ment but it is also a positive learningenvironment. There is no doubt this is real expe-rience. You are in medical school and yourcommitment to learn must be genuine.

Yes, we have flat screen TVs and access toradiographic images and videos on a computer.But they can’t replace dissection. You learnmanual skills-how to handle a scalpel andforceps, a dissecting scissors, a Striker saw-inthe anatomy lab. The experience helps youbecome a better physician in a lot of differentways beyond simply learning the anatomy. Youlearn how to learn under stress and how to dealwith your emotions, while at the same timesupporting those around you. Computer simula-tions can’t convey the difficulty encountered inteasing out a nerve or preserving an artery in anobscured dissection field.

Medical school is four years long. We havean explosion in many fields. We have molecularbiology and molecular genetics. There is some-thing new every day. You have to find moreefficient ways to convey information and betterways to teach future physicians to learn on theirown. But I think students would feel they gotcheated if they didn’t have the traditionalanatomy lab. I feel sorry for those who don’t getto do the whole dissection because they aremissing out not only on the anatomy but on allthe other skills this unique laboratory experi-ences teaches.

45

For more information, contact the School of Medicine and Dentistry Office of Alumni Relations at [email protected] or (800) 333-4428.

Visit us online at www.urmc.rochester.edu/smd/alumni

SAVE THE DATES! OCTOBER 10–13, 2013

School of Medicine and Dentistry Reunion & Meliora Weekend

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Visit www.urmc.rochester.edu/news/ for the latest URMC and SMD headlines and to sign up for e-alerts. You also can catch up on news from fellow alumni with Rochester Medicine Magazine online at www.urmc.rochester.edu/news/publications. Submit your news and updates to [email protected].

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