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WOMEN IN MEDICINE New perspectives on sex difference, research ethics, and academic medicine

Michelle Roett (M’03), Chair Department of Family Medicine


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WOMEN IN MEDICINE

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Sex: What’s the Difference? To better understand human health, researchers study sex as a biological variable in the lab.

Persistence and Progress for Women in Academic Medicine Georgetown Women in Medicine fosters a collegial, supportive community of female faculty in pursuit of equity.

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Georgetown University Medical Center’s Trailblazing Women Highlights from the many who helped shape history

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Ethics: Pregnancy and Research Under the Microscope New guidance offered on Zika and the responsible inclusion of pregnant women in scientific research.


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Check Up News & Research

On Campus Alumni Connections What’s in my white coat? Reflections on medicine

FROM THE ARCHIVES: First-year Georgetown medical students assembled in 1906 on the steps of the Dental Infirmary. According to a June 12, 1910 article in the Evening Star, several went on to receive their diplomas four years later. At graduation, University President Rev. Joseph Himmel, S.J., noted that the hospital hoped to add a new maternity ward, and invited any millionaires in the audience to consider endowing it. In his address, Professor John B. Hird advised the graduates to stick closely to the ethics of their profession, avoid talking too much, and discourage patients from using tobacco or liquor. He added that “the only time a physician or dentist had the right to use either is after the day’s work is completely done.”


READER FEEDBACK

A publication for alumni and friends of Georgetown University Medical Center Editor Jane Varner Malhotra

Contributors Omar Abubars Kate Colwell Jeff Donahoe Allan Hutchison-Maxwell (S’14) Patti North Kate Potterfield (C’04) Leigh Ann Renzulli Camille Scarborough Karen Teber Kat Zambon

Design Director Robin Lazarus-Berlin, Lazarus Design

University Photographer Phil Humnicky

After appearing in the Fall/Winter 2016 Georgetown Medicine magazine, this photo has continued to generate reader interest.

Executive Vice President for Health Sciences and Executive Dean Edward B. Healton, MD, MPH

Dean for Medical Education

Disaster Drill, III: The Intrigue Continues From the editor: We received letters from two alumni, Joseph T. Thornton (M’58) and Tom Magovern (M’58), both wishing to correct the record from a previous reader who, it appears, saw himself in the image of another. They assert that the smartly dressed fellow in the disaster drill photo, donning a jacket and bandaged hands, was actually their classmate, Ronald P. Meagher (M’58). In addition, they identified several other members of the Class of 1958 in the scene. Per Dr. Thornton, the first three figures we see from left to right are: Joan Wohlgemuth, Sister Thomas Anne Fitzmaurice, Julie Wershing, and then perhaps —but he is uncertain—Robert Gfeller in the background. Dr. Magovern works from right to left to identify Phil Rodilosso, an unknown woman next to him, and then Hal Reilly in the head bandage and glasses (who called Dr. Magovern to discuss the photo, and both checked Ron’s yearbook picture to confirm their memories of the disaster simulation). He guessed that the figure in the sweater behind Ron is Bob Farese, and that the guy to his right is Lou Maffei rather than Robert Gfeller. He noted that Sister Mary Thomas Ann Fitzmaurice is now Patricia McCormack. Perhaps this terrific group of historians will reenact the scene for their 60th reunion in 2018!

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Stephen Ray Mitchell (W’86), MD, MBA

Georgetown Medicine is published by the Georgetown University Office of Advancement Communications. Visit the magazine online at gumc.georgetown.edu/magazine. The magazine welcomes inquiries, opinions, and comments from its readers. Address correspondence to georgetownmedicinemagazine@ georgetown.edu or: Jane Varner Malhotra, Editor Georgetown Medicine Office of Advancement P.O. Box 571253 Washington, DC 20057-1253 For address changes contact alumni records addup@georgetown.edu or 202-687-1994. For up-to-date information on Georgetown events and alumni news on campus and around the world, visit Georgetown Alumni Online: alumni.georgetown.edu. © 2017 Georgetown University Medical Center


CHECK UP NEWS & RESEARCH

Global Health Expert Returns to Georgetown Mark Dybul (C’85, M’92) joins new Center for Global Health and Quality n n

This summer, the university welcomed returning global health expert and double-Hoya Mark Dybul, MD, to co-direct the new Center for Global Health and Quality (GHQ) at Georgetown University Medical Center. “We are experiencing a remarkable period of rapid geopolitical and economic change in the world,” says Dybul. “As a result, this is a critical time in global health, but we are in a position where if we are careful, smart, and strategic, we can take hold of a tremendous opportunity and make great progress.” The mission of the GHQ is to work with partners to respond to current and emerging health challenges and bring quality services to scale while maximizing resources. The center will bring together top critical thinkers in academia to collaborate on developing and deploying strategies, explains Dybul. “By supporting countries as they tackle major health challenges, we also contribute to economic growth and development,” he adds. “We can achieve our Georgetown mission of cura personalis by taking care of global communities.” GHQ is a multi-disciplinary enterprise that leverages the leading minds in global health, health care, big data, service delivery, economics, program design, international relations, law, and management. The center will examine the ways in which data—such as quality metrics and private sector information— can complement existing health metrics. Its wide-ranging areas of focus will be developed in partnership with countries and other stakeholders. Dybul began his work in HIV research as a fellow at the National Institute for Allergy and Infectious

Some universities have developed expertise at implementing global health programs, but the GHQ approach will be different, says Dybul, who envisions “partnerships rather than paternalism.” He adds, “We are more interested in supporting people in the country to provide the services and establish the systems, so that the external support is no longer necessary.” Diseases. He went on to lead the International Prevention of Mother and Child HIV initiative for the Department of Health and Human Services. In 2009, he returned to Georgetown to serve as co-director of the Global Health Law Program at the O’Neill Institute. He left to serve as executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2013.

“We are excited about the new energy, experience, and leadership Dybul brings to Georgetown,” says Edward B. Healton, MD, MPH, executive vice president for health sciences and executive dean of the School of Medicine. “Mark joins a strong and dedicated cohort of Georgetown faculty who have devoted their careers to global health.” n

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Fat’s Lasting Impact

Animal study finds high-fat diet in second trimester increases breast cancer risk over generations. Feeding pregnant female mice a diet high in fat derived from common corn oil resulted in genetic changes that substantially increased breast cancer susceptibility in three generations of female offspring, reports a team of researchers led by scientists at Georgetown Lombardi Comprehensive Cancer Center.

The study suggests a research direction for examining the diet of pregnant women, says the study’s senior author, Leena HilakiviClarke, PhD, professor of oncology. “It is believed that environmental and lifestyle factors, such as diet, play a critical role in increasing human breast cancer risk, and so we use animal models to reveal the biological mechanisms responsible for the increase in risk in women and their female progeny,” says Hilakivi-Clarke.

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A high-fat diet is linked to excess inflammation, and studies connect inflammation and cancer risk, she says. In earlier studies, Hilakivi-Clarke found that when pregnant mice eat a high-fat diet, they produce “daughters” with an excess risk of the cancer. This study, however, found that if pregnant mice were switched to a high-fat diet during their second trimester, when the germ line mediating genetic information from one generation to another forms in the fetus, an increase in breast cancer risk is also seen in “great granddaughters.” A gene screen revealed a number of genetic changes in the first (daughter) and third (great granddaughter) high-fat mice generations, including several linked to increased breast cancer in women, increased resistance to treatment, poor prognosis, and impaired anticancer immunity. The researchers also found three times as many genetic changes in third generation than in first generation mammary tissue between high-fat diet progeny and the control group’s offspring. The amount of fat fed to the experimental mice matched what a human might eat daily, says Hilakivi-Clarke. In the study, both the control mice and the mice fed high levels of corn oil ate the same amount of total calories and they weighed the same. “But our experimental mice got 40 percent of their energy from fat, and the control mice got a normal diet that provided 18 percent of their energy from fat,” she notes. “The typical human diet now consists of 33 percent fat.” Pregnant mice ate the high-fat diet starting at gestation day 10, the time when a daughter’s ovarian eggs (and germ cells) begin to develop. This corresponds roughly to a woman’s second trimester. By comparison, eating a high-fat diet before and during pregnancy increases breast cancer risk in the subsequent two generations, but does not cause inheritable changes in the germ cells, Hilakivi-Clarke says. n

OPIOIDS: A NATIONAL EMERGENCY? In an opinion published online in JAMA in August, Lawrence O. Gostin, professor of medicine and faculty director of the O’Neill Institute for National and Global Health Law at Georgetown, joined colleagues to make the case for declaring the U.S. opioid epidemic a national public health emergency. The action “authorizes public health powers, mobilizes resources, and facilitates innovative strategies to curb a rapidly escalating public health crisis,” the authors explain. Six states and several tribal governments have already declared public health emergencies for the opioid epidemic, but a national emergency declaration would create a critical, coordinated “surge response.” The authors note that with 180,000 opioid overdose deaths predicted by 2020, “Opioid abuse is among the most consequential preventable public health threats facing the nation.” n

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Deficiencies in DNA Repairing Identified in Tumors

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A new investigation of more than 53,000 stored tumor samples finds evidence of a key deficiency in a repair process designed to keep DNA from being mutated and causing cancer. The DNA repair deficiency, called homologous recombination deficiency, or HRD, has previously been studied in only a few cancers, but as researchers at Georgetown Lombardi Comprehensive Cancer Center report, HRD can be found in all of the cancer types the researchers studied, including prostate, breast, pancreatic, and endometrial cancers as well as two of the more deadly types: ovarian cancer and glioma, a type of brain cancer. Looking at the tumor samples, researchers found evidence of HRD in the 20 cancer types studied. The findings could play an important role in identifying which mutated genes, and which types of cancer, could be targeted to take advantage of the deficiency and ultimately help in treating cancer. The most commonly mutated genes were found to be PTEN, BRCA2, BRCA1, ATM, and PALB2. “We know that patients with BRCA mutations are at high risk for developing breast, as well as pancreatic, ovarian, prostate and other cancers, and we

have learned over time that BRCA plays a very important role in DNA damage repair,” says the study’s lead author, Arielle Heeke, MD, a clinical fellow at Georgetown Lombardi. “But BRCA is just one of the many genes that encode important proteins in the DNA repair pathway known as homologous recombination. “With ongoing studies of the homologous recombination pathway and its impact on cancer development, we may identify additional genes that, when mutated, allow for either improved response to specific treatments or conversely, portend more aggressive tumor biology, and this could greatly inform development of new cancer therapies,” Heeke explains. While the clinical impact of many of these mutations remains unknown, a new clinical trial at Georgetown Lombardi is looking to evaluate the effects of inhibiting a DNA repair enzyme known as PARP in tumors with HRD. “If, as we postulate, the combination of chemotherapy and PARP inhibition is successful in treating patients with HRD tumors, I expect that others will start exploring

whether similar drugs or analogous therapies can make a difference in these diseases,” Heeke concludes. n

Homologous recombination is a DNA repair process for double strand breaks.

RUNNING HELPS OLDER WOMEN regenerate bone

density, offsetting bone loss during menopause, says Georgetown Professor of Family Medicine Ranit Mishori, MD (M’02), in a recent article in the Washington Post. Herself a runner and former triathlete, Mishori adds that running can help reduce other adverse effects of menopause including hot flashes, circulation problems, and depression. n

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Tumor Mutations: The Upside? n n

and therefore a more attractive object to attack. Tumor mutation load also could be used as a marker to determine which types of cancer and which patients could most benefit from immunotherapy. “We found that, as expected, melanoma had the highest TML, as we know clinically that this type of cancer responds best to immunotherapy,” says Salem. “Indeed, the mean TML for melanoma was nearly double that of the next highest mean, non-small cell lung cancer. In addition, we see that high TML often occurs in tumors lacking well-known cancer-related genes, like BRAF or NRAS genes in melanoma and EGFR or ALK genes in non-small cell lung cancer. This suggests that immune checkpoint inhibitors may be particularly effective in patients who are not candidates for common targeted therapies in these types of cancer,” he adds. “The next step is to validate and correlate TML levels with outcomes in patients who have received immunotherapy. We’ll look to see if patients had high TML levels before they started therapy and then determine if those with the highest levels had the best clinical outcome, which is what we might expect. If validation studies prove helpful, they could be very useful in designing clinical trials for many types of cancer,” Salem concludes. n

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A team of investigators led by researchers at Georgetown Lombardi Comprehensive Cancer Center has found that the tumor mutation load (TML) in a patient’s cancer biopsy varied by age and the type of cancer, along with several other factors. The findings include 14 types of solid tumors and over 8,000 tissue samples, offering one of the most comprehensive analyses of TML to date. TML is a measurement of the number of mutations in DNA. Mutated DNA can be subsequently translated to harmful changes in proteins. Mutated proteins often appear foreign to the immune system and can therefore activate a robust immune response that can be boosted by immunotherapeutic agents. “One of our more interesting findings was the fact that mutation load increased with age in many cancers,” says the study’s principal investigator, Mohamed E. Salem, MD, a former assistant professor of medicine at Georgetown Lombardi. “Older age correlated closely with TML in most of the cancers we examined, but in some cancers, such as bladder cancer, there was no correlation by age, which also makes for an important observation in a difficult-to-treat type of cancer.” Salem is interested in quantifying a cell’s TML because if it is high, then immunotherapy could be an effective cancer treatment. Immunotherapies work by “taking the brakes off ” the immune system, allowing immune-fighting cells to go after cancer cells. A cancer cell with more mutations may make it appear more alien to the immune-fighting cells,

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Better Autism Screening for Latino Children

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Georgetown autism specialists working with Latino families in Washington, D.C., have developed an effective screening program that identifies Latino infants who may be at risk for autism spectrum disorder (ASD), allowing the opportunity for early intervention. Pediatricians recommend that all children be screened for autism by age two. In the year before the study, few were screened for autism risk—less than 10 percent of Latino 18-30-month-olds received screening—and none were identified to be at risk for ASD. After incorporating the new screening model, more than 90 percent of the infants were screened during wellchild doctor visits. Four percent were identified to be at possible risk and referred for more specific ASD testing. “This rate mirrors the rate of positive screens found in studies of U.S. Englishlanguage toddlers,” says the study’s senior investigator, Bruno Anthony, PhD, former deputy director for the Georgetown University Center for Child and Human Development, and professor of pediatrics and psychiatry. “It appears that our approach is effectively picking up children who might benefit from early intervention that can improve outcomes such as cognition, peer interactions, language development, and

strategies to enhance families’ coping abilities,” explains Anthony. The years-long, federally funded effort took a deep dive into Latino cultural norms in order to develop an ethnically sensitive screening methodology. The typical screening tool used in the U.S. to diagnose ASD risk is the M-CHAT (the Modified Checklist for Autism in Toddlers), a questionnaire for parents regarding their child’s behavior. But the M-CHAT, even when translated into Spanish, is not often used with Latino parents, says Anthony. “Our prework for this study found that the parents

often did not understand the questions,” he says, noting that the questions can be ambiguous from a cultural perspective. Anthony and his group adapted the M-CHAT by providing explanations of some questions, and adding oral administration by bilingual, bicultural family navigators who themselves had experience raising children diagnosed with developmental disorders. Over time, health care workers gradually took over the screening process from the family navigators. “We found that Latino parents were often not comfortable talking about their child’s possible behavioral

issues and developmental delays,” notes Anthony. “We had to work hard to give them the sense that these conversations are appropriate and safe in a medical setting.” “The findings show that universal screening for ASDs and developmental delays in primary care can be effective if the program is responsive to community and provider needs that inform outreach, family engagement, training, and clinical procedures,” he adds. n

Health Policy and Kids For the latest on Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act, follow Georgetown’s popular “Say Ahhh!” health policy blog. The articles and reports are produced by the university’s Center for Children & Families (CCF), part of the Health Policy Institute at the McCourt School of Public Policy. CCF is an independent, nonpartisan policy and research center with a mission to expand and improve highquality, affordable health coverage. Founded in 2005, the center is devoted to improving the health of America’s children and families, particularly those with low and moderate incomes. n

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New Online Master’s in Health Care Leadership n n

A new master’s degree at Georgetown teaches health care professionals how to enhance patient safety and improve quality in an increasingly complex heath care system. The executive master’s in clinical quality, safety and leadership (CQSL), developed by Georgetown University Medical Center (GUMC) in collaboration with MedStar Health, is entirely online apart from a four-day on-campus residency, allowing professionals to complete the program in 16 months while continuing to work. The learner-centered course also includes simulation, team training, and a mentored capstone project. The unique program emphasizes community outreach and the Jesuit principle of cura personalis. “It’s hard to

imagine providing care of the whole person if attention to quality care and patient safety is missing,” says Anne Gunderson, associate dean for innovation in clinical education at GUMC and leader of the program’s development. Many medical and nursing schools do not provide enough quality and safety training, she adds. “There is basic training required by accreditation bodies, but it does not adequately prepare physicians and nurses for the complexity of medicine in today’s world.” This can lead to medical errors—a serious problem that affects both patients and the health care workers involved. “Many good physicians, nurses, pharmacists, and other health care

LAUGHTER IS THE BEST MEDICINE For the last five years, incoming first and second-year Georgetown School of Medicine students live the spirit of cura personalis by planning and running a sports camp for homeless children living in the DC General Family Shelter. “Trying new things and sharing in the laughter of the week requires a certain trust that these kids don't often get to develop in the chaotic environment of a family shelter,” says Jessica Haladyna (M’20), camp director. “The camp isn’t about the games that we play, but the sportsmanship and teamwork that grow into longlasting friendships and life lessons.” n

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professionals have left the field due to depression and lack of support from their colleagues,” Gunderson adds. She hopes to see a shift from an emphasis on institutional risk management to an integrated and comprehensive focus on patient safety and quality care. The eight courses that make up the degree come

largely from disciplines outside medicine including cognitive psychology, human factors engineering, and organizational management science. The program is designed to develop leaders in the advancement of safety science and quality health care who will go on to train others in their institutions, Gunderson says. n


RESEARCH 10

EDUCATION 16

HISTORY 22

ETHICS 26

WOMEN IN MEDICINE Today, one of every three American physicians is female, and women represent half of all enrolled medical students. In this issue, we chose to look at just a few of the many unique ways in which women are influencing medical research, practice, and education. We are proud to highlight some of the countless women in the Georgetown community who have dedicated their lives to healing others, as well as the women and men here who work to improve the health of women. While the path to achieving women’s equity sometimes seems to grow longer, perhaps we are just seeing further down the road from an increasingly higher vantage point. Science and the humanities come together in a special way at Georgetown to lead in this arena. An emphasis on the study of ethics and bioethics emerges from the very foundation of our Catholic, Jesuit values. Reading the words of the late Professor Estelle Ramey inspires us all to work harder for human dignity and justice through the lens of science—and the art of humor. Amid the effort to achieve equity, it can be easy to miss incremental, but meaningful, progress: the growing number of women leading academic departments at the Medical Center, the effort to include female subjects in basic science research. We aim to shed light on that progress in this issue, keeping in mind that—at a time when the Vatican has created a commission to consider the role of female deacons in church history—significant change often begins with a simple study. How are things evolving in your field? We welcome your feedback. Enjoy the read. Jane Varner Malhotra, Editor Jane.Malhotra@georgetown.edu

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SEX What’s the Difference? To better understand human health, researchers at Georgetown study sex as a biological variable in the lab. By Kat Zambon

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n laboratory studies, researchers have long considered and accounted for differing features of their subjects such as age and weight. But only since last year did the National Institutes of Health (NIH) require scientists seeking research funding to also consider the role of sex as a biological variable. The policy change has led to exciting new research at Georgetown that demonstrates the importance of studying differences between male and female cells, animals, and humans. But there is still a lot of work to do—for researchers studying sex differences, and for policymakers striving to address the impact of sex disparities in medical research. As director of the Center for the Study of Sex Differences at Georgetown, Kathryn Sandberg, PhD, has served as a leading national advocate for the inclusion of sex as a biological variable. She saw that a gap persisted in the use of female cells and animals in basic research, and took action. In 2013, Sandberg and Scott Fleming, associate vice president for federal relations at Georgetown, visited the offices of Rep. Nita Lowey (D-NY) and Rep. Rosa DeLauro (D-Conn), encouraging them to support the inclusion of females in publicly funded basic research. In 1993, Lowey and DeLauro had been actively involved in efforts to pass the NIH Revitalization Act, advocating for provisions that required the inclusion of women in federally funded Phase III clinical trials (using human subjects). Lowey and DeLauro then wrote to NIH Director Francis Collins, MD, PhD, and subsequently provided guidance in the form of language in the Appropriations Committee’s report accompanying the NIH funding bill. The report urged specific steps to address the problem, stating that the exclusion of female subjects undermined the credibility of research. Collins responded with a commentary in the May 2014 journal Nature, where he and Janine Clayton, MD, who directs the NIH Office of Research on Women’s Health, pledged to improve the balance of male and female subjects in preclinical research supported by NIH. Kathryn Sandberg, right, studies the molecular mechanisms underlying sex differences in hypertension and associated cardiovascular and renal disease.

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conditions, to very basic cell biology or cancer biology. I realized that there’s a group of people who are interested in why the sexes are different, and what the causes of those sex differences are.” In addition to pursuing her own research on sex differences, Sandberg promotes the study of sex differences on campus at Georgetown and at national meetings, where she often chairs sessions on the topic. “We promote it within our community and support our colleagues who are studying it,” she says. “If there’s a really good paper that I’ve reviewed, I offer to write an editorial to try to help promote it. And I sit on study sections and I bring it up when appropriate there. You have to go from all sides.”

The estrous cycle myth

Mark Burns studies how traumatic brain injury (TBI) impacts normal brain function, and recently discovered strikingly different inflammatory responses between male and female mice.

In January of 2016, NIH began requiring all applications for research funding to “account for the possible role of sex as a biological variable in vertebrate animal and human studies.” At the time, women made up roughly half of all participants in NIH-supported clinical research but most basic and preclinical research focused exclusively on male subjects, an NIH announcement said, producing findings that failed to reflect the role of sex as a biological variable. “It was a step forward,” Sandberg says of the NIH policy.

Sex differences in hypertension Why do men typically develop hypertension at an earlier age than women? As a professor of nephrology and hypertension in the department of medicine, questions like this sparked Sandberg’s interest in the study of sex differences. The hypertension difference was evident in female animal models as well. “Because that was such a striking difference and because I’m a molecularly trained person, I wanted to understand what was behind that,” Sandberg says. She began to investigate the renin angiotensin system, a key regulator of blood pressure. Receiving an invitation to a meeting of the Society for Women’s Health Research only solidified Sandberg’s interest. “It was on sex differences, but not just limited to my specialty,” she says. “It was everything: neuroscience and psychiatric

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Researchers frequently argue that they need to use male-only subjects in basic medical research because monthly hormonal variations caused by the estrous cycle in female subjects will produce skewed results. Sandberg challenges that assumption. Several different studies have found that there is actually more variation in male subjects than females, including one paper that Sandberg cites where researchers studied more than 700 different measures of metabolism in significant numbers of male and female subjects. Despite the research, the myth about variability caused by the estrous cycle persists, she says. “I think people are still convinced that we can’t include females in animal studies because you must control for the estrous cycle,” Sandberg says. “While the cycle does impact different functions and different measures, variability is also present in the male. We just don’t understand it.” In a practical sense, the variation caused by the estrous cycle isn’t always relevant. In a recent study of traumatic brain injury (TBI) that included male and female mice, Mark Burns, PhD, associate professor of neuroscience at Georgetown, did not control for the estrous cycle. “We justified that decision by saying, females playing sports aren’t all on the same cycle, it’s random, therefore we used random as well,” he says.

Considering the role of sex, not just doubling up The requirement that researchers consider the role of sex as a biological variable means that those submitting grant applications must justify why they chose their particular research subjects. “If they’re interested in hypertension, they need to talk about what’s known about the differences between men and women in terms of hypertension and why they are selecting the model they’re choosing,” Sandberg says. “If hypertension is equally prevalent in both males and females, why are you only studying males? You’d have to make an argument for why you’re only studying that model, only in males, and then the reviewers


Women made up roughly half of all participants in NIHsupported clinical research, but most basic and preclinical research focused exclusively on male subjects. would look and see whether it made sense or not.” However, complying with the requirement isn’t just about conducting research on equal numbers of male and female subjects. Burns pilots his neuroscience studies with both genders to see if there’s variation. When he discovers a potential difference, he says, “then we power the studies appropriately to detect that.”

Sex differences in TBI In a study published June 13 in the neuroscience journal GLIA, Burns showed that male mice have much greater brain inflammation and nerve cell death one week after experiencing a TBI than female mice. The study looked specifically at the

way that sex affects inflammation in the brain after TBI, and demonstrates the importance of including female subjects in basic research. “We were very surprised at the different inflammatory profiles—just such a different inflammatory signature for TBI, different infiltration of peripheral inflammatory cells into the brain, different activation of the brain’s resident immune system. We were surprised at the results, and how strong the results were,” says Burns. The study also demonstrates the challenges in drug development to treat TBI. Researchers conducting basic science typically use male cells or animals. However, the findings from that basic research become the basis for the clinical trial of the treatment, a phase that since 1993 requires the inclusion of both male and female human subjects. Researchers have known that biological sex can impact the recovery from TBI, Burns explains, but basic science has typically excluded female subjects from research. This may be part of the reason that treatments developed to help TBI patients, such as anti-inflammatory drugs, have failed in clinical trials when both sexes are included. This is a really important finding, says Burns. “If there are completely different inflammatory profiles in males and females, why would we expect a drug targeting inflammation to work the same in males and females?” Burns praises the NIH and Sandberg for promoting the importance of including both sexes in basic research. “NIH has done an excellent job of really pushing this idea forward, and

When Pregnancy Gets Complicated Studying preeclampsia helps scientists better understand blood pressure and kidney function in women and men.

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istorically, the findings from basic medical research conducted on male subjects have been used to develop potential treatments for both men and women. But in the study of pregnancy, this leap becomes much more challenging. “A lot of what people have tried to extrapolate to pregnant women has come from non-pregnant men,” says Jason

Umans, MD, PhD, associate professor of medicine and obstetrics/gynecology at Georgetown. “And that’s comical.” Around half of the population can potentially become pregnant, yet there isn’t a lot of research on what a healthy pregnancy looks like. Pregnancy is challenging to study because it is a complex physiological state, says Crystal A. West, PhD, assistant professor in the

department of medicine at Georgetown. “Adaptations that are required for a normal, healthy pregnancy would be pathological if they were to occur in a non-pregnant individual,” West says. “We know what normal physiology looks like, but pregnancy just flips everything on its head.” In lectures to first-year medical students, Umans demonstrates this “flip”

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Kathryn Sandberg was one of the people advising the NIH to make sure that sex was included in preclinical trials,” he says. “To me, that’s what government policy is about—identifying a need or gap and saying, this is what we’re interested in.”

Impact of the NIH policy When researchers apply for NIH funding, their applications are scored by study sections, and those scores determine in part whether their grant application will receive funding. Failing to address the role of sex as a biological variable in a grant application can now lead to a lower score, and in today’s hypercompetitive funding environment, that can tank the grant. “A great grant can still end up with a score that makes it no longer fundable,” Sandberg says. Researchers seem to be taking the study of sex difference more seriously, as evidenced by an increase in the number of conferences that address the topic. But Sandberg is still waiting to see an increase in the publication of preclinical research that includes females before declaring that the NIH policy was effective. In the August issue of the American Journal of Physiology Renal Physiology, Sandberg writes that only 15 percent of the animal studies published in the journal from January to July 2017 included both sexes. For every study with female subjects, five studies were conducted solely in males. The journals Kidney International and the Journal of the American Society of Nephrology were even more lopsided, she says.

Renal physiologist Crystal West, PhD, studies how the kidney adapts during pregnancy.

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“If there are completely different inflammatory profiles in males and females, why would we expect a drug targeting inflammation to work the same in males and females?” “The basic science leads the way for drug discovery,” Sandberg says. Pharmaceutical companies carefully review medical literature to identify treatments for potential investment, she adds. “If you’re only looking at studies in males, then you’re biasing all drug discovery toward what’s perfect for the male. So you’re missing out on drugs that could be beneficial in the female.” “It turns out that women exist in real life,” Burns says with a smile. “And publicly funded science should absolutely be working for them too.” n

by showing the students blood chemistry values from a pregnant patient. While the values displayed would be a cause for concern in a nonpregnant woman, they’re all in the normal range for pregnancy. “I hope that gives our students a certain sense of understanding and insight—but also humility and caring —for pregnant women and the ability to understand what’s going on,” he says. “And how much we still have to learn.” The paucity of research on normal pregnancy makes it more challenging to study complications of pregnancy. “In order to fully understand the disease state and to treat the disease state, you have to know what the baseline for normal


physiology is,” West says. “And a lot of times, that gets ignored.”

The role of blood volume One major complication of pregnancy is preeclampsia, a condition that is characterized by high blood pressure and evidence of damage to another organ system, usually after 20 weeks of pregnancy. Preeclampsia affects 4-6 percent of pregnancies and about 10 million pregnant women worldwide every year. In a healthy pregnancy, a woman’s blood volume increases by a whopping 40 percent and her blood vessels dilate, accommodating the increase. In fact, healthy pregnant women typically experience a decrease in blood pressure due to the dilation of blood vessels. In many pregnant women with preeclampsia, this vasodilation fails and can be converted to vasoconstriction, causing the blood pressure to increase. Preeclampsia can develop quickly. In addition to high blood pressure and protein in the urine, symptoms can include severe headaches, changes in vision, and upper abdominal pain, all indications of potentially life-threatening organ damage. Sudden weight gain and swelling in the hands and face are associated with preeclampsia but they also occur during healthy pregnancies, making them less reliable symptoms. The consequences of preeclampsia can be devastating. For the mother, they can include seizures, organ damage and increased risk of developing cardiovascular disease. For the fetus, preeclampsia is associated with growth restriction, low birth weight, and prematurity. In the developing world, preeclampsia is a leading cause of maternal mortality, with approximately 80,000 women and 500,000 babies dying each year from causes related to preeclampsia.

Discovering new answers to an old problem The research landscape for preeclampsia

has changed dramatically over the last 20 years as scientists have developed a deeper understanding of its underlying mechanisms. “We understand more at a molecular level about preeclampsia than we ever had before,” Umans says. “Does that mean we know the answer? No. But we know some answers and we’re getting better at asking more sophisticated questions because of what we have learned. “For a scientist, that makes it an exciting time because here’s a grand problem with major public health implications for us to solve during this generation instead of just reading about it,” Umans adds. “From my patient care point of view, I’d rather read about it and have it solved, of course, but intellectually, it’s cool to see it unfold at such a quickening pace.” As a renal physiologist, West’s research focuses on how the kidney works and how the kidney adapts during pregnancy. In a normal pregnancy, the kidney retains sodium which allows for blood volume expansion—without increasing the mother’s blood pressure, because the blood vessels dilate. Last fall, West received a grant from Georgetown University Medical Center’s Partners in Research to study the mechanism of blood volume and blood pressure regulation in pregnancy. Receiving funding from Partners in Research, a program that connects researchers with donors who are interested in supporting their work, was a rewarding experience for West. “It was neat to have people in your community involved and getting a say in what they wanted to study,” she says. “And it was really cool for me because I study women’s health and I’m talking to a group of mostly women, and they get it. That was a special experience that I don’t think I could have gotten anywhere but at Georgetown.” In her research, West found that when a protein of interest called PAR2 was activated, it decreased blood pressure and

increased renal sodium retention—two necessary responses to accommodate the maternal blood volume expansion which, in preeclampsia, becomes compromised. West’s research may have applications for researchers studying non-gestational hypertension, notes Kathryn Sandberg, PhD, professor of medicine and director

In a healthy pregnancy, a woman’s blood volume increases by a whopping 40 percent.

of the Center for the Study of Sex Difference in Health, Aging, and Disease. “If you can understand how the female kidney does something so amazing that the male kidney can’t, then you may find a drug target that might be able to be used in both males and females,” she said. But West remains focused on helping pregnant women. “The long-term goal of this research is to find new therapeutic options for women with preeclampsia,” she said. “This could ultimately result in decreased maternal and fetal deaths, and reduce the long-term cognitive and cardiovascular burden to children by improving fetal nutrition.” n

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WOMEN IN MEDICINE

Persistence and Progress for

Women in Academic Medicine Georgetown organization fosters a collegial, supportive community of female faculty in pursuit of equity. By Kate Potterfield (C’04)

GWIM

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hat spurred one professor to travel around the globe to provide medical care in Cameroon? Her life-changing experience as one of the first presidents of Georgetown Women in Medicine (GWIM). The organization offers a supportive community of women colleagues at Georgetown University Medical Center who inspire each other to reach their goals. After she became involved with the group, Professor of Medicine Marilee Cole, MD, had an awakening. “I felt empowered to take a closer look at myself and ask: Are you where you want to be professionally?” she recalls. “The answer was absolutely no. I was part-time and on the lowest rung as an instructor. So the next year, encouraged by the support of my stellar female colleagues, I decided to fulfill my professional dream— to work in Africa.” In 1998, she traveled throughout Zimbabwe and Tanzania, and finally settled in Cameroon. There she worked with an organization to improve medical care in the region, and wrote an HIV/AIDS protocol that impacted one third of all Cameroonians. In 2004, she created the Georgetown Global Health Elective, bringing three residents with her each year to Cameroon. Developing the elective “was and remains the highlight of my professional career,” Cole says. The inspiration and drive to pursue the opportunity came directly through her involvement with GWIM. “Just name all the GWIM presidents—they’re my best friends at Georgetown,” she adds. “They’re my support and I’m their support.” An all-volunteer organization dedicated to the professional advancement of women faculty at Georgetown University Medical Center (GUMC), GWIM aims to establish policies and a working environment that promote equality and diversity in hiring, promotion, and compensation throughout the Medical Center. The

organization offers engagement opportunities for faculty across the GUMC sectors: School of Medicine, School of Nursing & Health Studies, and Biomedical Graduate Research. Cole and a group of colleagues, including GWIM’s first president, Terry Taylor, MD, founded the organization in 1994 and called it the Society of Medical Women Faculty. In 2005 the group became GWIM (pronounced to rhyme with “swim”). Because GWIM’s support and encouragement was life-changing for Cole, she now returns the favor by mentoring others: she consults faculty at other universities to develop similar elective programs and is advising Kacie Saulters, MD, assistant professor of medicine and director of the school of medicine’s Global Health Track, to further expand the elective to include physicians from multiple disciplines. “It all comes from GWIM’s efforts,” Cole says. “By helping others, it turns out I was really helping myself.”

Gender inequities in academic medicine

This isn’t to say that her path in medicine has been easy. Like many women in academic medicine, Cole faced obstacles to her career advancement. A nationwide study published earlier this year in the Journal of the American Medical Association reports that women physicians in academic medicine are less likely than men to become full professors— 11.9 percent versus 28.6 percent. Another study found that start-up funding packages, which help to launch academic careers, on average are more than two-thirds higher for men ($980,000) than for women ($585,000). A third study showed that women physicians in academic medicine are paid 8 percent less than men. National disparities manifest in various forms at different institutions, ranging from differences in career progress and pay, to work cultures that exhibit gender biases.

Georgetown Women in Medicine (GWIM) President Kristi Graves, left, hopes to bring more visibility to female leaders through the organization’s new “Women on the Walls” campaign. FA L L / W I N T E R 2 0 1 7

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Local children join Marilee Cole and two members of the visiting medical team from Georgetown. The residents begin their month-long Global Health Elective by shadowing a Cameroonian physician.

Initiatives such as GWIM have driven significant progress at Georgetown in recent years. At the dean level today, a full two-thirds—16 of the School of Medicine’s 24 deans—are women. Nationally, only 16 percent of medical school deans are women, according to the Association of American Medical Colleges (AAMC). Of the full-time faculty at Georgetown University Medical Center, which includes the School of Nursing & Health Studies, 37 percent are women (688 of 1846)—close to the national average of 38 percent. Twelve percent of the Medical Center’s department chairs are women, tracking similarly to AAMC’s national rate of 15 percent. GWIM has also focused on creating a more inclusive work culture at Georgetown, seeking to develop an environment that supports women’s careers and proactively addresses issues of bias. Susan Cheng, senior associate dean for the Office of Diversity and Inclusion, says GWIM “thoughtfully cultivates the role of mentorship,” noting professional development efforts, such as a regularly occurring speaker series, that bring attention to women’s advancement in medicine.

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Recently, in partnership with Cheng, GWIM has worked to increase awareness of unconscious bias, including its effect on hiring, promotion, and talent retention. Through speakers, on-campus trainings, and off-site trainings run by the AAMC, GWIM has been at the forefront of efforts to raise awareness of the issue within Georgetown’s medical community. Judy Huei-Yu Wang, PhD, associate professor of oncology, and immediate past vice president of basic science for GWIM, notes the impact of these efforts but signals that more work remains. “How do we continue to put that training into action?” she asks. “How can clinicians translate bias training into their practices?”

GWIM’s founding and progress This spirit of persistence and the commitment to equity have characterized GWIM since its founding. It all began in 1992 in the department of medicine. Its new chair, John Eisenberg, MD, formed multiple task forces to look at how the department functioned. Two members of the department (who

would later become GWIM’s first two presidents), Taylor and Cole, joined the task force on tenure and promotion. Over the course of the committee’s yearlong effort, Cole recalls, they were struck by the inequities they identified. Noting that Eisenberg’s goal was “to uncover and address inequities,” she says that she received a salary adjustment as a result of the task force’s work. As a busy physician and educator, it was the first time she had stopped to consider the possibility that she was making less than her male counterparts. “I wasn’t thinking about it; I was thinking about taking good care of my patients.” At around the same time, a guest lecturer from the AAMC addressed a group at the Medical Center about similar inequities nationwide. When considering the progress of her own career, Cole found the national statistics eye-opening. “That was a wakeup—an epiphany—for me,” she recalls. “I always thought my lack of progress had to do with me and nothing else. But I came to see it wasn’t my issue in particular but a gender issue nationwide.” Taylor approached Cole about forming an ongoing committee to further study and address this issue, and with Eisenberg’s support, they did. Word spread across the medical school and colleagues from other departments expressed interest in joining their efforts. Taylor and Cole expanded the focus from their department to the entire medical school, forming the organization that would later become GWIM, in 1994. “It was an exciting time,” says Bonnie Green, PhD, professor emeritus of psychiatry. “We felt empowered to accomplish things together, but it was also a time when we felt that women were at a disadvantage in the medical environment. It could feel like an uphill battle.” Still, she notes, the camaraderie among her colleagues created a powerful momentum.

On the national stage In 2003, in recognition of the progress


of GWIM’s first decade, the AAMC awarded the organization its annual Women in Medicine and Science Leadership Development Award. “It put us on the national stage,” recalls Cole. “But we could see so much that we hadn’t yet done.” One sign of progress was the university and school administration’s official support of and commitment to GWIM and its priorities. According to Cole, “everyone recognized that if women weren’t fostered and promoted to the limits of our abilities, then everyone was losing out. We were a resource that was just not being utilized.” GWIM received the prestigious award again in 2014, making it the first and only entity in the nation to be twice recognized by the AAMC for work fostering the advancement of women in medicine.

Strategic focus Even as GWIM achieves progress, its list of issues to address remains long. GWIM’s immediate past president, Stacey Kaltman, PhD, professor of psychiatry, instituted the practice of setting three strategic priorities for the organization each year. This helps organize its efforts and benchmark progress. Under current president Kristi Graves, PhD, associate professor of oncology, last year’s strategic priorities were mentorship, leadership equity, and procedural justice—for example, having clear and transparent institutional processes regarding how decisions are made, and how resources are distributed. This academic year, the group’s priorities are visibility, outreach, and policy. The emphasis on visibility will take the form of showcasing women in leadership positions within the Medical Center, and highlighting the importance of having women in visible roles. GWIM hopes to expand outreach to let more women faculty know about the organization, particularly those with faculty appointments who may work at offsite clinics or hospitals. For policy, the group plans to work

Justice and Gender at Georgetown By Jeff Donahoe

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cholarship, policy, law, medicine, and society at large are increasingly addressing equality issues related to sex and gender—sex being biologically determined differences between male and female, and gender being socially determined ideas of what is feminine and masculine. Georgetown faculty have a history of scholarship and activism in gender-related issues, including biology, sexuality, and racial and economic injustice, but until now have not had the benefits of an intersectional, interdisciplinary approach to gender studies across the university’s campuses. The new Gender+ Justice Initiative is fostering a more integrated approach, starting with how the name is styled. The plus sign attached to “gender” is intentional—it announces how closely gender is intertwined with inequity and other justice issues, says Georgetown law professor Naomi Mezey, one of the initiative’s leaders: “The Gender+ Justice Initiative fits with Georgetown’s core mission of social justice and scholarship at work in the world.” The initiative began two years ago, and last year sponsored a day-long colloquium. Faculty across all campuses, including the School of Foreign Service Qatar, gave more than a dozen presentations including: n What Differences Do Gender Differences in Ways of Speaking—and Listening—Make? n Sex Differences in Memory and Language n #CanYouHearUsNow—American Muslim Women Responses to Islamaphobia n Custom in Question: Female Circumcision Between Cultural Accommodation and Universal Rights The second Annual Gender+ Justice Initiative Faculty Colloquium is scheduled to take place in October 2017, with the work ahead to make the initiative a permanent Georgetown fixture. “The potential impact is an increase in dialogue, scholarship, and policy about gender, racial, and economic justice,” says Kristi Graves, associate professor of oncology at the Medical Center. “Ideally we increase the visibility of gender issues at Georgetown as a whole.” In addition to Mezey and Graves, GJI leaders include: Denise Brennan, professor and chair of anthropology; Nan Hunter, professor of law; and Kathryn Sandberg, professor of medicine and director of the Center for the Study of Sex Differences. “It is wonderful that Georgetown is at the forefront of other justice issues,” Mezey says, noting that the Gender+ Justice Initiative takes inspiration from the university’s racial justice initiative. “There’s a real interest and a broad desire to pursue this effort. The many faculty members who work on these topics are thrilled to see the university embracing it.” n

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with faculty governance to create official guidelines that promote gender equity in search, hiring, and promotion.

Wall-worthy women To support its priorities in recent years, GWIM sponsors programming, speakers, and awareness campaigns—including the “100 Current Women Professors” campaign, to encourage the School of Medicine to reach the milestone of having 100 women full professors active on the faculty. To support this goal, GWIM helped institute formal one-toone coaching and encouraged women to apply for promotion to professor. The medical school reached and celebrated the 100-women-professor milestone in 2016. This year, GWIM is launching the “Women on the Walls” campaign, which aims to install more portraits of women along the halls of the Medical Center. Graves says she sees this campaign “as a complement to last year’s theme of leadership equity, where we highlighted the fact that not enough women are in leadership positions. But this year, we are highlighting the need to recognize women who have been successful in leadership positions.” Seeing more women on the walls offers a tangible way to inspire future female leaders, says Graves. “Having a role model helps others see opportunities for themselves in leadership.” Further underscoring its efforts to provide visibility and recognition for women’s career development, GWIM also hosts an annual event to present three main awards. The John Eisenberg Career Development Award is given to four women faculty who demonstrate leadership potential and are selected to attend the AAMC’s Women Faculty Professional Development Seminar. The Estelle Ramey Mentorship Award honors both women and men faculty who have provided outstanding encouragement, support, and mentorship for women faculty. It is named for the

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At the annual retreat, GWIM members collaborate to develop goals for the coming year.

legendary endocrinologist and physiologist who called Georgetown home for decades (see page 25). The Karen Gale GWIM Outstanding Achievement Award is given to a woman faculty member who has demonstrated outstanding achievement through her research, education or service, who is recognized at a national or international level, and who has contributed to the Georgetown community—three qualifications exemplified by the award’s namesake. GWIM held a reception in September to recognize two recently appointed women chairs at the Medical Center: Michelle A. Roett, MD, MPH (M’03), in the department of family medicine, and Edilma L. Yearwood, PhD, in the department of professional nursing practice in the School of Nursing & Health Studies.

Community and camaraderie In addition to the more formal achievements, many GWIM members express gratitude for the community and friendships it has brought them. Years ago, colleagues from the early GWIM leadership started meeting monthly to discuss the group’s progress and direction. More than a decade later, that monthly meeting has become a

monthly dinner amongst friends who share common passions, interests, and goals. The dinners emphasize the spirit of collegiality fostered by GWIM—the personal friendships it has facilitated and the professional collaborations it has enabled. “We push each other,” says former GWIM president Miriam Toporowicz, MD, MPH, professor of pediatrics. “We push women to get promoted, to gain leadership skills, to get into positions of power, regardless of who they are—and they bring that experience with them whether they stay at or leave Georgetown.” Rhonda Friedman, PhD, professor of neurology, and another former president of GWIM agrees, pointing out the importance of women supporting women across departments, and fostering connections among the faculty employed by both the university and MedStar Health. Mentorship and support thrive in the GWIM community, and differences are embraced, says Alfiee Breland-Noble, PhD, associate professor of psychiatry. She points to her friendship with her mentor, the late Karen Gale, PhD, professor of pharmacology. Gale was a previous co-president of GWIM, and to this day is remembered as a force who encouraged many to join the organization. Breland-Noble recalls how Gale approached their relationship from the


very start. “Right away, Karen shared with me her passion for social justice. It was the guiding force behind her passion for GWIM.” She says they spoke frankly about their different perspectives: Gale as a white woman, and BrelandNoble as a woman of color. They acknowledged their different experiences and perspectives, and worked to support each other as women in medicine. Current president Graves values the sense of community GWIM offers. “Some of the things I appreciate most about GWIM include the camaraderie, knowing there’s someone else you can speak to about career development

concerns, and recognizing the fantastic diversity of women and their accomplishments. GWIM has a ‘family feeling’ of sorts—a sense of culture, connection, and community,” says Graves. “GWIM has helped define my career at Georgetown. I love the science and education I do, but I’m equally passionate about raising awareness around equity for women in academic medicine. GWIM is the true home for this work,” Graves says. “I really value and appreciate that—and the work that has come before me. It’s an honor that the leadership of the Medical Center now looks to GWIM as a partner for input and recommendations.”

Nady Golestaneh, PhD, MS, GWIM president-elect and assistant professor of ophthalmology, neurology, biochemistry, and cellular and molecular biology, echoes Graves: “Due to the efforts of the GWIM founders, presidents, and officers, today GWIM is recognized as a part of the Medical Center. We’ve seen progress but we still have a long way to go. We’re acknowledging the shortcomings, which is the first step.” Taking a long view, she adds: “I’m happy to believe that this work can help the next generation of women at Georgetown—and anywhere else.” n

Volunteers Needed for Mentoring in Medicine

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ow do current Georgetown students explore career options? Many use Hoya Gateway, an online platform established in 2013 to help students connect with alumni for conversations about different professions. Kelly Loraine-Dauer Pham, MD (M’10), in Seattle signed on to Hoya Gateway as a way to give back to the Georgetown community through mentoring. “As a medical student, you are embarking on the most difficult journey that you will ever take,” Pham says. “A mentor can be a person who shares experience, normalizes what you are feeling, and be a smiling face in a city of strangers. I believe the same to be true at any level of medical education. The more support you have, the more successful you will be.” The number of students using Hoya Gateway has more than doubled since its upgrade in January 2017. Key to its growing success is that alumni from a variety of fields sign on as mentors. Currently around 10 percent of the participants are in the health and medical profession. In response to student interest, program administrator Matt Kelly hopes to boost that number in the coming year. This spring, the program received help from an unexpected source: a group of Georgetown undergraduates working on a class project. During an interdisciplinary course on shaping national science policy, teams of students identified and designed solutions for challenges facing policymakers today. One research group studied the importance of mentorship for new medical students. In the complex field of health and medicine, physician mentors offer helpful perspectives on

specialty choice, job shadowing, family and work balance, medical research, academia, and more. To their surprise, the students discovered a significant lack of female surgical mentors, as well as female role models in academic medicine. “My student group consisted of only women and we were understandably upset by our findings,” says Sylvie Hullinger (C’19). The professor asked all the students to draw up two solutions: a legislative one and a non-legislative one. On the legislative end, the group recommended a national survey to address gender disparities in the medical field. Their nonlegislative approach involved helping support Hoya Gateway and encouraging alumnae to join and expand the network of Georgetown women mentors in health and medicine. Their efforts are currently underway. n Learn more at hoyagateway.georgetown.edu.

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Georgetown University Medical

TRAILBLAZING By Patti North

Generations of ‘women for others’ found their calling at the Georgetown University Medical Center. Rather than waiting for cultural mores to evolve, they moved forward with tenacity and vision, paving the way for women’s progress in health and medicine around the world.

From its founding in 1851 up until 1930, the university’s Medical Department (bottom row, second from right) was located downtown. Pictured in Ye Domesday Booke, 1916.

Annie Rice, MD, (1853-1884) and Jeanette Sumner, MD, (1846-1906) were the first female students to enroll at Georgetown University, joining the School of Medicine in 1880. After only one year, both transferred to the Women’s Medical College of Pennsylvania where they earned medical degrees in 1883. A month later, the two doctors returned to Washington, D.C. to establish the Women’s Dispensary, serving the area’s impoverished women and children. Rice died the following year of a chronic heart condition. Sumner maintained her connections with Georgetown, marshaling resources from friends, faculty, and alumni to expand health and medical services for women and children in need. She died in 1906 and is buried in Rock Creek Cemetery in Washington, D.C.

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WOMEN IN MEDICINE

Center’s

WOMEN The first women graduates of Georgetown University, pictured with hospital administrator Sister Pauline, O.S.F., received their diplomas in 1906 from the newly founded Georgetown University Hospital Training School for Nurses. The school’s first students, all female, enrolled three years earlier in 1903. As graduates, they helped open the door for others to learn in what is now the Georgetown School of Nursing & Health Studies, and they helped pave the way for other female students to attend Georgetown as each of its schools became integrated. The 1906 graduation announcement in The Washington Post included highlights of the Gaston Hall ceremony along with the names of the eight women: Edith Merry, Elizabeth Hemler, Lillie Crumbaugh, Lillian Welker, Grace McCarthy, Lela Montgomery, Sister Mary Jane, O.S.F., and Sister Mary Baptista, O.S.F.

Library of Congress

Sofie Nordhoff Jung, MD, (1864-1943) became the first female appointed to a teaching position at Georgetown School of Medicine in 1923, as an instructor in gynecology. The prospect of hiring women faculty first arose in 1913, but the school’s leadership decided that it would be “improper” to have female physicians instructing male medical students. Born in Prussia, Nordhoff Jung emigrated to the United States and earned her medical degree at Columbian School of Medicine (now George Washington University Medical School) in 1893, and practiced at D.C.’s Columbia Hospital for Women. She was a prominent Washington physician and civic leader, as was her husband, Dr. Franz Jung. Both had studied medicine in Germany and had received many honors from the German government for their civic service. During World War I, she helped organize the American Red Cross in Germany and Bavaria. She also helped establish an American hospital in Munich, and studied under Louis Pasteur in Paris. She was honored by Georgetown on Founders Day in 1934 with “the highest insignia of the Angelo Secchi Academy of Science with letters patent, sealed with the Great Seal of the University.” She died in 1943 and is buried in Rock Creek Cemetery in Washington, D.C.

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Sarah Elizabeth Stewart, MD, PhD (M’49) (1905-1976) was the first woman to graduate from Georgetown School of Medicine. Born in Mexico to a Mexican mother and an American father, Stewart earned her doctorate at the University of Chicago in 1939. She worked in a lab and studied viruses at NIH, joining the faculty of Georgetown School of Medicine in 1944 as an instructor in bacteriology. In 1947 she began coursework as a second-year medical student (alongside five other women admitted that year), earning her MD in 1949. How did her male classmates treat her? “They had to be nice to me. I was their instructor,” she explained to The Washington Post in 1964. After an internship at the United States Public Health Service Hospital in New York, she went to work at the National Cancer Institute, launching the research for which she would earn international acclaim. In the face of intense skepticism in the scientific community that viruses could cause cancer, she pioneered the field of viral oncology, in collaboration with her colleague Bernice Eddy. They produced cancer in mice from a virus they had grown in tissue culture, which they named the SE-polyoma virus—SE for Stewart and Eddy, and polyoma meaning many-tumored. Stewart went on to make seminal contributions to the identification of other agents, including herpes simplex, Burkitt’s, and C type viruses.

School of Medicine class including women when she enrolled in 1947. A member of the Medical Mission Sisters, she was known to many as Sister Frederic. She graduated valedictorian of the Class of 1951, and received a gold medal for the highest scholastic average in bacteriology. After Niedfield completed her surgical residency at Georgetown, the sisters assigned her to their Holy Family Hospital in Mandar, India, in a famine-struck region of Rajasthan. In a December 1953 article in the Post, she said of her work, “I love it. I don’t even want to come home. It is so much more satisfactory to be where you are needed.” She served the area as surgeon for four decades, working in remote rural areas, and training local schoolteachers and agricultural workers in basic medicine and health care. She even trained a border post radio operator working in an area so remote that no professionals could reach it during the winter. She was known, if needed, to suspend an operation in order to draw a unit of her own type O blood to transfuse the patient before continuing with the surgery. In 1992, she returned to the U.S. to care for AIDS patients in San Diego. She passed away in 2007.

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Photograph courtesy of the Medical Mission Sisters Unit North America Archives

Sister Eileen Niedfield, MD (M’51), (1920-2007) was part of the first


Estelle Ramey, PhD, (1917-2006) was born in Detroit and grew up in Brooklyn. She entered college at age 15, and earned a master’s in chemistry at Columbia and a doctorate in physiology from the University of Chicago in 1950. In 1956 she joined the faculty at the School of Medicine, focusing her research on the relationship of the endocrine and nervous systems, including how hormones condition individuals to make appropriate responses to stress situations. In 1970, history called. Edgar Berman, a prominent Democratic Party advisor and surgeon, publicly declared women to be unfit to hold high office because of their “raging storms” of hormonal imbalance. Using her scientific expertise, Ramey sharply refuted him in a letter published in the Washington Evening Star. The National Women’s Press Club hosted a debate between the two, in which the Post reported that Ramey “mopped the floor” with Berman. He opened with “I really love women.” She responded, “So did Henry VIII.”

“...what is human and the same about the males and females classified as Homo sapiens

Photograph courtesy of the Montana State University Library

is much greater than the differences.”

Winning the debate kicked off a new career for Ramey as a sought-after lecturer and social commentator. It also influenced her research. She wrote and spoke widely about how the women’s movement might benefit men, who continued to suffer more disease than women and typically predecease them. “My research is a form of extreme altruism; I’m trying to find out how to keep men alive longer,” she quipped. Women need to be willing to make waves to make a difference, Ramey asserted. When the new anatomy textbook arrived on campus in 1972, it featured lewd text and suggestive photos of female anatomy. Ramey successfully fought to have it pulled from the market. In a profile published by the Journal of American Medical Association in June 1982, she said, “If you don’t want to stick your head above the foxhole, then nobody’s going to bother you very much. But you may remain an assistant professor for the rest of your life, and everyone’s going to think you’re a real sweet girl.”

She appreciated the many men who supported women scientists over the years, including her husband James, Atomic Energy Commissioner. “There have always been men who have not been blinded by gender when they’re looking at quality,” she told JAMA. “There just haven’t been enough of them.” Ramey passed away in 2006. Her obituary in the Post noted, “Her wit was rooted in statistics, scientific research, and personal experience with discrimination.” Her memorial service featured remarks by both Gloria Steinem and Ruth Bader Ginsburg, as well as numerous members of the medical school faculty. She often said her epitaph should read: “I am my sister’s keeper.”

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WOMEN IN MEDICINE

Ethics Pregnancy and Research Under the Microscope

© Traci Daberko

By Kate Colwell

When many of us think of pregnancy, we envision a time of eager anticipation. But for hundreds of thousands of women in the United States—and millions more globally— the experience of pregnancy is complicated by serious medical illness. Heart disease, diabetes, autoimmune disorders such as lupus, and even cancer are part of the story of pregnancy for many women; malaria, HIV/AIDS, and tuberculosis impact pregnant women around the world. Left untreated, all have devastating effects on the woman’s health—and the health of the baby she will bear. But treating disease during pregnancy also carries risk. How do medications behave in the pregnant body? Surprisingly little evidence has been gathered about the effect different drugs might have on the fetus, or on what dose of needed medication would be effective given the drastically changing physiology during pregnancy. This leaves pregnant women, their partners, and their providers facing what can be agonizing guesswork about how to treat their illnesses.

Maggie Little, PhD, a bioethicist at Georgetown and director of the Kennedy Institute of Ethics, has a mission to change that. Together with colleagues at two other universities, she is developing ethics guidance to ensure that pregnant women’s needs are represented in the global research agenda. Little and colleagues are also working to outline novel pathways that will help encourage responsible research with pregnant women.

Leading a cultural shift For more than a decade, Little has focused on finding pathways to improve the evidence base for medication use in pregnant women. With Anne Lyerly, MD, an obstetricianbioethicist at the Center for Bioethics at the University of North Carolina at Chapel Hill, and Ruth Faden, PhD, a public healthbioethicist at Johns Hopkins’ Berman Institute of Bioethics, Little has worked to highlight the problematic exclusion of pregnant women from the broader research agenda. “Pregnant women get ill, and ill women get pregnant,” Little says. “They, and the

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children they will bear, need and deserve an evidence base to make sure their needs are met.” In 2009, Little, Faden, and Lyerly founded The Second Wave Initiative, which helped steer a cultural shift from exclusion to inclusion of pregnant women in clinical research. The initiative held its first national workshop on Georgetown’s campus, funded by the university’s Reflective Engagement grant program.

The majority of clinical research excludes pregnant women, even when pregnant women are critically affected by the disease being studied. The Second Wave Initiative asserts that pregnant women should not be categorically excluded from clinical research; instead, pregnant women can and should be included in carefully designed trials that are responsive to the special scientific and ethical complexities this population presents. The initiative, which was highlighted in a special conference hosted by the Office of Women’s Health at the National Institutes of Health in 2010, spearheaded the movement to responsibly include pregnant women in clinical research. Since the Second Wave Initiative began, an increasing number of leading health organizations have endorsed the critical need for expanded research with pregnant women, including the World Health Organization, the American College of Obstetricians and Gynecologists, and the Council for International Organizations of Medical Sciences.

Zika research without pregnant women? The Zika virus epidemic has reminded the global health community of just how high the stakes can be when disease intersects with pregnancy. ZIKV, as the virus is known, causes devastating neurological impairments to some babies whose mothers are infected during pregnancy. The severity of Zika virus infection has galvanized the global research community to develop vaccines against the pathogen, ranging from killed, inactivated vaccines to novel DNA vaccines. However, researchers have been reluctant to include pregnant women in clinical trials for these vaccines. In fact, the majority of clinical research excludes pregnant women, even when pregnant women are critically affected by the disease being studied. “Zika virus is of particular concern to our work because,

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while the virus has quite mild effects on adults, the consequences of infection for pregnant women and their fetuses can be catastrophic,” Little says. “Though the substantial burden of Zika virus lies, clearly, with pregnant women, the vaccine development community has been reluctant to include them in the research.” In June, Little and her colleagues published ethics guidance on pregnant women and Zika virus research through a £1.2 million grant from the London-based Wellcome Trust awarded to the Berman Institute for Bioethics. Designed with input from a 15-person working group of global experts in immunology, health policy, and research ethics, the guidance offers concrete recommendations for funders, researchers, regulatory authorities, ethics committees, and other key actors to promote the equitable inclusion of pregnant women—those most affected by the Zika virus epidemic—in the Zika virus research response. The guidance centers on three moral imperatives: n Develop a Zika virus vaccine that can be responsibly and effectively used during pregnancy n Collect data that are specific to safety and the ability of a vaccine to effect an immune response in pregnant women to all Zika virus vaccines to which pregnant women may be exposed n Ensure pregnant women have fair access to participate in vaccine trials that offer a reasonably favorable ratio of research-related risks to potential benefits. “These guidelines are essential not only to ensuring that pregnant women’s needs are met in the Zika virus response, but also for laying the foundation to ensure that we are ready to include pregnant women in the response for the next epidemic,” says Little.

HIV research and pregnancy Little also serves as co-investigator on the Pregnancy and HIV/AIDS: Seeking Ethical Study (PHASES) project, a multi-year grant awarded to the Center for Bioethics at UNC. The project seeks to identify barriers to conducting HIVrelated research with pregnant women. Looking for novel and creative trial designs, PHASES researchers hope to discover critically needed information on treatments and preventives in pregnant women while maintaining the highest standards of safety. Pregnant women have been prioritized within the HIV research agenda for some time, serving as a vanguard for the inclusion of pregnant women in clinical research. However, this research, which focused primarily on preventing HIV transmission to the child, often ignored the women’s own health needs, says Little. She and colleagues on the PHASES

project want to ensure that pregnant women’s health needs are prioritized in future research. As a critical component of their work to develop these ethics guidelines, the PHASES team has conducted extensive qualitative research with pregnant women in both the United States and Malawi to elicit their views of participation in research. “This is a major advance,” says Kevin FitzGerald, SJ, PhD, of the Edmund D. Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center. “We’re starting to understand that part of the complexity of health care is how the patient or research participant sees things,” he adds. “For it to work well, health care requires that the person you’re treating be completely engaged.”

Public health, ethics, and medical innovation The working group’s recent recommendation to include pregnant women in the Zika virus vaccine research agenda has already reached a global audience. The international research and bioethics communities have responded with support for this important goal. “Infectious diseases impact everybody,” says Rebecca Katz, PhD, MPH, co-director of the Center for Global Health Science and Security at Georgetown. Including pregnant women in pandemic vaccine research is critical to public health emergency preparedness, she explains. “When we study disease and epidemiology, we have to include the entire population. It makes no sense to exclude populations who are impacted by a disease.” The universities’ multiyear project through the Wellcome grant, called PREVENT (Pregnancy Research Ethics for Vaccines, Epidemics and New Technologies), is now setting sights on ethics guidance for the inclusion of pregnant women in other public health emergency research. For example, the emerging threat of Lassa fever poses particularly severe consequences for pregnant women, suggesting that their needs should be prioritized in responses to the virus. Little is confident that Georgetown will continue to impact the world through the university’s commitments to public health, ethics for global human good, and medical innovation. “Together with other allies at other universities, Georgetown is leading the charge to ensure that pregnant women are ethically included in the research agenda. Georgetown is uniquely positioned to contribute to this work,” Little says. “Ethics is in the DNA of Georgetown.” n

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PharmedOut Turns 10 Program looks at industry influence in pharmaceutical marketing, asks the tough questions By Kate Colwell

F

ueled by both a passion to tackle major public health issues, and an ever-flowing stream of espresso and homemade cookies, Adriane FughBerman, MD (M’88), has a full plate. When she isn’t teaching students, organizing conferences, or gardening on the roofs and grounds of the Georgetown

In addition to education and research on industry influence, Adriane Fugh-Berman tends several urban gardens around campus. The gardens feature wildflowers, culinary herbs, tree fruits, and medicinal plants, and are used in biology and pharmacology courses at Georgetown.

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campus, the pharmacology and physiology professor serves as director of PharmedOut, a GUMC research and education project examining pharmaceutical industry marketing practices and supporting evidence-based, cost-effective prescribing. PharmedOut has continued to expand since Fugh-Berman launched it 10 years ago with funds from a grant created by a multiple-state claims settlement against illegal drug marketing. “When I saw an announcement in 2006 that the attorneys general had

started a grant program to educate consumers and prescribers about pharmaceutical company influence, it just felt like that had my name on it,” Fugh-Berman says. PharmedOut grew from her interest in the forces at work that may not be visible to the public but may impact public health. Pharmaceutical and medical device companies can influence everything from what health care practitioners learn and choose for treatment, to how government regulates the industry. In the 10 years since the project began, PharmedOut members have published dozens of articles in biomedical literature, educated health care providers through grand rounds and lunch seminars at hospitals, pioneered the first peer-reviewed papers on how industry representatives influence others (from surgeons and pharmacists to payers and people with expensive diseases), testified at FDA hearings, and inspired scientists and ethicists to take a stand against conflicts of interest. The organization also collaborates with the D.C. Department of Health to analyze prescription drug marketing costs, and to offer non-commercial, independent continuing education free of charge to D.C. physicians and health care professionals through the D.C. Center for Rational Prescribing (DCRx). By contrast, industry-funded continuing medical education offers a prime example of potential conflict of interest. “Lawyers and accountants and aerobics instructors pay for their own continuing education,” notes Fugh-Berman. “And yet in medicine, we think it’s perfectly okay for the people who stand to profit from


our decisions to educate us. It’s really a problem. Even well-meaning physicians who don’t see drug reps and don’t go to company-funded meetings are still getting misinformation from conventional sources, because corporate influence permeates many of the sources of information that health care providers have.” Industry manipulation can take many forms, including a practice known as “disease mongering.” Companies may brand common human discomforts associated with menopause, overeating, shyness, or low libido as medical conditions requiring pharmaceutical remedies. Alison O’Rourke Windels, MD (C’10, M’14), and Grace Lee (MS’15), winners of the 2017 PharmedOut conference’s student abstract competition, researched 60 online CME modules on male hypogonadism and found much of the information to be misleading. After interning with PharmedOut as a master’s student in physiology, Lee gained a critical eye for reliable and impartial sources of medical

education, a perspective she took with her to medical school at UCLA. “Part of why I’m attracted to the work of PharmedOut is that it talks about information that medical students often don’t learn about,” Lee says. “As a future physician, I’m more aware of how variable CMEs can be, and that they’re not necessarily all accurate.” PharmedOut has trained more than 100 interns and several volunteers. In

2015, the biennial conference drew 140 registered attendees. At the 2017 conference, looking at industry influence on medical discourse, registration rose to 210. “The conference attracts a great mix of individuals from a variety of health professions, including doctors, nurses, lawyers, pharmacists, researchers, students, and patient advocates,” says Alycia Hogenmiller, project manager and sole

A sample of industry-free, web-based continuing education modules available through PharmedOut and DCRx Drug Approval and Promotion in the United States Medical Cannabis: An Introduction to Biochemistry & Pharmacology Getting Patients Off of Opioids Rational Prescribing in Older Adults Generic Drugs: Myths & Facts

Alumni and student volunteers Christian Bruni (MS’16), Selena DuBar (MS’17), and Aida Roman (MS’17), staff the donation table at the PharmedOut 2017 Conference, “Does Industry Influence Medical Discourse?”

full-time staff person for PharmedOut. Cross-disciplinary dialogues at communal lunch tables further enrich the conference experience for attendees, she says—conversations sparked by the engaging and provocative content from presenters. Georgetown’s emphasis on public policy draws a strong pool of studentleaders to the PharmedOut program. Fugh-Berman can recall interns who arrived as timid pre-med students, but left as future physician-advocates determined to use their medical degrees to change public policy. “We may be giving students unrealistic expectations of how much can be accomplished by a few people with a limited budget and a limited amount of time,” says Fugh-Berman with a smile. “But it’s wonderful to see them grow into concerned and effective citizens. They are empowered to try and change things. That, to me, is our most important success.” n

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Anatomy, Cadavers, and

The Art of the Obituary On the first day of anatomy lab, you can feel it in the air. Whether it’s excitement or anxiety or terror, emotions are running high among the first-year medical students. They wonder what the cadavers will look like, what they will feel like, and who were these people that so generously donated their bodies to science. But after a few weeks, those feelings fade as routine takes over. For many students, anatomy lab becomes a fourhour formaldehyde-scented class, just another piece of the grueling schedule in the medical school curriculum. It’s a common theme in literature written by doctors, says Bethany Kette (M’20) who is on the board of Georgetown Arts & Medicine, a student group, and on the Literature and Medicine Track at the School of Medicine. “The awareness that your cadaver was an actual person turns into, ‘Oh, just another assignment.’ It just doesn’t hit you anymore.” That’s why Kette enlisted Emily Langer (C’06), obituary writer for The Washington Post, to teach an obituary workshop to a group of 25 first-year medical students. Langer led a variety of creative writing exercises for the students to reflect on their time in anatomy lab, and imagine fictional lives for their donors that would aid them in writing actual obituaries. Langer stressed that obituaries are not about death, but rather about life on the

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Bethany Kette (M’20) organized the obituary writing workshop for medical students.

occasion of someone’s death. “You’re here because you want to understand the life of someone you came to know so well in death,” she said. In order to write an obituary about someone, you have to know about that person’s life. However, the only information medical students are given about their cadaver is age and the cause of death. “Originally, this workshop was going to help us write strictly fictional obituaries,” says Kette. But when she

mentioned the idea to Mark Zavoyna, director of the cadaver lab, he suggested they ask families if they would want to be interviewed by medical students to write real obituaries. Several families agreed. Students conducted interviews and then wrote tributes to the donors, which were then read to families at the Anatomical Donor Memorial Mass in May. Kette’s obituary for a donor and alumna can be found on the following page.


Remembering Dr. Carol E. Kennedy (M’70) By Bethany Kette (M’20)

Each day in anatomy lab this year, we were joined by instructors who taught and guided us through each physiologic system, sharing with us the knowledge that is integral to our medical education. In their starched white coats, each embroidered with ‘Dr. So-and-So’ in neat script, we addressed them by name, asking for their help when we were unsure of our next steps. But there was another doctor among us each day in those rooms, one who did not wear her white coat and whose name we did not know. One who had stood in our exact footsteps in 1968, and came back to be our most selfless teacher of all. Dr. Carol E. Kennedy, artist, physician, and graduate of Georgetown University School of Medicine, passed away in December of 2015 at the age of

77 in Alexandria, Virginia. Dr. Kennedy was born in a small farm town in Wisconsin and spent her childhood in Washington. She eventually completed her pharmacy degree at Washington State University, where she met and married her husband Andrew, and had her first son, Andy. When their family moved to Virginia, Dr. Kennedy decided to forgo her career as a pharmacist and began medical school at Georgetown. She had her second son, Jim, during her fourth year of school and graduated with the class of 1972. She became an internist at Fairfax Hospital—one of very few female physicians there at the time. Her close friend and colleague Dr. Grundlehner said that “medical school was not a very easy place for women” when they attended.

There may have only been two women’s restrooms in a 10-floor building, but Dr. Kennedy never complained because she always considered it a privilege to be a physician. She was a deeply religious woman and continued to serve others through her church long after she retired from medicine. In addition to devoting time to reading for her three book clubs, coaxing plants from the earth in her garden, and riding horses, Dr. Kennedy chose to retire early so that she could finally pursue her artistic talent. A friend described her as a formidable artist who had had no opportunity for formal training while she was a physician, but Dr. Kennedy soon remedied that when she went on to study at the Torpedo Factory in Alexandria and at the Corcoran Gallery of Art. Multiple art shows exhibited her work—beautiful depictions of vibrant orange lilies and muted purple orchids that I wonder if she painted directly from her own garden. Despite her many accomplishments in life, her son Jim noted that above all else Dr. Kennedy was fiercely proud of graduating from Georgetown—and it was a pride that never faded. I knew that fact to be true when he also mentioned that she remained a loyal patron of The Tombs and often brought her family there along with her. Her love of Georgetown is why she wanted to come back here one last time and continue serving others just as she did her entire life. n

A painting by artist and physician Carol E. Kennedy.

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AL UMNI CONNECTIONS

What’s in my white coat? “My lucky stethoscope!” laughs Michelle Roett, MD, MPH (M’03), chair of the department of family medicine at Georgetown. After misplacing her first two stethoscopes that she had diligently labeled with her name and cell phone number in medical school, this one she has kept for 14 years—without a label. Today Roett’s pockets are much lighter than they were as a student or in her early years of practice. “When I was in medical school our pockets were laden down with calipers, eye charts, and reference books,” she notes. “Eventually the books were replaced with devices. I had a Palm Pilot at first. My smartphone has most of the information now. Students might still carry otoscopes or ophthalmoscopes, and tuning forks. I do too if the need arises.” And the tissues? “Sometimes when my patients cry, I cry with them. Sometimes everyone on the team is affected by the story a patient tells us: domestic violence, losing housing or a job, losing a loved one, end-stage cancer. You go through a lot of heartbreak with your patients—and of course joy too. I’ve celebrated my younger patients’ milestones, such as being a first generation college student. In my opinion, the most joyful event you can be a part of is delivering a baby—nothing tops that.” Roett’s background in psychology and public health drew her to family medicine, where she could follow her interest in working in underserved communities, patient communication, and health disparities. Recently appointed chair of family medicine, Roett remembers a meeting she had as a medical student with then-chair Jay Siwek, MD (C’71, M’76), to learn more about the field. “He asked me about my 5-, 10-, and 15-year plan. I told him I wanted to teach, see patients, deliver babies, publish research, and work on community-based projects. A little surprised, he asked me how I would do all of these things, and I told him I’d like to have his job. He has been in my corner every step of the way.” Another supporter is Stephen Ray Mitchell, MD, MBA, Dean for Medical Education. “I have a not-so-secret mission to increase primary care presence on campus,” Roett says, “and open students’ eyes to both community engagement and being the doc who does full-spectrum care. Dean Mitchell always says, ‘Yes! What can I do to help?’ Inspiring mentors in the GUMC department of family medicine and tremendous support from my parents and medical school family made it possible to reach this destination.” n Have a story to share about what you carry in your white coat? Contact us at georgetownmedicinemagazine@georgetown.edu.

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OB in OK Obstetrician and gynecologist Kate Arnold, MD (M’13), has been named an assistant professor and associate residency program director for the University of Oklahoma College of Medicine. She provides general obstetric/ gynecologic care and has a specific interest in inclusiveness, working with pediatric, adolescent, LGBTQ patients, and individuals with gender fluidity. After Georgetown, Arnold completed her OB/GYN residency at the OU College of Medicine.

Leading Diversity and Equity at SIU In June, Southern Illinois University Medicine named Wendi Wills El-Amin, MD (M’98), its new associate dean for equity, diversity, and inclusion. El-Amin is an associate professor of family and community medicine and medical education. Her mission is aimed at fostering community partnerships, enhancing the cultural competence of medical students, faculty, and staff, and creating more opportunities for K-12 students to find their passion for medicine.

Rural Health Meets Religious Pluralism

Salwan Georges/The Washington Post

Three years ago, Ayaz Virji, MD (C’96, M’00), moved with his family to Dawson, a small town in western Minnesota, to pursue his interest in practicing rural health. A Muslim of South Asian heritage, Ayaz was born in Kenya and

grew up in Florida. According to a July 1 story about him in The Washington Post, despite their differences, the family was warmly received by the community and Ayaz became one of just three practicing physicians in the town. After the 2016

Ayaz Virji lectures on Islam at City Hall in Granite Falls, Minnesota.

presidential election, he was shocked to learn that his community voted predominantly for a candidate who espoused anti-Muslim rhetoric. He and his wife gave serious consideration to moving out of the country. Instead, he chose to speak about Islam to his community, and began a modest lecture tour in the region that drew hundreds to libraries and community centers, where audience members could ask questions, and learn about what it means to be Muslim. From the Post article: He introduced himself as a doctor who had studied comparative religion at Georgetown with professors who were “the epitome of intellect and scholarship.” He said that what he learned was that if you want to understand Islam, or anything, “you have to be sincere” and “you have to use your brain.” He looked around at the crowd. “Because it’s easy to demonize. You know, ‘Everybody else is crazy and I’m just right,’ ” he said sharply. “And what kind of society does that create? That’s what ISIS does. That’s what these zealots do. Do we want to be like that? As Americans, don’t we want to be better than that? We better be better than that.”

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GEMS Family

CELEBRATES YEARS

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More than 200 gathered in D.C. in July to celebrate the 40th anniversary of the Georgetown Experimental Medical Studies (GEMS) program. The event honored those who created the program and the people who continue to contribute to its success. The black-tie gala also recognized alumni of the program, a one-year post-baccalaureate study for disadvantaged minority students interested in applying to medical school. Several alumni credited GEMS for opening the door to their medical careers. Kimberly Henderson, MD (C’91, L’95, M’00), said that without the GEMS program, “there would not be a medical career. It made my career.” In addition to practicing emergency medicine in Mount Sinai Beth Israel Hospital in Manhattan, she serves as regional medical director for CVS Minute Clinics. A total of 767 students graduated from the GEMS program since 1977. About 72 percent have completed their medical degrees, or are currently enrolled in medical school. The remaining alumni are in other health-related careers. Special recognition went to Fernando Pagan, MD (M’96), medical director of the translational neurotherapeutics program at Georgetown University Medical Center and director of the movement disorders clinic at MedStar Georgetown University

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Hospital. Part of the GEMS class of 1992, he was awarded the GEMS Physician Alumni Leadership and Innovation in Medicine Award. Pagan treats patients with Parkinson’s disease and other movement disorders, and conducts research on medical interventions to either slow the progression of disease or to treat the many symptoms caused by neurologic diseases. Wendy Diaz-Huarcaya (M’21), GEMS class of 2017, credited the program for giving her a chance to fulfill her dream of becoming a doctor. She learned about GEMS after her applications to 25 medical schools weren’t accepted. “GEMS is a place of selfimprovement,” she said. “It is a family away from home.” David Taylor, associate dean for student learning at the School of Medicine and GEMS program director, reinforced the idea that everyone who contributes to GEMS becomes part of its family, especially the alumni. “As a family, we take it very seriously that we care for one another,” Taylor said. That attitude is shared by everyone from study session leaders like Christopher Kaingo, MD, to Antonio Celey, who runs the market and coffee shop in the Pre-Clinical Science Building, and who were both in attendance. “That’s what makes us so special,” Taylor said. “Everyone is rooting for that GEMS student’s success.”


Two new clinical lectureships were announced during the event to honor the legacies of Arthur Hamilton Hoyte, MD, and Dean Emeritus Joy Phinizy Williams (pictured on page 36), long-

time leaders of the GEMS program. Hoyte began advocating for the enrollment of underrepresented students soon after joining the School of Medicine department of community and

People you cherish

Places you remember

family medicine in 1973. He founded GEMS in 1977 with Heinz Bauer, MD. While Hoyte could not attend the event, he sent his thanks in a letter read to the attendees, noting “the ongoing disparities that have existed for decades are the reason GEMS still exists.” Williams joined the program soon after its founding, and was a valued mentor for 35 years. She was “measured, patient, supportive and kind, with a great sense of humor,” GEMS alumna Tiffany Pittman, MD (M’12), told attendees. Williams served as the GEMS program director and senior associate dean for students and special programs before retiring in 2014. In addition to her work at Georgetown, she also participated in many mentoring programs for high school and undergraduate students interested in health careers. “It was an honor to have worked with GEMS students,” Williams said. n

Stories that inspire

Reminisce with old and new friends alike October 27-29, 2017. Visit medreunion.georgetown.edu for the latest information.

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Women Philanthropists Celebrate a Night of Hope Annual Women & Wine event raises awareness, funds, and a spirit of community to support breast cancer research at Georgetown. By Allan Hutchison-Maxwell

The stories of cancer survivors connect with us on a visceral level because they ring true in our own lives. They mirror our own experiences and the experiences of our friends, family members, and loved ones. By reaching out to others who have been through the same tribulations with the disease, we create a community dedicated to beating cancer. To fight back against the disease, women are organizing events where they can share stories, raise funds for research, and stand in solidarity with survivors. At Georgetown’s annual Women & Wine event—organized by and hosted for women —survivors, donors, and business leaders come together to celebrate life and pursue the fight against breast cancer. Proceeds from the event directly benefit Georgetown Lombardi Comprehensive Cancer Center’s Nina Hyde Center for Breast Cancer Research, established in 1989 by designer Ralph Lauren and the late Washington Post Company president Katherine Graham, as a tribute to their friend Nina Hyde, legendary fashion editor at The Washington Post. From its beginning 12 years ago with 100 women in a room at the Palm Restaurant, Women & Wine has grown significantly, and raised a total of $2.5 million for cancer research at Georgetown Lombardi. The springtime event now features business networking, an extensive silent auction, and Georgetown doctors and scientists presenting the latest developments in cancer research to 650 attendees. At this year’s Women & Wine, the Spirit of Life Award was presented to Susan Miller, a local business leader and mother of four who was recently diagnosed with stage 4 breast cancer. The award honors a cancer survivor who exemplifies leadership in the community while promoting cancer research and awareness. In her speech at the event, Miller advocated strongly for investment in cancer research at Georgetown Lombardi: “You’re investing in hope: for you, for your children, for my four children, for your grandchildren.” At the volunteer-managed event, passion for the cause drives

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Event co-chairs Janet Davis (left) and Barbara McDuffie (right) help awardee Susan Miller to the podium.

sellout crowds each year. Networking connections and word of mouth have made it a signature event for women in the Washington, D.C. area. Event co-chair Barbara McDuffie says that the passion comes from how directly women can relate to breast cancer survivors: “Through family and friends, every woman has been impacted by breast cancer—they want to attend, and make a difference.” Growing research on gender and philanthropy points to different giving trends between men and women. For example, a 2015 report from the Women’s Philanthropy Institute at Indiana University Lilly Family School of Philanthropy notes that women increasingly engage in forms of collaborative donor models such as giving circles. More than half of giving circles in the U.S. are women-only, and many prioritize issues that impact women and girls. Women & Wine is a modified example of this giving circle model, says Andrea Pactor of the Women’s Philanthropy Institute. “The women convene once a year to mingle, connect,


and focus their attention on a cure for breast cancer. Historically, women tend to rely on each other for advice, problemsolving, and now, philanthropy. The excitement around the event, the common commitment to solving this problem, the opportunity to be with like-minded women, and the knowledge that women are making a difference—these features are why events such as Women & Wine resonate so deeply with the audience.� Women & Wine co-chairs McDuffie and Janet Davis agree, adding that women are familiar with the struggle that breast cancer survivors have faced, and they want their philanthropic dollars to make a direct impact. n Next year’s event will be held at The Ritz-Carlton, Tysons Corner on April 18, 2018. Contact Sharon Courtin (sc830@georgetown.edu) to learn more. Conor and Susan Miller discuss her care with Susan Moreland, DNP.

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Reflections on medicine with

Wanda Lo (C’76, M’80) science and working with people. I met my husband Richard Heather (M’80) on the first day of medical school. He sat in front of me and asked to borrow a pencil for a reading test. After a long lecture explaining EKGs, our professor asked if there were any questions. One brave student raised his hand and said, “Uh, can you just repeat that whole thing?” The lectures from Proctor Harvey on cardiology and auscultation were some of the best. His auscultatory lectures with his knuckle sounds stayed with me all through my career. Our class saw tuition double. As a result, a third of our class joined the military, a third sought help from wealthy family, and a third signed up for the National Health Service Corps like me.

My service corps scholarship got me through medical school without debt. They wanted primary care and they wanted you right out of residency. I completed my three-year obligation service at a migrant farm worker’s clinic in central Washington, in a small town called Toppenish on the Yakama Indian reservation. In 1987 I came to San Luis Obispo, California. The population was 30,000, plus Cal-Poly students. Our pediatric practice covered four emergency rooms, phone calls after hours, three nurseries. It was crazy. Things improved when they added a NICU. I retired in 2016. When I was on call, I’d drive 15 miles on lonely roads to hospitals, sometimes in the

middle of the night through dense fog. Over the years, meningitis, H-flu, rotavirus, and pneumococcal vaccines changed the face of pediatrics and eliminated many of the bad cases we hated to see.

When hospitalists came, it revolutionized our work and cut way back on stress level and worrying about patients at night.

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I liked helping children with ADD, asthma, diabetes. My son developed Type 1 diabetes at 9 years old, which was heartbreaking for me. There’s always pressure to see more patients. With my practice style, I was always behind, never a 30-40 patients a day doc.

Electronic medical records increased my workload. The system creates the need for a scribe, which I didn’t have. I took work home, reconciling billing, finishing notes, responding to messages that I didn’t get to during the day. My workdays were long. Good thing my husband cooks! He had dinner on the table every day. He is an internist with his own business. Students have to go through the process themselves to understand why some have advised them not to pursue medicine. You get swept up in the current, you catch the enthusiasm of classmates. It’s a powerful energy. Without that momentum and

drive, you won’t make it. Honestly, I spent a lot my career wondering if this was the thing I was supposed to be doing. For new doctors, my advice is to take care of yourself: enjoy family, friends, time away. Get help when you’re not feeling well. I’ve had a lot of anxiety and perfectionism—a terrible combination when you do this kind of work. It caused me to worry about patients, take things home in my head. It’s important to set boundaries and not let work engulf you.

Avocations are important, besides occupations. I coach an adapted knitting class at the senior center, am an avid fountain pen user, read Buddhist literature, take tai chi and qigong, and hike as much as I can. n © Dreamstime / iStock

I was born in Boston and moved to the D.C. area when I was four. I was a psych major at the college, pre med and a bio minor. Medicine attracted me because I always loved


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LOOKING BACK After the 2017 White Coat Ceremony, family and friends squeeze in to photograph the first year medical students. Look inside for a snapshot of the incoming cohort gathered just 111 years earlier—and see how far women in medicine have come.

Profile for Georgetown University Advancement

Georgetown Medicine Fall/Winter 2017  

Georgetown Medicine Fall/Winter 2017