{' '} {' '}
Limited time offer
SAVE % on your upgrade.

Page 1

GM_Spring15_Layout 1 4/23/15 3:04 PM Page 2

SPRING/SUMMER 2015

Caring for the Whole Person with

Integrative Medicine


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 3

FROM THE ARCHIVES This spring Georgetown’s new Booth Family Center for Special Collections opened on the fifth floor of Lauringer Library, featuring a high-tech classroom, revamped reading room and state-of-theart storage and exhibition facilities. Historic photo archives include many gems from the Medical Center, including the above image of an unidentified nun in the lab. Have historic photos or materials to donate to the collection? Call 202-687-7444 or email speccoll@georgetown.edu.


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 4

SPRING/SUMMER 2015

Caring for the Whole Person with

Integrative Medicine 10

GEORGETOWN’S EVOLVING STUDY IN COMPLEMENTARY AND ALTERNATIVE THERAPIES Integrative medicine in the classroom

15

PUTTING INTEGRATIVE MEDICINE INTO PRACTICE Alumni share post-Georgetown experiences with integrative medicine

20 24

28

WHERE’S THE EVIDENCE? Georgetown researcher probes the underlying mechanisms of acupuncture

A PATIENT’S EXPERIENCE WITH ENERGY HEALING Georgetown Lombardi patient complements chemo with Reiki

31 3

20

28 31 32

CHECK UP: NEWS & RESEARCH ON CAMPUS STUDENT VOICE ALUMNI CONNECTIONS


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 5

Integrating New Approaches Dear Friends, I hope you enjoy this edition of Georgetown Medicine, with enlightening features about the ways in which complementary medicine is being integrated into the medical student educational experience at Georgetown University. Those of us involved in medicine in the U.S. tend to think in a rather self-centered way about Western medicine, regarding other approaches with skepticism. But even a skeptic would have to acknowledge the pioneering work being done at Georgetown and around the country to bring the principles of holistic and traditional Chinese medicine into play in our health care settings. Notions of caring for the “whole person” are obviously longstanding at Georgetown, so this integration plays well on our campus. The progress is exciting, and I’m gratified to observe how these disciplines are being integrated with conventional medicine. This groundbreaking work is also bringing innovative pedagogical ideas forward. The new paradigm could change the way we train health care providers, analogous to Georgetown’s systems medicine approach—which looks at bodily systems as part of an integrated whole—and the work underway at our new Center for Education and Leadership in Education (CENTILE), which aims to raise the bar in biomedical pedagogy at GUMC. As is the case with many programs on our medical campus that integrate education and clinical practice, the collaboration with our clinical partner, MedStar Health, continues to play a key role in developing and implementing these new approaches. Finally, I would like to take this opportunity to share some personal news. I have accepted the position of vice chancellor for health affairs and dean of the School of Medicine at University of California, Irvine, beginning in July. This is an opportunity for me to be responsible for all three mission areas—patient care, education and research. I am grateful for the eight years spent leading Georgetown University Medical Center. Our journey together has made evident the need to strive for excellence, to do more for our constituent communities: patients, students, staff and faculty. It is with the greatest sense of pride that I have served as the EVP for health sciences and executive dean. Our tradition and successes will continue with new leadership. Sincerely,

A publication for alumni and friends of Georgetown University Medical Center

Editor Jane Varner Malhotra

Contributors Daliha Aqbal Todd Bentsen Bill Cessato Kate Corboy Elissa Ernst Camille Scarborough Renee Twombly Lauren Wolkoff

Design Director Robin Lazarus-Berlin, Lazarus Design

University Photographer Phil Humnicky

Executive Vice President for Health Sciences Howard J. Federoff, M.D., Ph.D.

Dean for Medical Education Stephen Ray Mitchell, M.D., MACP, FAAP (W’86)

Georgetown Medicine is published by the Georgetown University Office of Advancement Communications. 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 Contact alumni records for address changes: 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.

Howard J. Federoff, M.D., Ph.D. Executive Vice President for Health Sciences Executive Dean, School of Medicine

2

G EO RG E TOWN MEDICINE

© 2015 Georgetown University Medical Center

Cover photo: © Daniel Reiter / STOCK4B


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 6

CHECK UP

News & Research

Gender Equality in the Lab Georgetown group recommends new policies to eliminate preclinical research bias

I

n September 2014, the Georgetown Consensus Conference Work Group —comprised of science, medical and population health researchers in addition to experts from publishing, industry, advocacy and policy— assembled at Georgetown University Medical Center to develop specific and practical recommendations for the National Institutes of Health to correct over-reliance on male cells and animals in preclinical research. “Sex is a fundamental biological variable with profound consequences,” the group writes. “Underrepresenting female cells and animals has resulted in a poorer understanding of the biological, physiological and pathophysiological mechanisms in the female compared to the male.” Kathryn Sandberg, Ph.D., director of Georgetown’s Center for the Study of Sex Differences in Health, Aging and Disease, convened the group and was the lead author of the recommendations. The findings were published online in February 2015 in the Journal of the Federation of American Societies for Experimental Biology.

“This diverse group arrived at a consensus in their recommendations concerning a highly controversial issue,” states Sandberg. “It was a nice surprise.” Sandberg and Scott Fleming, associate professor for federal relations at Georgetown, visited two members of Congress—Nita M. Lowey (D-N.Y.) and Rosa DeLauro (D-Conn.)— to make the case for gender equality in publicly funded research. The representatives had been instrumental in passing the NIH Revitalization Act in 1993, requiring NIH to include women in federally funded phase three clinical trials. After the meeting with Sandberg and Fleming, the congresswomen penned a letter to NIH Director Francis Collins, M.D., Ph.D., stating that the lack of female animals in basic research undermines the credibility of the results. Collins took the letter seriously, vowing to balance male and female cells in future preclinical trials using research funds. “Men and women are not the same, but when they are treated that way, medicine

Kathryn Sandberg, Ph.D., (left) directs Georgetown’s Center for the Study of Sex Differences in Health, Aging, and Disease

suffers. The Food and Drug Administration has withdrawn several drugs from the market, and therapeutic doses have been changed due to the after-market discovery of serious toxic side effects in women,” explains Sandberg. As Collins and Clayton point out, there are a number of conditions now known to differ between the sexes: multiple sclerosis, Parkinson’s disease, schizophrenia, stroke, drug addiction, obesity and metabolic disorders. “Sex may well contribute to the troubling rise of irreproducibility in preclinical biomedical research,” they state. In October 2014, NIH began rolling out new policies to address gender discrimination. Sandberg

worries that now some researchers might begin a study with both male and female cells but, seeing no initial differences, switch to male cells only. If that’s the case, the new policies will not spur meaningful change. Rather than attempting to achieve a male/female balance in every preclinical study, she says, NIH could ensure that the overall research budget is spent equitably in aggregate on male and female cells and animal models of disease. “I propose that the proportion of male and female models used to investigate specific diseases should reflect the disease’s prevalence in the general population,” explains Sandberg. “I call this a Title IX approach.” n

SPRING/SUMMER 2015

3


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 7

CHECK UP

Reversa Mills, M.D. (M’09), the first Fund a Fellow recipient, with Fernando Pagan, M.D. (M’96), director of the Movement Disorders Program.

Fund a Fellow for Parkinson’s

Inspired Patients and Families Fund Training for Movement Disorders Specialists

T

welve years ago, airline pilot Rick Schena felt something amiss— the onset of tremors, some rigidity and issues with processing vision. When he was diagnosed with Parkinson’s six years later, the speed fanatic who races cars and go-karts was devastated. After his general practitioner said there was nothing he could do, Schena visited a neurologist. “It was a terrible experience. It was clear he didn’t

4

know anything about Parkinson’s disease,” he says. A friend of his with the same disorder recommended that he see Fernando Pagan, M.D. (M’96), director of Georgetown’s Movement Disorders Program. “Dr. Pagan turned my life around,” Schena says. “The treatment he and his team provided was so incredible. I left feeling a lot of hope, and my health has since remained stable, although

G EO RG E TOWN MEDICINE

I know this disease is a formidable enemy.” Janis Buchanan felt the same way about the Parkinson’s disease care Pagan gave her husband. When Schena and Buchanan happened to meet, they decided they wanted to pay it forward— to do something for the physician who is doing so much for them. Schena and Buchanan sat down to lunch with Pagan in 2013 and discovered some alarming information: only

25 percent of Parkinson’s patients nationwide see a movement disorders specialist because there are so few of them. These specialists treat a variety of conditions that involve involuntary muscle movement or tics as seen in Parkinson’s and related disorders. “In fact, there are many states that don’t even have such a specialist,” Buchanan says. “It’s important for Parkinson’s patients to receive treatment from a specialist because the disease symptoms vary from person to person.” They also learned that Pagan had personally funded and trained 16 fellows as movement disorders specialists since 2005. Using research grant funding meant to support his time, he created the two-year, $160,000 fellowships. “The lack of movement disorders specialists is a problem across the country,” Pagan says. “There is a big demand for these physicians, but there aren’t enough fellows. Training hasn’t caught up with this specialty. Even today, you can easily graduate from medical school without ever taking care of a Parkinson’s patient or even rotating through neurology. “But things have definitely changed. In the old days, people didn’t want to go into movement disorders because after making a diagnosis of Parkinson’s, you couldn’t do


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 8

anything to treat it,” he says. “Now we can do a lot. We have new medicines, deep brain stimulation—a kind of pacemaker for the brain, and Botox to quiet muscles. Now in treating Parkinson’s, we concentrate on taking care of the whole person.” Pagan has built an impressive fellowship program as well as a large Movement Disorders Program. Its five specialists work at MedStar Georgetown University Hospital and at two satellite clinics in Virginia and Maryland. He considers the fellowships a good investment. “It’s true that I have taken a hit. But I felt that it was important to do so. With my fellows I can do a lot more research, provide better care,

and see more patients,” Pagan says. “This investment benefits the community in all those different ways.” True believers, Schena and Buchanan decided to start “Fund a Fellow” to help support Pagan’s program for Parkinson’s treatment. In 2013 they raised $80,000 for their first fellow, Reversa Mills, M.D. (M’09), and last year the fund raised $160,000 for the last year of Mills’ fellowship and the first year of the new fellow’s term. “It is only the fortunate who have the opportunity to see these specialists, as we do here at Georgetown,” says Schena. “Our goal, which we are meeting with the generous support of so many people, is to help ease that situation by funding one new

Parkinson’s specialist a year,” Buchanan adds. Mills will join the National Institutes of Health in June to pursue research before seeking a permanent clinical or research position at an academic medical center. She met Pagan during her medical school interview at Georgetown, and became hooked on what he was doing—transforming the care of movement disorders and conducting exciting research on clinical issues. After pursuing a residency outside of Georgetown with minimal exposure to Parkinson’s disease patients, she learned of the Fund a Fellow program and jumped on it. “I couldn’t be more grateful for the training I have been

For more information on the Fund a Fellow for Parkinson’s program, please contact Kristina Madarang at kristina.madarang@ georgetown.edu or (202) 687-2464.

given,” says Mills. “And now we are zeroing in on newer approaches to help patients with Parkinson’s and other movement disorders live full lives. This is the kind of work I want to do.” n

New Research on Asians and Cancer Care

G

eorgetown researchers are exploring the impact of cultural beliefs on cancer care in the Washington, D.C. area’s growing Asian-American population. While there is no one-size-fits-all approach, broadening communication channels between caregivers and patients is essential, and more education is needed, says Judy Huei-yu Wang, Ph.D.,

associate professor of population sciences at Georgetown Lombardi Comprehensive Cancer Center. “Physicians need to be aware of and sensitive to Asian patients’ culturallybased health care views and communication styles, which may be more passive due to a tradition of conformity and respect for authority,” Wang says.

Judy Huei-yu Wang, Ph.D., an associate professor of population sciences at Georgetown Lombardi, studies the influence of culture on cancer care.

SPRING/SUMMER 2015

5


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 9

supplement use, and checks a database to make sure there is no interaction between these agents and cancer drugs.

SCREENING AND CLINICAL TRIALS

Aiwu Ruth He, M.D., an oncologist with a large Asian patient practice, works to overcome challenges to boosting cancer screening rates and enrolling patients in clinical trials.

“Likewise, Asian patients need to learn evidence-based practice such as preventive concepts and how to communicate with physicians. For example, they can learn that asking questions—and asking for explanations or further referrals—is a part of patient rights and common practice in mainstream health care,” she adds. Wang is working with Aiwu Ruth He, M.D., a Georgetown Lombardi oncologist who specializes in liver and stomach cancers and sees many Asian patients. Together they are exploring ways to increase cancer screening rates and enroll more patients in clinical trials.

EMPHASIS ON SELF-CARE In Asian communities, self-care through natural approaches such as diet, Chinese medicine and mind-body fitness is widely

6

accepted. Many pharmacies offer composition herbal remedies to treat a variety of diseases, ranging from hypertension to diabetes to infections. “Due to the emphasis on self-care, many do not think it is necessary to see physicians for semi-annual or annual checkups if they do not have any symptoms. When the physician’s opinions do not meet what is believed or read, they tend to shop around for another opinion,” notes He. Along the same lines, translating educational materials about disease process, evidence-based disease prevention, surveillance, treatment and patientdoctor communication helps encourage patients to take advantage of medical care resources available to them, she adds. With her cancer patients, He always asks about

G EO RG E TOWN MEDICINE

Wang studies the willingness of patients of Asian descent to participate in screening for breast and colorectal cancer, and how physicians communicate with this population. Educational level often does not have much bearing on how Asians regard both screening and clinical trials, both Wang and He have observed. “A patient may be highly educated, and may express an understanding of data from clinical trials, yet somehow clinical trials do not become part of the treatment options he or she would consider,” says He. Many patients lack knowledge about clinical trials and feel uncertain about the effects of the treatment being tested. Also, the informed consent process can be overwhelming for patients with linguistic barriers.

OPENING COMMUNICATION CHANNELS Language barriers are not the most important issue in cancer screening and survivorship care, the researchers say. “The problem is communication channels—whether their physician is willing to

listen or talk, whether the patient is willing to ask or learn,” says Wang. Knowing these challenges, she has worked to understand how to improve low breast and colorectal cancer screening rates among Chinese Americans. Culturally competent communication from the physician and testimonials from cancer survivors help encourage Chinese American women to consider breast cancer screening, her research finds. “Results show that increasing knowledge through education was able to change fatalistic views of cancer and help women incorporate regular screening into part of their self-care practice,” Wang notes. Increasing Asian participation in clinical trials is important for both individual patient care and population research. For example, Asian lung cancer patients are more likely to have a genetic mutation in a receptor known as EGFR, the knowledge of which predicts good response to anti-EGFR therapy. Including patients of Asian descent in clinical trials helps reveal the efficacy of certain anticancer therapies in patients with different ethnic backgrounds. “Providing educational materials on these types of examples may encourage Asian patients to get involved in clinical trials,” He says. n


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 10

Neuroscientists Explore Music and Movement in the Blind

© MARKA / Alamy

H

ow do you “keep the beat?” Do you close your eyes and sway to the sounds? Do you watch dancers move their bodies, and do the same? Or do you tap your foot to the good vibrations? It’s complicated, say neuroscientists at Georgetown University Medical Center. The answer may be all—or none—of the above. One thing is for certain: the scientific solution to the question will tell them a lot about these functions in terms of sensory input and functional output. “We believe that expressing rhythm—feeling the beat—in music involves the integration of many senses— audition, motor, vestibular and vision,” says Jessica Phillips-Silver, Ph.D., a postdoctoral researcher in GUMC’s Laboratory of Integrative Neuroscience and Cognition, headed by Josef P. Rauschecker, Ph.D., professor of neuroscience. Phillips-Silver specializes in the neuroscience of music. “We really want to understand how music resides in the brain and the

body,” she says. “We want to capture a process that is at the core of what music means to humans universally.”

BALANCE AND RHYTHM To help understand how the brain processes rhythm, Phillips-Silver and postdoctoral researcher Paula Plaza, Ph.D., are turning to individuals who have been

blind since infancy. It’s known that hearing and touch are enhanced in the blind, taking over the brain space dedicated to vision. “The brain is very plastic, which is why the visual cortex lights up in imaging studies of the blind,” says Phillips-Silver. “It has been reconnected to the auditory cortex to bolster that sense and potentially others as well.” That may mean that the blind could have a leg up on musicianship given their improved capacity to hear and to touch the instruments, Phillips-Silver says. Think of Stevie Wonder, Ray Charles, José Feliciano,

Doc Watson and many other renowned blind musicians. She and Plaza are studying other effects of blindness on rhythm—namely, how being blind might impair one’s ability to feel the beat, due to loss of visual input. “We get information about the beat when we watch musicians play or dance with each other,” Phillips-Silver says. Plaza, who specializes in kinesiology—the science of movement—suggests that the challenges of maintaining good posture and balance faced by many with visual impairments could weaken their ability to move to the beat.

SPRING/SUMMER 2015

7


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 11

CHECK UP

USING SOUND TO ‘SEE’ Through their research, Phillips-Silver and Plaza want to develop a model of brain plasticity in the blind, and to create interventions to help these individuals overcome recognized deficits. For example, some balance and posture problems could be improved with a device— consisting of a headset fitted with a small camera—that scans and converts images into audible signals that the blind can use to master skills that depend on vision, Plaza says. The research group recently launched a program that trains visually impaired people to use the device. “Our hope is that with training that improves posture and balance over time, they won’t need to use it daily. They will be able to stand and walk and do everything they have wanted to do, without the need for professional help,” Plaza says. As part of the training, the researchers measure changes in the brain linked to plasticity. The effort ties a basic neuroscience discovery

8

regarding brain plasticity to a clinical application that can improve quality of life, says Rauschecker. This line of research has two main objectives, he says. “One is to understand the incredible plasticity of the human brain, especially during early development; and the other is to come up with practical solutions to improve blind people’s lives. “Over the past decades, we have made good strides towards the first goal, and we are now moving into a new phase where we think our research can really make a difference for the blind in practical terms,” Rauschecker says. “Blindness in children is still a public health problem, especially in many developing countries, and we hope that one day we will be able to make a difference there.” n The research is supported by the NIH’s National Eye Institute.

G EO RG E TOWN MEDICINE

Words as Pictures

W

hen we look at a known word, our brain sees it like a picture, not a group of letters needing to be processed. That’s the finding from a Georgetown University Medical Center study published in the Journal of Neuroscience, which shows the brain learns words quickly by tuning neurons to respond to a complete word, not parts of it. Neurons respond differently to real words, such as turf, than to nonsense words, such as turt, showing that a small area of the brain is “holistically tuned” to recognize complete words,

says the study’s senior author, Maximilian Riesenhuber, Ph.D., who leads the GUMC Laboratory for Computational Cognitive Neuroscience. “We are not recognizing words by quickly spelling them out or identifying parts of words, as some researchers have suggested. Instead, neurons in a small brain area remember how the whole word looks—using what could be called a visual dictionary,” he says. This small area in the brain, called the visual word form area, is found in the left side of the visual cortex, opposite from the fusiform face area on the right side, which remembers how faces look. “One area is selective for a whole face, allowing us to quickly recognize people, and the other is selective for a whole word, which helps us read quickly,” Riesenhuber says. n

© Dragana Gerasimoski

“Musicians need to be able to know where their hands are and what else is in relationship with their arms,” says Plaza. “If you have never had visual-spatial feedback, it is likely harder to move your body in the right way all the time.”


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 12

Christopher King joins the Department of Health Systems Administration as director of experiential learning and professional development.

Launching Health Leaders Georgetown introduces executive master’s in health systems administration

T

he School of Nursing & Health Studies is offering a new executive master’s program in health systems administration. The program, which prepares students to take on executive-level leadership roles within the health care sector, will enroll its first cohort in fall 2015. Students will have access to a dynamic learning environment during the two-year, full-time program, which includes virtual “face-to-face” class sessions, online course materials to read any time, and exposure to the benefits

of a program located in the nation’s capital. “We are thrilled to add this program to our academic offerings,” says Patricia Cloonan, Ph.D., R.N., the school’s interim dean. “Our graduates make a meaningful mark across the health sciences continuum. This program enhances our ability to bring Georgetown’s rigorous, values-based curriculum to aspiring health care executives across the United States.” Program faculty will use a hybrid model to deliver the courses. Students will learn

through online classes and four week-long on-campus sessions, according to Ryung Suh, M.D., MPP, MBA, MPH, program director and associate professor of health systems administration. “We expect that our students will be mid-career administrators, nurse managers and physicians who are seeking to further develop their skills to become the leaders and shapers of the health care industry,” Suh says. Christopher King, Ph.D., FACHE, the new director of experiential learning and

professional development in the Department of Health Systems Administration, brings executive experience in health systems management and population health improvement. Before coming to Georgetown this winter, King served as the first assistant vice president of community health for MedStar Health, a notfor-profit health system comprised of 10 hospitals. His accomplishments include planning, launching, and managing a new corporate function designed to apply more rigor and evidence in community health planning, implementation, and evaluation. “One of my interests is bridging the gap between the health care and the public health sectors,” says King. “Social determinants of health are strongly correlated with health status, and managing the care of populations requires us to think outside the walls of our institutions. We must consider how to more formally integrate social factors in how systems of care are organized and delivered. This shift in thinking is aligned with cura personalis, and is critical for improving the health of the nation.” n

SPRING/SUMMER 2015

9


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 13

Georgetown’s evolving study in complementary and alternative therapies By Jane Varner Malhotra

F

ifteen years ago, Georgetown began an effort to bring a new conversation into the medical school classroom. The newly established National Center for Complementary and Alternative Medicine at the National Institutes of Health awarded Georgetown’s School of Medicine a grant to integrate the study of nonconventional therapies into the four-year curriculum. Students would learn about what many of their patients were already using—complementary and alternative medicine (CAM) including acupuncture, herbal therapies, chiropractic treatments and mind-body medicine.

PATIENTS SEEKING KNOWLEDGE In 1997, to connect with the community as an educational resource, Georgetown’s School of Medicine began offering an eight-week series of mini-medical school classes to the lay public. The science and medicine courses covered everything from what is molecular biology to why cells go bad, and the program was a hit. After that first session, organizers, including physiology and medicine professor Adi Haramati, Ph.D., sought customer feedback. “When the course ended, we asked people, ‘What do you want next semester? An eightpart series on cancer? On neuroscience? On cardiovascular?’” recalls Haramati. The results? “Number one: nutrition. Number two: alternative medicine.” He pauses. “What did I do with that? I ignored it. I didn’t think they were serious topics.” At the end of the second semester of classes, they again surveyed participants. And again the results were the same. After the third round of classes and repeated feedback, despite his own bench-science skepticism, Haramati felt compelled to understand why nutrition and alternative medicine interested so many people. He began looking into the field. At the same time, he was approached by Georgetown scientist Hakima Amri, Ph.D., who was researching the effects of plant extracts, and her colleague Vassili Papadopoulos, Ph.D. The two asked Haramati about using the mini-med infrastructure for a special series

10

G EO RG E TOWN MEDICINE


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 14

Hakima Amri, Ph.D., associate professor of biochemistry and cellular and molecular biology, leads the complementary and alternative medicine graduate program in the division of integrative physiology.

in complementary medicine. Their timing could not have been better. Until this point, academic medicine had mostly ignored the fact that one third of Americans were using complementary medicine, and that many more were curious. The patients and the public drove the university to take a deeper look. In 1999, Georgetown’s first session on CAM was offered through the mini-medical school format. The successful program generated new questions for Georgetown faculty. Seminar attendees revealed their thirst for more information on nonconventional medicine, but also a reluctance to discuss CAM usage with their physicians. This disconnect between patient and care provider prompted

Georgetown faculty to ask why the gap existed and consider ways to bridge the gap. They realized that future physicians would need to be better versed in the field, and one way to address the problem was to better prepare Georgetown medical students. With momentum growing in CAM, NIH sought to support more education and research in the field. In 2001, the national center awarded Georgetown a $1.7 million grant to develop a plan to incorporate complementary medicine into the medical school curriculum. Haramati recalls some uncertainty around the method for how to actually make it happen. “We were walking a path where the advocates were saying, ‘You’ve got to do more,’ while skeptics

were saying, ‘What are you doing teaching nonsense?’” he recalls. “And we were going down the path saying, ‘We’re going to look at this objectively.’” In 2002, faculty began to weave aspects of integrative medicine into basic science courses, with some topics explored in-depth as electives. In 2003, Georgetown introduced a one-year master’s program in physiology with CAM, the first degree in science with a focus on complementary medicine offered at a conventional academic medical center in the U.S.

WHERE’S THE SCIENCE? When the CAM mini-med school began, Amri was studying the effects of saw palmetto on prostate cancer and

SPRING/SUMMER 2015

11


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 15

A group of medical school students and facilitators begin their weekly mind-body medicine session with meditation.

ACADEMIC MEDICINE HAD MOSTLY IGNORED THE FACT THAT ONE THIRD OF AMERICANS WERE USING COMPLEMENTARY MEDICINE, AND THAT

Ginkgo biloba on stress in the department of cellular and molecular biology. She noted the growing public interest in the field of integrative medicine, but in her view, something was missing. “I realized that, in my research, I was using top-notch technology in the biomedical sciences,” says Amri. “You name it—PCR gene expression, animal studies, cell culture. I’m using all this here, to study a plant extract. What was really missing from the field of complementary and alternative medicine was this hardcore science.” Georgetown carefully designed the CAM curriculum to emphasize an evidence-based, scientific, critical but open-minded look at integrative medicine. The exposure to CAM in both the master’s program and in the medical school curriculum is not designed to advocate or promote complementary medicine, Amri says, but to train the next generation of researchers and

12

G EO RG E TOWN MEDICINE

MANY MORE WERE CURIOUS.

practitioners to understand it. “Because we are scientists in a medical center, the goal is to nurture critical thinking in the students,” she explains. With a broad and deep knowledge of the different complementary modalities, graduates of the program are able to analyze the research, distinguish between a good and bad study, and be critical of what is published. “And be really anchored in the science,” adds Amri.

WIDE-OPEN MINDS, WIDE-OPEN EYES In the master’s program today, 25-30 students graduate each year to follow a variety of pursuits including allopathic medicine, naturopathic medicine, dentistry, pharmacology and research. They study human physiology, biochemistry, pharmacology and evidence-based

medicine. The students also take an overview course covering CAM disciplines from the U.S. and around the world, including acupuncture and other traditional Chinese medicine, Ayurveda form India, the Unani system of Greco-Arabic-Islamic medicine, pharmacognosy, naturopathy, homeopathy and the physiology of mind-body medicine, given by Michael Lumpkin, Ph.D., former chairman of the department of physiology and biophysics, where the program started. Students come into the program with a range of preconceived ideas and cultural experiences in complementary medicine. Amri has had students who grew up being treated only with homeopathy, or only with herbs, who want to understand how it works. Some students say every nonconventional


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 16

therapy they have tried has been effective, but then realize the science does not support some of their experiences. They learn to analyze the studies, ask questions and seek conclusions based on scientific ground. “On the other end of spectrum,” she says, “I’ve had students who have worked in big pharma, and they sit in the back of the class with their arms folded. I see them and think: I’m not going to influence anybody. I’m just going to deliver the material, with objectivity and rigor—that’s our mission— and see how it’s going to be perceived.” And often Amri sees those students come to the middle. “They say, ‘I think I can understand how the plants work because I understand the mechanisms of drugs, and it could be working on this receptor and that receptor,’ and they see some sense to that.” Amri enjoys seeing students open their minds to new concepts. Learning disciplines like homeopathy may require students to radically disregard their previous understandings about receptors and responses in toxicology, for example. “I tell students that for the next few hours, put aside all they have learned in biochemistry, pharmacology and cell biology—empty their brains—because homeopathy is a completely different concept. Then I see big eyes on their faces!” laughs Amri. “We are not teaching them how to treat and diagnose,” says Amri. “We are teaching them how to evaluate the science of the therapy, critically analyze it and learn about these medical systems in the most open-minded way. We want them to make informed decisions about their career and later with their patients.”

MIND-BODY MEDICINE TAKING HOLD As the founders of this initiative

continued to develop the complementary medicine curriculum, they looked to bring an experiential element to the students along with the didactic approach. The mind-body medicine program evolved from that interest. The course has three principle objectives, explains the program’s director, Nancy Harazduk, M.Ed., M.S.W. One goal is to enhance self-care and self-awareness so that the students will lead a balanced life and become more mindful physicians. The course also aims to help busy medical students manage and reduce their own stress by introducing them to a variety of mindbody skills. Third, the program aims to create supportive and compassionate

hypnosis), biofeedback and healing through journaling, drawing and movement. The course is offered as an elective, meeting once a week for a two-hour session over 11 weeks. The close-knit groups are limited to 10 students with two trained faculty facilitators. Students spend the first hour of each session building connections, checking in with each other and creating a space for compassion in an atmosphere of non-judgment, explains Harazduk. The second hour is spent learning a new mind-body skill. Students take the program during the second half of their first year, but

Faculty in Georgetown’s CAM program includes Aviad Haramati, Ph.D., left, and Michael Lumpkin, Ph.D.

relationships among students, faculty and staff. Some of the skills taught in the program include meditation, guided imagery, autogenic training (self-

many come back for more, continuing with their group in some cases for all four years. The calm and supportive environment offers a welcome change in an otherwise intense time in their lives.

SPRING/SUMMER 2015

13


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 17

Led by adept and compassionate facilitators—many of whom the students see in other teaching roles in the school—the small group mind-body sessions teach students skills that as physicians they will use again and again:

“The goal is to have physicians who are aware of not just the physical but the emotional, social and spiritual aspects of a disease—and treat them all,” says Harazduk. “If they’re not able to do this alone, these physicians will respect and

WE ARE TEACHING THEM HOW TO EVALUATE THE SCIENCE OF THE THERAPY, CRITICALLY ANALYZE IT AND LEARN ABOUT THESE MEDICAL SYSTEMS IN THE MOST OPEN-MINDED WAY.

how to slow down, be fully present, and build meaningful relationships. The mission of the mind-body medicine program aligns with cura personalis, says Harazduk. “Holistic medicine treats the emotional, physical, social and spiritual aspects of a person. When someone has a heart attack, you ask what caused it: what are your relationships like, what is your work like, can stress be a part of it? When they become physicians, students who practice mind-body medicine will look at patients this way. What is the root of the problem? That’s what they want to heal, and that’s what I hope to teach.” Since it began in 2002, over 1200 students have taken the mind-body course, and over 90 clinicians, researchers and educators on the faculty have been trained as facilitators. In addition, the program is now offered to students at the School of Foreign Service and the Law Center. Harazduk believes that while not in the mainstream yet, use of mind-body medicine is growing, and that the use of complementary medicine in addition to allopathic is best for the patient.

14

G EO RG E TOWN MEDICINE

give credibility to the other practitioners who can help. Truly integrative medicine is not quite here yet, but things are much better than when I started 13 years ago. Its time is coming.”

FROM ALTERNATIVE TO INTEGRATIVE Earlier this year, NIH changed its research center’s name to the National Center for Complementary and Integrative Health (NCCIH), dropping the “alternative” and inserting “integrative.” What’s the difference? According to NIH, alternative medicine is defined as “unproven practices used in place of conventional medicine.” And this kind of practice, they say, is rare. Integrative care, on the other hand, brings together the traditional Western medical practices and the complementary therapies—a trend that is growing. “We have called it CAM—complementary and alternative medicine—but it’s not alternative to medicine,” explains Haramati. “It is part of medicine.” With NIH moving away from the alternative terminology, look for other leading national institutions—including Georgetown—to do the same.

Since the early years of complementary medicine research and education at Georgetown, the university has held a critical place on the national scene. Hosting multiple cross-disciplinary dialogues, Georgetown has convened chiropractors and conventional doctors, acupuncturists and anesthesiologists to advance the science-based study of integrative medicine. In 2002, Haramati and Lumpkin helped found the Consortium of Academic Health Centers for Integrative Medicine—along with leaders from 10 other institutions including Harvard, Stanford and UCSF—with a mission to advance the principles and practices of integrative healthcare within academic medical centers. “Georgetown has been a catalyst in the national study of integrative medicine,” says Haramati. “We’ve made it credible to ask the questions and have the conversation.” Over the past 15 years, the way CAM has been taught at Georgetown has evolved, but the goals have remained constant: to train students to objectively and rigorously assess the safety and efficacy of various modalities, and explain the mechanistic basis for therapies like acupuncture, massage, herbs and supplements, and mind-body interactions. “With cura personalis, the patient is at the center. How can you not look at options outside of Western medicine? You have to,” asserts Haramati, who calls himself an open-minded skeptic. “If we approach complementary medicine scientifically, there is no question we can’t ask. As my colleague articulates, ‘We should be bold in our questions, but cautious in our conclusions.’ We study what is happening and then make conclusions about why. And we need to be prepared to have our closest-held beliefs disproved.” n

T


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 18

Putting Integrative Medicine

Into Practice

T

Through both the master’s program and the medical school’s

four-year curriculum, Georgetown

alumni are graduating with a growing understanding of complementary and integrative

medicine. Some come to study

the subject with a pre-existing interest, while others discover the field during their time on campus. For many students, the

study impacts not only their years of medical school, but also how they lead their lives after Georgetown. In different ways,

Rebecca Berkson, L.Ac., Dipl.OM (MS’07) Acupuncturist, Kaplan Center for Integrative Medicine McLean, Virginia

these four alumni are integrating what was once referred to as “alternative medicine” into their post-Georgetown practice.

have always been moved by the complexity and elegance of organisms. My fascination with the human body started in a high school biology class. The summer after graduating high school, I was exposed to two things that led me down the path of integrative medicine. First was an internship with the National Institute of Mental Health (NIMH) in the Clinical Brain Disorders branch studying the neurobiology of schizophrenia. The second was an introduction to the experience of meditation, a practice that at the time was being

I

dismissed in western medicine. In one summer I came to know both the importance of research and the power meditation, and my interest was solidified at the intersection of science and alternative medicine. I studied biology at Dickinson College while continuing the practice and study of meditation, herbs and ultimately acupuncture and Chinese medicine. At Georgetown I earned a Master of Science in Physiology and Complementary and Alternative Medicine. The program bridged the gap and enabled me to study physiology together with CAM. Despite being accepting to medical school, I decided I was better suited to work on the CAM side and build bridges into conventional medicine. I chose to pursue a degree in acupuncture from Bastyr University in Seattle, because its curriculum is integrated with basic sciences and conventional medicine. The three and a half year program included over 900 hours of clinical training. After graduating in 2013, I began working at the Kaplan Center for Integrative Medicine in Virginia. Dr. Gary Kaplan is involved with the Georgetown’s CAM program. I am a Licensed Acupuncturist and a Diplomate of Acupuncture and Oriental Medicine (AOM), which is the national board certification.

SPRING/SUMMER 2015

15


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 19

I provide acupuncture, its associated techniques including moxabustion and cupping, and Chinese herbal medicine. I practice this medicine because it works. This is an exciting time to be part of the acupuncture profession because new studies are continually being published illustrating its benefits and mechanisms. Acupuncture and herbal medicine are fast becoming part of our system of medicine. The rewards of doing acupuncture and Chinese medicine are vast. I am able to offer people relief from pain and symptoms plaguing them, often ones that conventional medicine has been unable to resolve. The relief they get

Berkson’s tip: acupressure for headaches A common acupuncture point is HeGu, referred to as LI4, the fourth point on the large intestine meridian. Located on the dorsum of the hand, between the first and second metacarpal bones, it is used in combination with other points for headaches, toothaches and swelling in the eyes or face. The point can be stimulated manually to reduce pain by squeezing the webbing of the hand for 20-30 seconds. Note that due to its ability to promote labor, this point is not recommended for pregnant women.

”Tip

16

G EO RG E TOWN MEDICINE

is without the use of pharmaceuticals that often have side effects and risk for dependence. One of the biggest challenges with integrating East Asian medicine into our medical system is the terminology. Words used in acupuncture such as “qi” and “meridians” are often misinterpreted in translations, yet they are at the foundation of a system of medicine that offers a unique perspective on the human body and unequivocally has significant clinical results. As the science behind acupuncture is revealed, it is important to educate medical providers and the public on the value of retaining traditional systems and their unique perspectives, which will continue to provide insight on health and healing. There has been some progress in integrative medicine as modalities including acupuncture, naturopathic medicine, herbal medicine and meditation are becoming more accepted. The next step is to expand education to physicians regarding how each modality can benefit their patients. Only by education and collaboration will we provide the best possible healthcare. My hope is that eventually there will be no such thing as alternative, complementary or integrative medicine—it will simply be good medicine.

Steve Silvestro, M.D. (C’02, M’06) Pediatrician Rockville, Maryland

hen I played sports as a teen, my dad taught me to use visualization—something he may have picked up from studying martial arts. During my undergraduate years at Georgetown, we all took a course called The Problem of God. We explored Buddhism, Taoism, Hinduism and Confucianism, which sparked my interest in meditation, along with a campus visit by the Dalai Lama. During my first year in medical school, I joined the mind-body medicine program, which turned out to be one of my favorite medical school experiences. I participated for three out of my four years. While today I mostly practice traditional Western medicine, I regularly incorporate what I learned in the mindbody training at Georgetown, including meditation, breathing and imagery.

W


© 1993 Charles Hoberman

GM_Spring15_Layout 1 4/23/15 3:04 PM Page 20

One summer I helped on a research project about the mind-body program, compiling data evaluating Georgetown med students’ well-being. The results showed that by the end of the 11-week course, mind-body participants felt better able to handle the stresses of medical school, and their relationships with family and friends had improved. What struck me was the change in how much they cared about the struggles and well-being of fellow medical students. In a pre-course survey, most answered that they cared somewhat, but by the end of the course, almost every student answered that they cared wholeheartedly about their classmates. In med school, you can feel isolated, worrying that you should be studying more, or that others are working more. But the mind-body course offered a place for us to share experiences, and all that sharing helped us realize we were in the same boat. A sense of camaraderie and connectedness developed not only within that small group of students, but it also extended out to the rest of our class. In the mind-body program, the goal was to teach tools both for us to use with future patients and for us to use with ourselves. If we became more self-aware, balanced and healthy people, we could be more healthy, balanced, caring physicians. Similarly, in my pediatrics practice, I share mindfulness and self-awareness tools both with the kids I see, and with their parents. If parents can learn to manage all the stress of raising children and also take care of themselves, then they can take better care of their kids. I do my best to ask parents how they are doing, especially in those difficult first few months of parenting, and try to be available to offer resources or tools to help. As the kids get older, I also

Silvestro’s tip: mindfulness for kids One thing I’ve used to help kids practice mindfulness is a Hoberman’s Sphere. Available in toy stores, it looks like a little plastic star that expands into a big ball, and it’s fun to open and close. I use it as a breathing ball: the kids take a breath in as they open it, and a breath out as they close it again. The exercise may not last long, about 30 seconds or so, but it offers them a visual cue to connect to their breath.

”Tip

share mindfulness tips for handling tantrums. With kids, I use breathing, meditation and imagery to help them handle anxieties and sleep disturbances. I use it when I do procedures like taking stitches out—I have them take deep breaths or listen to calming music. For a more painful or bigger procedure, I do a short imagery with patients to get them to relax before I get started. Imagery brings all of their senses into the experience. For children with sleep issues, I commonly use a cloud imagery.

With a soothing, measured voice, I have them imagine that they are floating on a cloud, and imagine what it looks like, feels like, what color it is. I then encourage them to imagine the sun warming the body, and to imagine the body growing heavy, sinking into the soft fluffy cloud. Kids are really visual, and they can picture this image. Through the process, they are also seeing and learning that they can control the sensations in their bodies, choosing to feel that their arms and legs are heavy and warm. Ideally over time, the children recognize that they can make their bodies and minds calm down. In this instance they are using a picture to help facilitate that relaxation. To use mind-body medicine in my practice, I have to be creative with the limited time I’m given. I’ve had to come up with ways to offer the most effective and beneficial parts of a tool, simplifying methods to help parents and patients understand them in as short a time as possible. In some instances, we need an additional full visit. But in most cases, I look for alternatives to having them schedule another appointment. For example, in a regular checkup, when I’m feeling a child’s belly, I might take 15 seconds to say, with my hand on the belly, “Take a big deep breath and watch what happens to my hand.” As they see it go up and down I say, “Anytime you’re sad or upset, you can put your own hands on your belly. Then take slow, deep breaths and watch your hands go up and down.” That gives them a visual cue so they’re not thinking about the thing that made them upset. It also gets them to take slow, deep breaths, which will release the chemical mediators that foster relaxation. It’s a very simple tool, and I have worked it into their regular checkup.

SPRING/SUMMER 2015

17


strong foundation in physiology and biochemistry. Through our critical assessments of complementary medicine research, I also learned how to look at literature objectively. We looked for bias, biostats, P values and different methods to assess an article in a short amount of time.

Brian Nwannunu, M.S. (MS’11) M.D. Candidate, Howard University Medical School 2015 Washington, D.C.

’m a first-generation Nigerian American. While growing up, I learned about remedies outside of regular cough medicine from my parents. I always heard about nontraditional therapies, such as different teas for colds and headaches. I wanted to know the science behind all of it. In the CAM master’s program, we took courses in physiology, biochemistry, the history of medicine, mindbody medicine and an overview of different systems that span the globe, including unani and ayurvedic medicine. From an academic standpoint, I learned a lot from Dr. Hakima Amri’s course on various CAM modalities; we were exposed to everything that’s out there. From a personal standpoint, I found the mind-body course to be very powerful. We were taught to evaluate our own being. The mind-body practice gave me a rare sense of peace—I felt at ease. Earning my master’s with CAM at Georgetown helped me tremendously in medical school, as I came in with a

I

18

G EO RG E TOWN MEDICINE

Nwannunu’s tip: an old family remedy for the common cold To alleviate colds and associated symptoms such as a stuffy nose, headache and fever, his family makes a soup from leaves native to Nigeria: uziza, utazi and nchanwu, along with hot pepper. “Before I eat,” explains Nwannunu, “I put a towel over my head and lean over the soup pot, inhaling the steam as it starts to cool down. This herbal soup will knock out any cold any day,” he laughs.

Tip

As a student and future clinician, I try to be mindful every day, and I find that meditation helps reduce my stress level. My plan is to go into orthopedic

surgery. For my patients experiencing back pain, I will work with CAM practitioners such as acupuncturists and chiropractors in addition to offering allopathic medicine. After my own experience with a low-back injury during a workout, I went to a chiropractor for a few weeks and felt tremendously better. The biggest challenge in using CAM is, without a doubt, the lack of evidence-based medicine. In the literature that has been published, the quality is not there. Papers have a low number of subjects, or the studies are not blinded. Today we still don’t know the mechanisms of action for many of the complementary therapies. I have been surprised how unfamiliar most medical practitioners are with CAM. Some who have been working 30 or 40 years don’t know anything about herbs and other treatments that many patients are taking. With Howard University Hospital’s large immigrant community, I meet many patients who are interested in complementary medicine. People from the Caribbean as well as East and West African countries tell me about different herbs and spices they use. When they let me know what they are taking, I try to make sure their remedies will not counteract with any allopathic treatments they are receiving. My parents use herbs, so I understand where they are coming from. I took a holistic medicine and pediatrics course last summer, and people were speaking quietly about homeopathy. I find it interesting to see how many practitioners approach complementary medicine like it’s voodoo. But that is changing. As holistic medicine becomes more prevalent, more students are talking about it, and we’re being taught to be aware and accepting.

Bottom photo: © Odilon Dimier/AltoPress/Maxppp

GM_Spring15_Layout 1 4/23/15 3:04 PM Page 21


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 22

Megan Blunda, M.D. (M’11) Family Physician Seattle, Washington and Kodiak, Alaska

hile at Georgetown for medical school, I took the mind-body medicine course all four years, and found that it really personalized the med school experience for me and taught me to stay grounded through the ups and downs. It’s hard to be a doctor—all the stresses we face, the sadness we see—but the mind-body program gave us all something from the very beginning to help us be mindful and stay true to ourselves. This formative experience created the framework for how I now approach my career and daily life. The techniques of mindful breathing, loving kindness meditation and visual imagery are tools that I use for myself and my patients on a regular basis. I worked with Steve Schwartz, M.D., in the Introduction to Osteopathic Manipulative Medicine elective at Georgetown. I have carried the skills I learned in that course to my career as a family physician in Seattle. Over the last year and a half, I have been training in the art of cranial osteopathy. Through

Bottom photo: © George Dolgikh

W

work with a mentor and an intensive 40-hour course, I have learned the skills to perform basic treatments for patients with headaches, neck pain and back pain. The ability to actually make a patient’s pain better, instead of masking it with medications, is incredibly fulfilling. In medical school I was introduced to the role of herbs and supplements in sessions with Adriane Fugh-Berman, M.D. I completed the Integrative Medicine area of concentration at my residency, Swedish Cherry Hill Family Medicine, and have created a bank of resources and knowledge of herbs and

Blunda’s tip: food as medicine Fish and fish oil may help depression, eczema, heart disease and ADHD symptoms. Cinnamon lowers blood sugar. Honey has been shown to be equally effective as common over-thecounter cough medicine in decreasing the frequency of cough symptoms during a cold, and it has antiviral properties. Ginger helps treat nausea, especially in pregnancy. Gargling with a solution containing sage can help with a sore throat. Adding turmeric—an anti-inflammatory—to food can help arthritis and joint pain.

supplements that has really amplified my practice. Expanding my toolkit to include prescription medication alternatives and adjuncts for depression, menopausal symptoms and headaches, for example, has allowed me to provide higher quality and more personalized care. Administering holistic medicine is usually more time-consuming than just refilling a pain-relief prescription. I also have to consider the price, since I work with a lot of low-income folks, and many supplements are not covered by insurance. I need to know how much the remedies cost and where to get them. While my primary experience has been with the immigrant and underserved populations of Seattle, I have also worked with both the Alaskan Native population in Kodiak (I travel there every few months to practice rural medicine), and with more affluent patients in Seattle. In all of these settings, I have been met with openness and gratitude from my patients for including integrative medicine in their treatment plans. This has allowed me to connect with patients more deeply, while providing personalized, costefficient care that I can feel good about. n

Tip SPRING/SUMMER 2015

19


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 23

WHERE’S THE EVIDENCE? PROBING THE UNDERLYING MECHANISMS OF ACUPUNCTURE BY JANE VARNER MALHOTRA

O

On a recent Friday afternoon, a dozen second-year Georgetown medical school students gather for class. The guest lecturer for this pharmacology elective on traditional Chinese medicine (TCM) is physiologist, nurse anesthetist and licensed acupuncturist Ladan Eshkevari, Ph.D. The professor of nursing, pharmacology and physiology shows the students three different pulse points on each hand used in TCM to diagnose the health of specific anatomical organs. The best practitioners employ over 70 different ways to describe the subtle variations in the human pulse, she explains, as the students touch their own wrists. Is the pulse skipping, surging, floating, faint? Determining the right descriptor can be a challenge, Eshkevari adds, but the richness of the options reveals the complexity and nuance of the ancient practice. “In traditional Chinese medicine, organs are viewed by their energy function, not their anatomic function,” Eshkevari continues, showing visual maps of the body linking heart and small intestine, lung and large intestine. She explains that with holistic medicine, everything is connected, versus the

20

G EO RG E TOWN MEDICINE

Medical students in Eshkevari’s pharmacology elective get a close look at acupuncture needles.

more typical American, allopathic medical practice of dividing the body into compartments and developing specialties.

PATIENTS ON PINS AND NEEDLES Eshkevari herself began as a specialist, practicing in cardiac anesthesia. In her early career, she noticed that good medications were available for acute pain, but that patients suffering from chronic pain had fewer options. “As I

started looking at the research,” she recalls, “I found there wasn’t much out there on alternative medicine. I talked to other practitioners and they agreed. I thought maybe we could look at alternative medicine as a way to augment what we do with Western medicine.” Dating back 4000 years, traditional Chinese medicine must have some staying power, Eshkevari concluded. She decided to study acupuncture, completing a three-year certification program in


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 24

THE STUDY FOUND THAT ACUPUNCTURE HELPS BRING STRESS HORMONE LEVELS BACK DOWN TO CONTROL LEVELS.

SPRING/SUMMER 2015

21


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 25

see if anyone had studied if acupuncture impacts stress. And, believe it or not, there was nothing. No scientific basis to find out: Is this happening? Is it a phenomenon? Is it real?”

ACUPUNCTURE IN THE LAB

Ladan Eshkevari, Ph.D.

Maryland. Eventually, what she noticed with patients in her private practice would lead her to more questions—and recent discoveries—about the way acupuncture works. In her acupuncture practice in the years to follow, Eshkevari saw many patients with chronic pain. And of those whose pain was not relieved by acupuncture, many said that they still felt better after the series of treatments. They were sleeping better, or they gained an overall sense of well-being

22

G EO RG E TOWN MEDICINE

that was difficult to explain. Eshkevari wanted to understand why. “I wondered, maybe rather than affecting pain, I’m affecting stress that is caused by the pain or just general stress that makes the pain worse,” she says. “All of the symptoms acupuncture seemed to be helping were stress-related symptoms. In anesthesia we understand stress physiology because that’s the whole point of anesthesia: taking physiologic stress away during surgery. So I started going into the literature to

Eshkevari turned to rats to help her find answers. Using a successful stress model developed by a fellow researcher at Georgetown, she exposed three of four groups of animals to one hour a day in a container with a layer of ice water on the bottom. After two weeks, the rats measured high stress hormone levels that would not come down to baseline. They had chronic stress. Of the four groups of rats used in the study, a control group had neither stress nor acupuncture. The second group had stress but no acupuncture. The third had stress followed by “sham” electronic acupuncture along the tail, where there are no acupuncture points. The fourth group had stress followed by electronic acupuncture on a point just below the knee called Stomach 36. “We chose Stomach 36 because it’s a potent acupuncture point in both rats and humans,” Eshkevari says. “It’s on the stomach meridian, which handles stress.” Using electroacupuncture helped ensure that each animal was getting the same treatment dose. The researchers then measured blood hormone levels connected to the two classic stress pathways: the sympathetic nervous system, for acute stress, which secretes NPY; and the hypothalamic pituitary adrenal (HPA) axis, which is the chronic stress pathway. The study found that acupuncture helps bring stress hormone levels back down to control levels by blocking the chronic, stress-induced elevations of the HPA axis hormones and the sympathetic NPY pathway. In other words, the rats


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 26

treated with acupuncture produced lower levels of stress hormones. Eshkevari and her colleagues have since published two papers from these findings and recently submitted a third awaiting peer review. The next stage for her research will be human trials—an expensive and complicated endeavor but one she is determined to explore. “This is where I’m now stuck,” she explains. “I’m trying to get grant funding to do research on humans to see if these discoveries translate.” Eshkevari remains hopeful that, with rising interest from both the public and scientific communities, this next critical step will find support. “When people read these kinds of studies, because they’re fairly novel, the general public gets interested,” says Eshkevari. “Chronic stress, PTSD— these are very real for people, and we’re learning more and more that stress affects all our systems, shortening telomeres, and causing heart disease and GI disturbances. If we can find an alternative to drugs to help chronic stress, then I think we’re moving the needle at least a little bit.”

BUILDING A FOUNDATION OF EVIDENCE Back in the classroom, Eshkevari and her students discuss how care providers can recommend treatments like acupuncture without understanding how it works. She notes that scientists do not know the exact mechanism for how inhaled anesthetics work, but that doesn’t prevent their widespread use. The curious students raise more questions about possible methods for the human study. What about fMRI? Biomarkers? Radiotracers? Can acupuncture help with psychiatric disorders? The discussion continues as Eshkevari pulls out some needles she brought to pass around for show and tell. Several students linger after class to take a closer look, including Racheli Schoenburg (M’17), who leads the Holistic and Integrative Medicine Interest Group. Schoenburg says that learning about complementary therapies from an evidence-based perspective helps students match it up with their regular coursework. She also finds the holistic approach helpful as they gain more hospital experience.

“We learn theories in class but then in the clinical setting, the lines are a lot more blurred,” she says. “We see patients with comorbid conditions— with multiple medical issues happening at the same time—so learning about a more holistic, integrative approach makes a lot of sense because no patient is presented to you with one problem.” With more research to help practitioners better understand complementary and integrative medicine, scientists like Eshkevari are taking these holistic therapies to the next step. Creating a body of evidence to reveal the underlying mechanisms of action in the ancient practice of acupuncture offers researchers a foundation to build upon in the future, and care providers a broader set of tools to help heal their patients today. “Western, allopathic physicians and nurse practitioners want to be able to point to the evidence, and see the research published in peer-reviewed journals,” says Eshkevari. “This helps us comfortably recommend complementary medicine to our patients. Finding the evidence—I think that’s the biggest step.” n

Slides reveal reduced expression of PVN CRH protein in chronically stressed groups treated with electroacupuncture (EA) at the Stomach-36 point, from Eshkevari’s study published in the Journal of Endocrinology in April 2013. Magnification 10x.

SPRING/SUMMER 2015

23


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 27

“The best way to learn about Reiki is to actually feel it,” says Denise von Hengst.

24

G EO RG E TOWN MEDICINE


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 28

A Patient’s Experience With Energy Healing BY ELISSA ERNST For a long time Denise von Hengst had a secret she kept from friends and physicians alike. As she was undergoing treatment at Georgetown Lombardi Comprehensive Cancer Center for a particularly aggressive type of breast cancer—triple positive, HER2 positive—she was also regularly receiving Reiki, an ancient form of Japanese healing, to mitigate the debilitating anxiety and fear that accompanied her cancer diagnosis.

“At first I told no one about the Reiki,” says von Hengst. “Fear of the ‘woo-woo’ factor. People might think I’m nuts.”

Denise discovered Reiki by chance after the sudden passing of her 47-year-old brother from a massive heart attack. Among his personal items left behind, Denise found a book written by an associate of her brother’s, the contents of which focused on energy healing and alternative therapies for disease. Her own coincidental connection with the author piqued Denise’s interest and over the next three years, in addition to becoming a Reiki patient, Denise became a master practitioner and teacher.

UNDERSTANDING THE UNSEEN An ancient Japanese therapy, the origins of which can be traced back over 2,500 years, Reiki revolves around the mind-body connection. The goal of Reiki is to reduce negative emotions and energies that people experience—such as fear, anxiety and stress—in order to promote healing and wellness. At Reiki’s core is a belief that the universe and human beings are surrounded by an invisible energy field, which can become unbalanced when the negative overtakes the positive through physical or mental illness. Correcting that balance, Reiki practitioners say, allows a person’s immune system to function optimally and promotes self-healing.

SPRING/SUMMER 2015

25


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 29

The treatment, delivered during a 60- to 90-minute session, begins with the patient lying fully clothed on a surface similar to a massage table. With the goal of channeling positive energy and restoring balance, the practitioner puts his or her hands in positions hovering just above the client’s body, starting at the head and moving towards the feet.

as they do not diagnose disease nor do they aim to provide treatment in lieu of modern scientific medicine. But, she believes, integrating the therapies can provide powerful results. “Reiki used in conjunction with good, sound medicine can feel like it’s working some kind of miracle,” says von Hengst.

design, number of participants and reporting mechanisms. Results of the trials are often inconclusive. Yet as the anecdotal proof mounts and Reiki’s popularity increases, prestigious medical centers around the country are taking note and offering the treatment to patients at their facilities. Reiki can be found at hospitals and medical centers such as Boston Children’s Hospital,

THE GOAL OF REIKI IS TO REDUCE NEGATIVE EMOTIONS AND ENERGIES THAT PEOPLE EXPERIENCE—SUCH AS FEAR, ANXIETY AND STRESS— IN ORDER TO PROMOTE HEALING AND WELLNESS.

The experience of receiving Reiki —including the actual process and outcome—varies from person to person and session to session, says von Hengst. She notes that immediate results often include feeling a warm and tingling sensation, calmness or overwhelming emotion, followed by an increased sense of peace and reduction in stress and anxiety. There are also long-term physical results that Reiki proponents report. People often turn to the practice for pain management and chronic conditions such as fatigue, asthma, arthritis, nausea and insomnia. Reiki has also been reported to speed the healing process following injury or surgery, which von Hengst experienced following her breast cancer lumpectomy. Practitioners do not recommend that the therapy be used in place of traditional treatment. Von Hengst stresses that Reiki practitioners work in conjunction with medical care providers,

26

G EO RG E TOWN MEDICINE

Von Hengst is familiar with the questions and skepticism surrounding not only Reiki’s usefulness, but also its origins, its ultimate purpose and its presumed connection to a religious organization or deity. “People have said to me, ‘Hmm, that sounds like a whole lot of hocus pocus. What kind of a cult is this?’” says von Hengst. She explains that Reiki is neither a cult nor a religion. “I tell them that Reiki is totally neutral, and that the best way to learn about Reiki is just to actually feel it. And once they’ve felt that energy, then suddenly they’re no longer skeptics.”

MEDICAL COMMUNITY QUESTIONS However, skepticism remains, not only in the general population, but also within the medical field. Recently, several clinical trials have emerged attempting to prove, or disprove, the effectiveness of Reiki. Many of these studies have been criticized for the trial

Dana Farber Cancer Institute, Stanford Health Care, Memorial Sloan Kettering Cancer Center, Duke University Health System and Cleveland Clinic, to name a few. Many academic medical centers such as Georgetown incorporate complementary therapies into their teaching curricula. Von Hengst’s oncologist at Georgetown Lombardi, Paula Pohlmann, M.D., M.Sc., Ph.D., understands both the skepticism and the potential surrounding alternative therapies. She draws a clear distinction between therapies such as Reiki that do not hinder conventional treatment, and others that may jeopardize the results of traditional Western medical regimens. Those methods raising concerns for Pohlmann include some taking herbal tablets, oral solutions and IV fluids, which may not have undergone enough scientific scrutiny to prove safety and effectiveness, and may interact negatively with conventional anti-cancer treatments.


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 30

Pohlmann encourages patients to inform health care providers if they are receiving complementary therapies. “I try to show my patients that I am open-minded about this. I ask them to run any treatments by us during our treatment to ensure safety.” Sometimes they tell her directly, and sometimes they inform someone else on the team like a nurse. Pohlmann works closely with her patients to look at adjunct therapies and discuss any potential issues, giving the OK for plans that do not interfere with the standard treatment. Sometimes patients choose therapies to replace conventional medicine, she says, based on the advice of others who believe they were cured from such a treatment. “Patients may jump into these treatments without considering the facts and clinical differences between their own cases and the ones they are placing their hopes on. Understandably, a patient’s anxiety may unfortunately

make you stronger,” she says. “And people can become more beautiful for having been broken.” She finds meaning in her experiences of loss and illness that led her to Reiki, and she feels that those negative experiences had an ultimate purpose: to learn, to grow and to heal, both physically and emotionally. Her most surprising and beneficial health outcome from the ancient therapy occurred during Reiki treatment she received prior to her cancer diagnosis. After watching a dear friend lose her battle with ovarian cancer, von Hengst found grief to be her constant companion. At the time, she wasn’t consciously aware of the internal battle she was waging as she struggled with the loss. “All I knew was that I was a hot mess,” she remembers. She sought out the healing method that she did not fully understand for a

Von Hengst and other Reiki proponents view the energy therapy as a tool in the arsenal to combat the invisible, emotional toll taken on the hearts and minds of those facing an overwhelming diagnosis such as cancer. “All you hear is that it’s cancer and that it’s aggressive,” she explains. She envisions providing Reiki to patients throughout their cancer journey, but especially just prior to surgical procedures. “Reiki helps people find calm and peace in the storm going on in their heads and brings relaxation that is so beneficial.” Ultimately, von Hengst understands the skepticism and the confusion surrounding this practice she has found to be immensely valuable. “Some things in life are really hard to explain and comprehend,” she says. “Sometimes we have to believe in things that we can’t see and don’t understand.” But she considers herself privileged to have discovered Reiki, and she is ready to

DR. POHLMANN ENCOURAGES PATIENTS TO INFORM HEALTH CARE PROVIDERS IF THEY ARE RECEIVING COMPLEMENTARY THERAPIES.

cause some degree of functional blindness,” says Pohlmann. “That being said, I am very supportive of any treatment that won’t negatively interfere with conventional therapy. Reiki is a great example.”

CALM IN THE CANCER STORM Although von Hengst does not attribute Reiki to any specific religion or higher power, she does believe the human experience that necessitates it can be part of a higher purpose. “Everything that happens will either kill you or

problem that she could not quite define. As the Reiki session proceeded, her practitioner’s hand hovered above Denise’s heart, and the tears began to flow. The practitioner’s instructions were simple: “Let it go.” She describes feeling as if something were physically being pulled from her body during that session, and then almost immediately feeling that the sadness was no longer ruling her life.

spread the word regarding its usefulness. “I’m not here to try to convince someone of the power of Reiki—I can’t do that. I can only speak for myself, and I found it to be very real.” n Elissa Ernst is the director of development for Georgetown Lombardi Comprehensive Cancer Center. For six years she has worked to raise philanthropic support for Georgetown Lombardi scientists and physicians, who are dedicated to improving cancer outcomes through research. She can be reached at es349@georgetown.edu.

SPRING/SUMMER 2015

27


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 31

ON CAMPUS

Match Day 2015 On March 20, nearly 200 fourth-year Georgetown medical students donning class t-shirts gathered in a steamy auditorium for the annual Match Day ritual. Surrounded by excited family, friends and faculty, the young men and women awaited the magical noon hour to rip open envelopes, revealing the location of their residency programs. “The ‘match’ is a critical day in the lives of these young men and women,” explained Stephen Ray Mitchell, M.D., dean for medical education at the School of Medicine. Claire Thesing (M’15) described her Match moment in one word: “Surreal!” She was excited and grateful to learn that she will be heading to her first choice, the program in family medicine at Thomas Jefferson University in Philadelphia. Once her residency is

complete, she will practice medicine in an underserved community as part of the National Health Service Corps. The federal program connects primary health care providers to areas of the United States with limited access to care, in exchange for financial and other support. “My National Health Service Corps commitment helped form my decision to pursue family medicine, as I felt this field would best prepare me to provide quality, comprehensive care to the greatest variety of patient needs,” Thesing said. Like many who pursue medicine, Thesing wants to make a positive, personal impact on the lives of others. During college, she interned with a pediatrician and in a public health foundation in her home state of New Hampshire, which further bolstered

her interests in medicine. Her awareness of and appreciation for primary care also came from her physician father, who practices and teaches in a Dartmouthaffiliated family medicine residency program. Reaching those with greatest need formed the basis of her calling to primary care. “My experiences working with refugees from Iraq, Bhutan and the Congo who have relocated to New Hampshire are what made clear to me that I not only want to be a doctor, I want to be in a position to provide vital, lifelong care to all people, especially underserved populations. Primary care embodies these ideals.” Reflecting on her medical studies at Georgetown, Thesing recalled inspiring ideas from her early courses. “The lectures explaining how patient care requires an understanding of the

“I want to be in a position to provide vital, lifelong care to all people, especially underserved populations. Primary care embodies these ideals.” — Claire Thesing (M’15)

28

G EO RG E TOWN MEDICINE


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 32

patient’s social background in addition to the medical history were compelling to me,” she says. During Thesing’s influential third-year family medicine clerkship, she observed relationships between physicians and families that included an understanding of the patients’ social and family life, in addition to their health conditions.

“I also had the opportunity to attend national family medicine conferences where I heard the same themes that were so important to me—care for the whole patient in the setting of their unique, personal life circumstances, and being there as a resource and anchor for them in whatever variety of health issues they may encounter,”

Thesing said. “All of these interactions confirmed that family medicine is the field for me.” Her faculty advisor, Vincent WinklerPrins, M.D., a family medicine physician, describes Thesing as one of the finest students he has worked with. “She has fully incorporated cura personalis into her DNA.” n

SPRING/SUMMER 2015

29


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 33

ON CAMPUS

Second Interprofessional Education Day Spotlights Health Disparities In January, Georgetown University Medical Center convened students from across the health care disciplines for the second annual day devoted to fostering interprofessional education and teambuilding. Nearly 350 students, including nursing and health care administration students from the School of Nursing & Health Studies (NHS), third-year medical students from Georgetown’s School of Medicine and pharmacy students from Howard University attended the daylong interdisciplinary workshop focusing on health disparities. Support for the event was provided by a gift from Thomas R. McGee, Jr. (C’81) and his wife Jill McGee, parents of a current nursing student at NHS, through a fund to promote student engagement in health disparities and communitybased work. The program included case

30

G EO RG E TOWN MEDICINE

studies on diabetes and asthma, two conditions that represent the potential impact of improved access to care. Shyrl Sistrunk, M.D., associate professor of medicine and senior associate dean for curriculum and assessment, co-led the event with Bernard Horak, Ph.D., FACHE, CPHQ, professor and director of the health systems administration master’s program at NHS. Organizers encouraged students to communicate with colleagues from other health care professions early on so that it becomes routine. Effective communication and teamwork help contribute to a culture of safety, impacting health care for underserved populations. “We have so many people in disparate parts of the country—and certainly in this city—who have major difficulties

(above) Interim NHS Dean Patricia Cloonan, Ph.D., R.N., was a member of the faculty planning committee for the day. (below) Megan Chochol (M’16) leads a small-group discussion on professional bias.

accessing the health care system,” says Sistrunk. “We have to develop better ways to take care of them.” Horak highlighted the importance of students learning together in order to work better together in the complex health delivery systems of today. Students discussed common misconceptions and biases; for example, doctors are seen as “detached,” nurses are “compassionate but not evidencebased,” administrators are “solely focused on finances,” pharmacists are “pill counters.” By airing and discussing these biases, students worked to open communication channels and debunk stereotypes. “Unfortunately, sometimes creating a culture of open exchange is challenging due to many factors: time, multi-layered responsibilities and more. However, conferences such as IPE help to shift the culture of health care in the right direction,” says Olayemi Okunseinde (M’16). “We must focus on the patients and their needs, but if we are to move modern health care forward, the collaboration between pharmacist, nurse, administrator, physician and so many more must be formally linked, recognized and nurtured.” n


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 34

A Global Perspective Shaped by Cura Personalis Daliha Aqbal (M’17) Georgetown has been an integral part of my life as a triple Hoya over the past 10 years. I have had the privilege to shape my thinking and beliefs through the classes I have taken and the people I have met. Living up to the ideal of cura personalis, Georgetown cares for my whole person—my educational, mental, social, ethical and moral, professional and personal upbringing. The care Georgetown has shown me inspires me to serve others and continue to embrace cura personalis as a future physician. As a first-generation American from Afghanistan, one of my passions in life is to address women’s rights issues, especially with respect to health, education and equality. I hope to work as a physician in international health and development. I was inspired to pursue my medical degree when I was in Afghanistan as an undergraduate, researching mental health issues. At a women’s clinic there, I met a mother of three who was about my age. She was seeking shelter from an abusive husband, and her eyes were filled with fear, strength and pain. She openly shared her emotions and experiences with me, perhaps because we were similar in age. I realized how much I wanted to support women like her and how lucky I was to live without fear. I had the freedom to be my own person, set my own standards and boundaries, and pursue my education.

This led me to a job with the United States Agency for International Development (USAID) after college. While working as a biomedical program analyst and technical advisor to their multi-million dollar HIV/AIDS prevention programs, I had a unique opportunity to travel to Phase III clinical trial sites in Africa. There we tested new women-initiated technologies to prevent heterosexual HIV transmission. I provided technical and managerial support to the team to ensure that the microbicide programs were managed efficiently. The opportunity to meet women in the USAID program made me realize that I wanted to see my work impact patients directly. I knew that a medical degree would allow me to be in the field with people—performing clinical trials, working with patients and making recommendations on public health issues. During this time, Georgetown continued to influence my work: I obtained a master’s in biomedical science policy and advocacy. This allowed me to unite my experiences in public health and medicine with policy and advocacy—two fields that are intimately connected when implementing changes to the health system in America. Today as a medical student, these experiences define how I see my future

STUDENT VOICE Introducing our new regular columnist, Daliha Aqbal (NHS’08, MS’12, M’17). Your intrepid editor spotted her across the aisle at a back-to-class event during Medical Reunion 2014. The keen second-year student had both an iPad and a laptop computer on her desk to make full use of all the tech options offered in the modern classroom. She recently went retro-tech, however, returning to old-school pen and paper for a change. Georgetown Medicine is grateful for this busy, thoughtful student’s current and future contributions to the magazine. –JVM

as a physician. I want to stand up for justice and equality and be an advocate for vulnerable populations. As I complete my medical school education, I can only imagine the fulfilling experiences I will continue to have at Georgetown, and I cannot wait to see what life has in store for me. What I do know is that cura personalis is a principle I will continue to uphold throughout my life. n

SPRING/SUMMER 2015

31


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 35

ALUMNI CONNECTIONS

To Your Health! Dine With a Doc program offers food and fellowship for alumni and students By Kate Corboy

In 2004, the newly formed Medical Student Alumni Ambassadors (MSAA) launched an alumni-student dinner series, which became known as Dine With a Doc. The popular student-run program, now in its eleventh year, brings current medical students together for casual dinners hosted by alumni. Dine With a Doc supports the goal of MSAA, promoting professional and personal relationships between current medical students and Georgetown School of Medicine alumni. Every year the program engages over 100 students and 25 medical alumni representing a variety of specialties, career paths and graduation years. It is not uncommon for medical alumni couples or classmates and friends to host dinners together. Additionally, the reach of the program extends far beyond the walls of the School of Medicine, with a number of past residents and fellows of the MedStar Georgetown University Hospital and even alumni who live outside of the Washington, D.C. area hosting dinners. Although Georgetown Medical Alumni Board chair Tim Duffin, M.D. (M’88, R’90), resides in Clarksville, Tennessee, he has been hosting Dine With a Doc dinners for the past eight years. “Before I began participating, I would hear how much fun the local doctors would have by hosting students, and I felt like I was missing out on something unique,” he says. Realizing that he didn’t need a house in the area

32

G EO RG E TOWN MEDICINE

to have a meaningful dinner experience, Duffin joined the fun in 2007, hosting a dinner at Morton’s each year he is in town. At the dinners, students have candid discussions with alumni about their career paths, specialties and work-life balance, among other topics. Long-time participants Jacqueline Wieneke, M.D. (C’85, M’90, R’97), and her husband, Kerry DeGroot, M.D. (M’92), value the chance to offer students practical insight into what life as a physician could look like in the years to come. “There is a

great sense of satisfaction in providing students with a forum to ask these types of professional and personal questions,” says Wieneke. As for alumni, the dinners offer not only an opportunity to share advice, but also a unique occasion to show current medical students how much the alumni family at Georgetown cares about them and wants them to succeed. “The students are so grateful, appreciative and enthusiastic,” says Nancy Ripp Clark, M.D. (C’77, M’81). “As a host, it makes me happy to provide a venue

Gathered at Morton’s in Georgetown are, from left to right, Robert Williams (C’17), Tim Duffin, M.D. (M’88, R’90), Vivian Yu (M’17), Kenny Softness (MS’13, M’17) and Sarah Venditti (M’18).

“As an alumna of the School of Medicine, it is rewarding to see the students so hopeful and optimistic about the future of medicine. It makes me feel proud to be a physician and graduate of Georgetown.” — Daphne Keshishian, M.D. (M’93)


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 36

Nancy Ripp Clark, M.D. (C’77, M’81), hosts students at her home in January. Ripp Clark is pictured with students and co-host Daphne Keshishian, M.D. (M’93).

where students can unwind from their day-to-day stresses and enjoy a homecooked meal.” Ripp Clark adds that not only do the students learn from alumni, but the alumni learn from students as well. “Having once been in their shoes,” she says, “I am able to put a long-term process into perspective for the students. At the same time, I am always interested to learn how the school and the curriculum has evolved and improved since I graduated.” Each year MSAA elects a student leader to champion the efforts of the program. Vivian Yu (M’17), the current Dine With a Doc chair, serves as the matchmaker and direct line of connection between alumni and student participants in the program. “Helping to foster a community between students and alumni has been very rewarding,” she says. “There is a significant amount of pride in the Georgetown traditions. Alumni feel a commitment to give back and mentor students in hopes that current students will someday do the same. It can be easy for students to lose perspective on the future when academia can be so challenging. They appreciate the encouragement from alumni.”

“There is a significant amount of pride in the Georgetown traditions. Alumni feel a commitment to give back and mentor students in hopes that current students will someday do the same.” — Vivian Yu (M’17) First year medical student and MSAA member Daniel Otterson (M’18) shares that sentiment. “The Georgetown alumni I met were so excited to tell us about our potential future in medicine and how to get the most out of medical school. My experience at the dinner made me realize how approachable and friendly the alumni base of Georgetown School of Medicine is.”

Many connections made through Dine With a Doc develop into important mentoring relationships that last beyond the students’ time in medical school. Not only are alumni sharing real-life experiences from their time as students and now as physicians, they are providing a window into the future to help students carve their own paths in medicine. n

If you are interested in hosting a dinner, please contact Kate Corboy, coordinator, GUMC Engagement & Annual Giving, at (202) 687-6673 or gumcengagement@georgetown.edu.

SPRING/SUMMER 2015

33


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 37

ALUMNI CONNECTIONS

A lifelong mission of healing Sister Fernande Pelletier, MMS, M.D. (M’59)

W

hen she stepped onto the Georgetown campus in 1954, Sister Fernande Pelletier joined just a handful of other women enrolled in the School of Medicine. Although originally interested in nursing, she was encouraged by her order, the Medical Mission Sisters, to help fill a growing need for female doctors. “Our mission is to be a healing presence,” explains Pelletier, a native of Maine who joined the order when she finished high school. “In those days, some of the sisters were beginning to be educated in medicine. In many parts of the world there were very few women doctors or doctors taking care of women. At that time in India, for example, women could not be seen by men doctors.” In her Georgetown medical school class of 1959, there were just seven women out of a total of 96 students. As a woman in a predominantly male environment, Pelletier did not find any special difficulties except those of every medical student. “The studies were hard,” she says. “You have to learn so much in time for the exams. We put in long hours on call at night—those were part of our training. Most of us accepted it. I accepted it, anyway. I kind of enjoyed it, actually,” she admits, laughing.

34

G EO RG E TOWN MEDICINE


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 38

Her fellow medical school students deeply valued and respected her and the path she had chosen to serve the world’s neediest. “I was very much supported by my classmates, and by the professors and doctors who trained us,” she recalls. “They knew that I wouldn’t stay in the states to practice medicine, but that I would be going out to what we call the mission fields.” After graduating from Georgetown, she did her internship at St. Francis Hospital in Trenton, New Jersey, along with a surgical residency. In 1961, the Medical Mission Sisters sent her to Berekum, a small town in Ghana, where she joined one other physician at the small but busy Holy Family Hospital. “That was my first mission,” says Pelletier. “And I’m still there!” When she arrived, she met with a teacher every afternoon to learn Twi, the local dialect, to help her communicate with both patients and other medical personnel. She quickly learned the vocabulary essential to health care.

doctors are Ghanaian, including Pelletier who became a naturalized citizen. While the infrastructure in Berekum and throughout Ghana has improved substantially since she arrived over 50 years ago, the community still faces the challenge of a shortage of good facilities and trained health workers. “If you come to our hospital on a Monday morning,” she says, “You see crowds of people going to the outpatient area. We triage them, treating the ones that will be outpatients and admitting the ones that need it. But the large number of patients compared to the small number of medical personnel is a big challenge. “We don’t have all the facilities that you have in the states,” she adds. “We have many times when we would like to do some tests but they aren’t available. So we try our best to diagnose it ourselves, or we send them on to a larger facility in another city, but the larger place also has a huge amount of patients.”

“What I learned at Georgetown formed the basis for my life as a doctor in the mission field. We were really well-trained. We were taught integrity, and putting the patients first.” In her early years in Berekum, if somebody needed an operation, they had to travel 100 miles down the road. For many years there were no Ghanaian doctors in the hospital. Today the hospital has grown to 200 beds, with a surgical specialist on staff, and a total of four doctors plus four graduates in the internship residency program. All the

Another challenge can be the use of indigenous treatments among the patient population, says Pelletier. “They take their own traditional medication, like leaves, which is alright,” she notes, “except if it’s a treatable disease that doesn’t respond to the herbal medicines, which is the case for many chronic diseases like diabetes and hypertension.”

In some cases, she sees patients who take herbal remedies and as a result, delay an inevitable hospital treatment, which can cause the disease to become worse. But overall, she finds the population to be patient and appreciative of the care they receive at the hospital. Pelletier sees a range of ailments, including malaria, TB, HIV and some cancers. While the cases may be complex, the most rewarding part of her

work is simple: “Treating the patients,” she says. “Diagnosing and giving the proper treatment, and then seeing them get well—that is the great joy, of course.” In honor of her lifetime of service to the sick and the poor, Pelletier received a Papal Award from the Apostolic Nuncio to Ghana in 2007. She looks back on her life-changing Georgetown medical education with gratitude. “What I learned at Georgetown formed the basis for my life as a doctor in the mission field,” says Pelletier. “We were really well-trained.

SPRING/SUMMER 2015

35


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 39

ALUMNI CONNECTIONS

We were taught integrity, and putting the patients first. We were taught to make sure people get well, and that we see it through.” Every five years, Pelletier returns to the U.S. to visit family and friends, and without fail she times her trips to coincide with her Georgetown med reunions. She remains close with many of her classmates, who have continued to support her mission over the past five and a half decades. They also pay for her reunion attendance. “She’s our Mother Theresa,” says classmate and devoted friend Joe Riggs, M.D. (C’55, M’59). “She’s the most humble, kind, giving person—just a beautiful person. God loves her so much.” “She’s been in Ghana for 55 years and she works very hard,” he says. “For example, she’s retired now which means she only works from 7 a.m. until 2 p.m. She doesn’t deliver babies anymore or perform surgery. But she takes care of patients in the TB ward.”

When asked if nuns retire, Pelletier laughs lightly. “Yes and no. Yes in the sense that if they are teachers, nurses, or so on, they do retire from their profession, but then they do something else, such as a lot of volunteer work. So no, they don’t really retire. They contribute something to the field that they were in, or they do something else,” she explains. “I’m supposed to be retired, but I volunteer at the hospital. “Honestly, I haven’t heard of a nun retiring,” she says with a smile. For the sister who survived—and thrived—in the mostly-male medical school of the 1950s, Pelletier has earned her Ghanaian name. “The Ghanaians call me ‘Afia Afrah,’” she says. “Afia means Friday, the weekday I was born, and because my parents had seven children and I was the only girl, they call me Afrah, which means I’m mixed up with boys,” she says, laughing. n

Longtime friends from the Class of 1959, Riggs and Pelletier enjoy being back in the classroom together at their 55th reunion in 2014.

36

G EO RG E TOWN MEDICINE


GM_Spring15_Layout 1 4/30/15 2:39 PM Page 40

s av e t h e d a t e

Medical Reunion Weekend October 22 - 25, 2015 georgetown university medical center medreunion.georgetown.edu

SPRING/SUMMER 2015

37


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 41

ALUMNI CONNECTIONS

Alumni Among “30 Under 30” for Health Care Earlier this year, two Georgetown University graduates, David Fajgenbaum, M.D., M.Sc. (NHS’07), and Eric Oermann, M.D. (C’07, M’13), were named to the Forbes “30 Under 30” list in the health care category. Fajgenbaum received his bachelor of science degree in human science at the School of Nursing & Health Studies, and Oermann received his bachelor of

David Fajgenbaum, M.D., M.Sc. (NHS’07)

38

G EO RG E TOWN MEDICINE

science degree in mathematics and his medical degree at Georgetown. Both made Forbes’ list of health care entrepreneurs, which is one of 20 categories with each featuring 30 standout achievers under 30 years old. The Forbes article states, “The 30 Under 30 in Healthcare focuses on a long list of founders, along with a few economists, policy wonks and

researchers, who are finally dragging our medical system kicking and screaming into the digital age.” “I join my colleagues Patricia Cloonan, Ph.D., R.N., interim dean of the School of Nursing & Health Studies, and Ray Mitchell, M.D., MBA, dean for medical education at the School of Medicine, in congratulating both of these graduates on this impressive accomplishment early on in their careers,” says Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences and executive dean of the School of Medicine at Georgetown University Medical Center.


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 42

UNRAVELING A RARE DISEASE Fajgenbaum is an adjunct assistant professor at the University of Pennsylvania, where he also is completing his MBA at Wharton. He was recognized for his work to cofound the Castleman Disease Collaborative Network. Forbes writes, “Fajgenbaum developed multicentric Castleman disease, a rare disorder of the lymph nodes, during medical school. When chemo failed, he had his last rites read to him. He survived, returned to med school, and published research that changed the way doctors think of the biology of the disease.” Fajgenbaum says the recognition is “truly a testament to the hard work of dozens of people from around the world fighting to solve this disease, and the first-of-its-kind approach that we’re taking to accelerate research.” Fajgenbaum embraced the Georgetown ethic of men and women for others while still an undergraduate. He founded a nonprofit called National Students of AMF, a dual acronym for his mother, Anne Marie Fajgenbaum, as well as “Ailing Mothers and Fathers.” Fajgenbaum’s mother passed away in 2004 from a brain tumor not long after he started at Georgetown. His undergraduate experience at Georgetown taught him the “importance of dedicating one’s life to helping others,” and “gave me the tools and skills that I’ve needed to be able to change the paradigm for multicentric Castleman disease and build a new model for advancing research for other diseases.”

PERSONALIZING THE PROGNOSIS Oermann is a resident physician at Mount Sinai Hospital in New York City. His Forbes citation notes, “Right now, generally speaking, lots of cancer

Eric Oermann, M.D. (C’07, M’13)

determine individualized therapies for patients with Stage IV cancer. He and his collaborators are using advanced mathematics to look at the crucial question of how long one has to live. Among his major influences, Oermann cites having spent six months studying the ethical dimensions of health care under the late Edmund Pellegrino, M.D., founding director of the Center for Clinical Bioethics at GUMC. “Having the chance to interact with him has colored how I approach my clinical work. Medicine was a vocation for him—if you are going into medicine it’s not just something you

“I join my colleagues Patricia Cloonan, Ph.D., R.N., interim dean of the School of Nursing & Health Studies, and Ray Mitchell, M.D., MBA, dean for medical education at the School of Medicine, in congratulating both of these graduates on this impressive accomplishment early on in their careers.” — Howard J. Federoff, M.D., Ph.D. patients get the same amount of radiation. What if an artificial intelligence could personalize this dose, making it more likely there’d be enough to kill the cancer but not too much? That’s one of the problems Oermann, a physician and mathematician, is working on.” At Georgetown, Oermann focused on developing techniques to predict individual patient survival and to

can do as your day job,” Oermann says. He hopes his future will continue to meld mathematics and medicine in the form of “personalized prognostics driven by modern computing,” he explains. “It’s about taking all these fancy computer science techniques and health care data to deliver results that are meaningful to patients.” n

SPRING/SUMMER 2015

39


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 43

ALUMNI CONNECTIONS

Class Notes

1950s Michael Caruso, M.D. (M’56), of Wheeling, W.Va., passed away in his home in October 2014. He is survived by his seven children and 21 grandchildren. Psychiatrist Marcella Pecora O’Neill (M’56, R’72), who had a private practice in Washington, D.C., from 1978 until her retirement in 1998, passed away peacefully at her home in Bethesda, Md., on July 9, 2014. Francis R. Perri (M’53), of Mt. Lebanon, Pa., passed away in January after a long battle with cancer. An avid fly fisherman and dedicated surgeon, Dr. Perri is survived by his wife Prudence, 11 children, 24 grandchildren and two great-grandchildren. He was preceded in death by a son, Robert. Seven of his children pursued careers in the medical field. The children of Richard B. Perry, M.D., MACP (C’51, M’55, W’62), would like to share our admiration, love and respect for our father who was recently awarded the Chapter Centennial Legacy Award by the American College of Physicians District of Columbia Chapter. This award celebrates the ACP’s Centennial by recognizing one seminal member in the first 100 years of the chapter’s existence whose service had a significant impact on the chapter’s viability. “This individual should exemplify the American College of Physician’s core values including leadership, excellence, respect, compassion, professionalism and responsibility.” Leon G. Smith, M.D. (M’56), was recently named by the New Jersey Health Care Quality Institute as the first recipient of a new award created in his honor: the Leon G. Smith Lifetime of Public Service Award.

40

G EO RG E TOWN MEDICINE

1970s

1990s

Raoul Wientzen, M.D. (C’68, M’72), was recently honored as a recipient of the McLaughlin-Esstman-Stearns First Novel Prize by The Writer’s Center. His first novel, The Assembler of Parts, was a dual Kirkus selection as one of the Best Books and Best First Fiction of 2013, and a semifinalist for the Cabell First Novel Award.

James St. Louis, M.D. (M’92), Surgical Director of Cardiac Transplantation at Children’s Mercy in Kansas City, Mo., has been named the Joseph Boon Gregg/ Missouri Endowed Chair in Cardiac Surgery. Dr. St. Louis is looking at ways to improve clinical outcomes for patients who have had heart transplantation and ventricular assist devices. On February 13, 2015, Dr. St. Louis and his team successfully performed the first pediatric heart transplant at Children’s Mercy on a 15-year-old patient with cardiomyopathy. Less than a week later, the team placed the hospital’s first ventricular assist device (VAD), a mechanical pump used to support heart function and blood flow, in an ailing toddler.

1980s Craig Czarsty (C’75, M’80), President of Health Horizons International, announced that HHI has received a grant from the World Diabetes Foundation. Partnering with the Ministry of Public Health of the Dominican Republic, HHI is beginning a two year project to educate local physicians about the care of diabetic patients and to educate local health promoters in identifying people at risk of developing diabetes. William Durkin, M.D., MBA (C’75, M’80, R’81), was featured as a lecturer at the June 2014 ICEM meeting held in Hong Kong. His topic was “Using LEAN Concepts in the Emergency Department.” Dr. Durkin is the immediate past president of the American Academy of Emergency Medicine. He and his wife, Patricia, reside in Alexandria, Va. Kevin G. Seaman, M.D., FACEP (C’80, M’84), was appointed head of Maryland’s Emergency Medical Services System in October 2014 following nineteen years of service as medical director of the Howard County Department of Fire and Rescue Services.

Matthew Cooper, M.D. (M’94), of Columbia, Md., has been named to the National Kidney Foundation (NKF) Board of Directors. Cooper is professor of surgery at Georgetown School of Medicine and the director of kidney and pancreas transplantation at the MedStar Georgetown Transplant Institute, which operates centers at both MedStar Georgetown University Hospital and MedStar Washington Hospital Center. He also serves on the Board of the United Network of Organ Sharing (UNOS). Dr. Cooper has participated in previous NKF transplant and public policy initiatives and seeks to address the national organ shortage through new NKF programming.

For more class notes and to submit news of your own, visit alumni.georgetown.edu.


GM_Spring15_Layout 1 4/23/15 3:05 PM Page 44


GM_Spring15_Layout 1 4/23/15 3:04 PM Page 1

NON-PROFIT ORG. US POSTAGE Georgetown University Office of Advancement Communications University Box 571253 Washington, DC 20057-1253

PAID PERMIT NO. 3901 WASHINGTON, DC

REAR VIEW

LOMBARDI HOSTS WEGMAN PHOTOS Jack enjoys the art exhibit of famed photographer William Wegman, who visited Georgetown Lombardi Comprehensive Cancer Center earlier this year. The artist and author shared his work with young patients and members of the community through the Georgetown Lombardi Arts and Humanities program.

Profile for Georgetown University Advancement

Georgetown Medicine Spring/Summer 2015  

Georgetown Medicine Spring/Summer 2015