GM_Cov_Fall14_FINAL_GM Cover 10/14/14 12:03 PM Page 1
A PUBLICATION Medical Alumni Affairs Office of Advancement University Box 571253 Washington, DC 20057-1253
NON-PROFIT ORG. US POSTAGE PAID PERMIT NO. 3901 WASHINGTON, DC
GEORGETOWN UNIVERSITY SCHOOL
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In This Issue n
Center for Cell Reprogramming: Redefining Personalized Medicine New Blood Test Predicts Alzheimer’s and Mild Dementia
Fr om t h e EV P
Dear Friends, Welcome to the latest issue of Georgetown Medicine. It is an exciting time for research at Georgetown University Medical Center. Earlier this year, a blood test that can predict with 90 percent accuracy if a healthy person will develop mild cognitive impairment or Alzheimer’s disease was discovered and validated by researchers at Georgetown and six other institutions. This novel study brings with it the possibility of developing earlier treatment options for patients with this devastating disease. There are plans to design a clinical trial to identify people at high risk for Alzheimer’s to test a therapeutic agent that might delay or prevent the emergence of the disease. With so many patients and caretakers affected by Alzheimer’s and with no current treatments or cures available, this holds enormous promise and we are excited about its potential to improve lives.
Howard J. Federoff, M.D., Ph.D.
In our cover story, we learn that researchers across GUMC are also working on discovering new uses for drugs already approved for safety and efficacy by the FDA. Nilotinib, originally designed to treat leukemia, has been found to halt toxic brain proteins linked to Parkinson’s disease. The senior investigator of the study is planning a clinical trial in humans to study the effects of the drug that could provide a novel strategy to treating neurodegenerative diseases. Along these same lines, we are using a computer model that compares the structures of drugs with information on the structures of proteins to find the best fits between the two and hopefully uncover even more indications for FDA-approved treatment options. Our diverse student population is doing great things as well. In this issue’s student profile, we meet Sister Grace Miriam Usala—a nun enrolled in Georgetown’s unique M.D./M.S. program in systems medicine who hopes to use her degree as a platform for improving lives through more precise diagnoses. I hope to see you all back on campus for Reunion Weekend 2014. As always, I invite you to visit medreunion.georgetown.edu for updates and weekend highlights.
Howard J. Federoff, M.D., Ph.D. Executive Vice President for Health Sciences Executive Dean, School of Medicine
Editor Andrea Sumner
Executive Vice President for Health Sciences Howard J. Federoff, M.D., Ph.D.
Design Director Robin Lazarus-Berlin, Lazarus Design
Dean for Medical Education Stephen Ray Mitchell, M.D., MACP, FAAP (W’86)
Contributing Writers Patrice North Ashley Regenovich Sarah Reik Renee Twombly Lauren Wolkoff University Photographer Phil Humnicky Printing ColorCraft of Virginia
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Fr om t h e D e a n
Greetings, I hope you all enjoyed your summer and were able to spend some time with loved ones. Fall is always an exciting time of year—a new academic year begins, bringing with it feelings of anticipation and excitement for what lies ahead. In the pages that follow, we give you a peek inside the lives of some of our current students and recent graduates—from art shows and triathlons, to supporting childhood cancer and earning competitive fellowships—our students continue to do amazing things and serve as men and women for others. This issue also dives deeper into some of our most recent and promising research being conducted at Georgetown University Medical Center. In the lab of Richard Schlegel, M.D., Ph.D., we learn about the work of the newly created Center for Cell Reprogramming. The center was designed to promote research and education of a discovery involving stemlike cells that hold great potential for personalized medicine. Since its creation, it has already has drawn scientists from around the world who are interested in learning a procedure known as the “Georgetown Method,” because of its establishment by our university researchers.
Stephen Ray Mitchell, M.D., MBA, MACP, FAAP, FACR
We also speak with a group of Georgetown physicians and scientists who are working to uncover new uses for drugs already on the market. One such researcher, Charbel “Charlie” Mousssa, M.B., Ph.D. discovered that nilotinib—a drug used to treat leukemia and other blood cancers—may be able to help patients with Parkinson’s disease as well. This work has the potential to have a profound effect on patient care and I invite you to read more about the work being conducted here. I’m hoping to see all of you at Medical Reunion Weekend, October 26-28. It’s always a great time to catch up with old friends and rekindle those old friendships we made here. I invite you to visit medreunion.georgetown.edu to see the full program of speakers, events and class parties.
Stephen Ray Mitchell, M.D., MBA, MACP, FAAP, FACR Dean for Medical Education
Georgetown Medicine is published once a year for alumni of the School of Medicine. Please address all correspondence and address changes to: Editor, Georgetown Medicine, Office of Advancement, P.O. Box 571253, Washington, DC 20057-1253. Georgetown University does not discriminate in its programs, activities or employment practices on the basis of race, color, national origin, sex, sexual orientation, religion, age or disability. The university’s compliance program under these statutes and regulations is supervised by Rosemary Kilkenny, vice president for institutional diversity and equity. She may be reached in Room G-10, Darnall Hall, or at (202) 687-4798.
For the most up-to-date information about events, what’s happening at Georgetown, and what’s new with alumni, go to Georgetown Alumni Online, Georgetown’s online alumni community, at alumni.georgetown.edu
© 2014 Georgetown University Medical Center All rights reserved.
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Above: Medical students and alumni in the W. Proctor Harvey Clinical Teaching Amphitheater listen to heart sounds from the state-of-the-art â€œsmart seatsâ€? as Stephen Ray Mitchell, M.D., dean for medical education, presents a young patient. Right: A look inside the most recent renovation of Dahlgren Chapel. On April 12, 2014, Georgetown celebrated here with a Mass of Thanksgiving at the celebration of Palm Sunday.
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Top Left: Oscar-winning actor and House of Cards star Kevin Spacey donned Georgetown attire to sit down with Ron Klain (C’83), a Georgetown faculty member and former White House politico, to discuss ethics, politics and power. Top Right: Irma Frank, DDS, senior associate dean for international programs, is recognized for her work and dedication to Georgetown’s Office of International Programs in the School of Medicine. The program began 20 years ago and sponsors electives abroad for fourth-year medical students, as well as summer opportunities for rising second-year students. Above: A team of 57 volunteers, patients and survivors representing Georgetown Lombardi Comprehensive Cancer Center’s Capital Breast Care Center at the two-day, 39.3-mile Avon Walk for Breast Cancer celebrated their achievement on the National Mall. Months of training and fundraising leading up to the May event where the group was announced as top fundraising team in the Washington region.
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New Blood Test Can Predict Alzheimer’s, Mild Dementia A blood test that can predict with 90 percent accuracy if a healthy person will develop mild cognitive impairment (MCI) or Alzheimer’s disease within three years has been discovered and validated by researchers at Georgetown and six other institutions. The study team explains in Nature Medicine how they discovered and then validated a set of 10 lipid biomarkers in the blood that predict both conditions. The discovery heralds the possible development of earlier treatment options for Alzheimer’s, when therapy could be more effective at slowing or even preventing onset of the disease.
‘Window of Opportunity’ “Our novel blood test offers the potential to identify people at risk for progressive cognitive decline and can change how patients, their families and treating physicians plan for and manage the disorder,” said Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences at Georgetown University Medical Center and the study’s corresponding author. There is no cure or effective treatment for Alzheimer’s disease, which, according to the World Health Organization, is expected to double every 20 years worldwide—from 35.6 million individuals in 2010 to 115.4 million by 2050.
From left: Georgetown researchers Howard J. Federoff; Amrita K. Cheema, associate professor of oncology and co-director of GUMC’s metabolomics shared resource; and Massimo S. Fiandaca, associate professor of neurology, are among the co-inventors of a blood test that can predict with 90 percent accuracy if a healthy person will develop mild cognitive impairment or Alzheimer’s disease within three years.
Federoff, also a professor of neurology and executive dean of the School of Medicine, explained that although there have been many efforts to develop drugs to slow or reverse the progression of Alzheimer’s disease, all of them have failed. He noted one reason could be the drugs were evaluated too late in the disease process. “The preclinical state of the disease offers a window of opportunity for timely diseasemodifying intervention, and biomarkers defining this asymptomatic period are critical for successful development and application of these therapeutics,” Federoff added. In addition to several Georgetown investigators, other team members include researchers from the University of Rochester, the University of California-Irvine, Rochester General Hospital, Unity Health System in Rochester, Temple University School of Medicine and Regis University School of Pharmacy in Denver.
A Major Step Forward “The lipid panel was able to distinguish with 90 percent accuracy these two distinct groups—cognitively normal participants who would progress to MCI or Alzheimer’s within two to three years, and those who would remain normal in the near future,” Federoff said. Researchers said the panel reveals changes in the breakdown of neural cell membranes resulting in 10 identifiable lipids, or metabolites, circulating in the blood. In particular, two of the 10 metabolites have strong links to the neuropathology of Alzheimer’s. “We consider our results a major step toward the commercialization of a preclinical disease biomarker test that could be useful for large-scale screening to identify at-risk individuals,” Federoff concluded. “We’re intending to design a clinical trial where we’ll use this panel to identify people at high risk for Alzheimer’s to test a therapeutic agent that might delay or prevent the emergence of the disease.”
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Federoff and Georgetown researchers Amrita K. Cheema, Ph.D., and Massimo S. Fiandaca, M.D., along with Mark Mapstone, Ph.D., of the University of Rochester are named as co-inventors on a patent application filed by Georgetown and the University of Rochester related to the technology described. n The National Institutes of Health (R01AG030753) and the Department of Defense (W81XWH09-1-0107) funded the study.
Capital Breast Care Center Event Commemorates Activist In early 2014, the staff of Capital Breast Care Center (CBCC) took part in a ceremony that commemorated a breast cancer activist whose memory inspires their work. CBCC is a community-based arm of Georgetown Lombardi Comprehensive Cancer Center that offers breast health services to underserved women, regardless of their ability to pay. The center dedicated a mammography room to the late Zora Brown, a three-time breast cancer survivor who succumbed to the disease in 2013. Brown’s fight served to harden her resolve to advocate for disadvantaged women, particularly low-income African American women, who often do not have the same access to information, services and care as more economically stable women.
“We can no longer be immobilized by fear.” — Zora Brown
Brown’s friends and family joined CBCC staff and other invited guests for the ceremony at the center, located in southeast D.C. Guests included Brown’s nieces, Monica Brissett and Melanie Nix; Alexine Jackson, current chair of the CBCC Advisory Council; and Vivian Pinn, M.D., first full-time director of the Office of Research on Women’s Health at the National Institutes of Health. Also on hand were Georgetown Lombardi faculty: Lucile Adams-Campbell, Ph.D., associate director for minority health and health disparities research and professor of oncology; Jeanne Mandelblatt, M.D., Ph.D., MPH, associate director for population sciences and professor of oncology and medicine; and Vanessa Sheppard, Ph.D., associate professor of oncology.
The late breast cancer advocate Zora Brown’s nieces, Melanie Nix and Monica Brissett, at a dedication ceremony to honor their aunt.
Adams-Campbell, a friend of Brown’s for 25 years, said Brown always fought for what she knew was right. “If you know nothing else about her, you should know that she was an impetus in influencing the current mammography screening guidelines,” Adams-Campbell said. Brown’s nieces, Brissett and Nix, proudly mounted their aunt’s plaque on the wall outside of the mammography room, sharing that they were glad that CBCC is “carrying on the work that she felt so strongly about.” The plaque bears Brown’s powerful quote: “We can no longer be immobilized by fear.” The ceremony comes on the heels of an event held in 2013 at Arena Stage, also in Washington, to honor Brown’s memory. n
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Young Scientist Receives Boost to Explore Alzheimer’s Theory Irfan Y. Tamboli, Ph.D., is a young neuroscience investigator with an intriguing theory of the origins of Alzheimer’s disease— getting at the fundamental question of why some people get it and others do not. He just needed a bump of support to pursue his hypothesis and see if it could stand up to further scrutiny. Tamboli, a research instructor in the department of neurology, received that bump when he was named the recipient of a $25,000 grant from the 2013 Music for the Mind event. The annual event, now in its fourth year, supports young investigators at Georgetown University Medical Center (GUMC) who have bright ideas for seeking treatments and cures for neurologic diseases. Tamboli said early funding like this Music for the Mind grant is critical for budding scientists who are establishing their research focus. In his case, the grant will allow him to collect additional research data to test his theory about Alzheimer’s disease and hopefully pursue additional funding down the line. “We have many good ideas—and now we can get started on them,” he added.
The Hypothesis Tamboli, who came to Georgetown in 2011 and has a background in molecular and cell biology and biochemistry, has long been fascinated with the role of lipids, or fats, in health and disease. As a Ph.D. candidate in Bonn, Germany, Tamboli had the opportunity to work in a lab that is known for deciphering the effect of lipids on Alzheimer’s disease.
Irfan Y. Tamboli, a research instructor in the department of neurology, is using the $25,000 grant he received from Music for the Mind to test his theory of the origins of Alzheimer’s disease.
Tamboli chose to look at APOE genes, which transport lipids in the brain. These genes are also the most prominent genetic risk factor for non-familial Alzheimer’s disease. The E4 form of APOE (APOE4) increases the risk of getting the disease by as much as eight-fold. The E3 form of APOE (APOE3) is the most common variant, but appears to have a neutral role in the disease. The E2 form (APOE2), which is much more rare, appears to be protective against the disease. Despite the known connection to the disease, it has never been clear what precise role APOE plays in neurodegeneration. Tamboli thinks he has a clue. Working in the Georgetown lab of G. William Rebeck, Ph.D., professor of neuroscience, Tamboli has found that the APOE4 variant is less efficient at transporting lipids to brain cells than either APOE3 or APOE2. It seems that a protein called LRP1, a docking station on neurons for APOE, binds differently with APOE4.
See page 14 to learn about the 2014 Music for the Mind event.
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“What we think is happening is that LRP1 does not bind in the same way to APOE4 as it does to APOE3 or APOE2. There is only one amino acid difference between the variants, but that can affect the ability of the cell to take in the lipid,” Tamboli said. This matters, he added, because lipids are critical structural and signaling molecules that serve many important functions inside the cell—including staving off cognitive decline. Cholesterol, a type of lipid, is essential to proper neuronal functioning; a malfunction in transporting and depositing cholesterol can damage neurons.
“If APOE4 is not efficient at depositing the lipids, then neurons will not get enough of the fats they are dependent upon. With time, we think that could lead to memory deficits and neurodegeneration,” Tamboli said. Rebeck is enthusiastic about Tamboli’s hypothesis. “He is testing whether this difference in APOE-neuron interactions makes the neurons more sensitive to damage that accumulates with aging,” Rebeck said. “Understanding why some people get Alzheimer’s and others don’t is one of the fundamental questions. The genetic predispositions give us an interesting place to start.”
A Look Ahead Much has yet to be done to prove Tamboli’s theory, and that is where the Music for the Mind funds will come into play. Tamboli plans to buy lipid particles made with different APOE compositions to reconfirm his initial findings that binding between APOE4 and LRP1 is altered. He then wants to look at lipid profiles in mice with either APOE3 or APOE4 in the brain. He hopes findings from these studies will lead to more research funding. In endorsing Tamboli for the award, Howard J. Federoff, M.D., Ph.D., professor of neurology and executive vice president for health sciences, said that moving the studies into mice models “can help investigators understand how they can mitigate plaque formation and reduce the occurrence of dementia.” n
GUMC Discovery Chosen for Time’s Top 100 Scientific Findings
“To realize squalamine’s potential as a broad
A discovery made by Georgetown University Medical Center scientist Michael Zasloff, M.D., Ph.D., has been included in Time Inc.’s book, 100 New Scientific Discoveries; Fascinating, Momentous and Mind-expanding Stories. The discovery, first published in the Proceedings of the National Academy of Sciences in September 2011, describes a compound initially isolated from sharks by Zasloff ’s group that could potentially serve as an agent to treat human viruses.
antiviral is immensely
“To realize squalamine’s potential as a broad antiviral is immensely exciting because we know from its use in treating cancer that it’s safe in humans,” said Zasloff, a professor of surgery and pediatrics at Georgetown University Medical Center and co-director of GUMC’s Center for Translational Transplant Medicine.
— Michael Zasloff,
exciting because we know from its use in treating cancer that it’s safe in humans.” M.D., Ph.D.
In both lab and animal experiments, the compound effectively demonstrated activity against human viruses ranging from dengue and yellow fever to hepatitis B, C and D, some of which cannot now be effectively treated. The book covers “the 100 most interesting discoveries” in fields such as chemistry, zoology, medicine, psychology, archeology, astronomy and technology. “Obviously, I was very pleased that our work was included along with other fascinating scientific findings,” Zasloff said. Clinical trials to test squalamine as an antiviral are being planned. n
Read more about how Georgetown is finding new uses for old drugs in the cover story on page 31.
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Commencement Speaker Advises New Physicians to Apply ‘Personal Touch’ The challenge of modern medicine is to continue to meet basic human needs and preserve timeless patient-centered values in an era of increasing technology and complexity, a leader in medical teaching told Georgetown School of Medicine’s Class of 2014. George Thibault (C’65), M.D., addressed 198 medical school graduates at their May 18 commencement ceremony, held at Warner Theatre, noting that their Georgetown formation has fully prepared them to face this professional challenge. Thibault is president of the Josiah Macy Jr. Foundation, a national foundation dedicated to improving the education of health professionals. “You have … been taught to listen to your patients, to elicit and understand their preferences and to address their personal needs and those of their families and the communities in which they live,” Thibault said. “You will give them the personal touch, the care and the intimacy that science and technology cannot replace … because you have been educated at Georgetown, in the Jesuit tradition that cares for both the body and the soul.”
‘A Man For Others’ Thibault was conferred an honorary Doctor of Science degree, the university’s highest honor. In reading the citation, Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences and executive dean of the School of Medicine, lauded Thibault, who was his residency director at Massachusetts General Hospital. “Dr. Thibault embodies Georgetown University’s ideal of a man for others, as well as the School of Medicine’s mission of preparing morally reflective health care leaders and scholars who strive to improve the health and well-being of all people,” Federoff said. George Thibault (C’65)
Members of the Class of 2014 excitedly await receiving their hard-earned degrees.
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The crowd of graduates, family and friends at Warner Theater.
Thibault also spoke of his father, who often served as the only doctor in a small town in upstate New York. “Dad never turned anyone away,” he said. “Patients were charged on a sliding scale. I still have some of his billing cards, and many bills were zero. I never felt my father worried about the business side of medicine.” He said that his father, who died at age 48 during Thibault’s freshman year at Georgetown, would have welcomed all the technologic advances made during the past 50 years, but believes patients today “… still want someone who knows them, someone who listens to them, someone who cares…”
‘Ready To Be Set Free In The World’ Dean for Medical Education Stephen Ray Mitchell, M.D., MBA, presented the graduates, including one dual M.D./MPH candidate and one M.D./MBA candidate, and Georgetown University President John J. DeGioia, conferred the degrees. DeGioia reminded the M’14 class of their responsibility to “bring your personal gifts to bear on the world in a way that serves and enriches it and embrace and support the gifts of others.” Commencement, he said, is truly the beginning for these graduates as they set out on their professional paths. “This is the moment that we confirm that your talents, your gifts, your deepest motivations are, in the words of [poet and essayist] Lewis Hyde, ready to be set free in the world,” DeGioia said.
A Solemn Oath
“Although I will likely have many different training experiences at various institutions in the future, I will always be a Georgetown doctor.” — Jenny Van Kirk (M’14), M.D.
Donald Knowlan, M.D., professor emeritus of medicine, administered the Hippocratic oath to the new physicians. Graduate Jenny Van Kirk (M’14), M.D., who will continue her training in internal medicine at Duke University, said her Georgetown education has helped shape her values as a physician and a person. “As I move on to my future training, I’ll always credit Georgetown for shaping me, not only as a physician, but as a person. Going forward, I intend to practice medicine in the spirit of cura personalis with an emphasis on the patient and their needs on all levels,” Van Kirk said. “Although I will likely have many different training experiences at various institutions in the future, I will always be a Georgetown doctor.” n
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Endowed Chair in Pediatrics Honors Friendship Born Half Century Ago A decades-long friendship rooted in a shared devotion to the health and well-being of children has culminated in a new endowed chair at Georgetown University. Georgetown celebrated the establishment of the Philip L. Calcagno, M.D., and Jeane and James Dixon Endowed Chair in Pediatrics at a ceremony May 6. The chair fulfills a gift made by the late Jeane Dixon, best known as an astrologer and psychic who penned a highly popular syndicated newspaper astrology column. Also a dedicated philanthropist, in 1963 Dixon founded the nonprofit organization Children to Children Inc. devoted to fostering the physical, mental, educational and spiritual growth of children. She remained active in the charity until her death in 1997 and the organization has fulfilled the gift agreement in collaboration with her estate in accordance with her wishes.
A Deep Friendship
Philip L. Calcagno (M’43), M.D., speaks at a ceremony marking the establishment of the Philip L. Calcagno, M.D., and Jeane and James Dixon Endowed Chair in Pediatrics.
“This new chair will
In the early 1960s, Dixon and her husband James formed a meaningful friendship with Calcagno (M’43), who was founding director of the department of pediatrics at Georgetown University School of Medicine. They were connected by a passion for children’s health issues. “… I am struck by the extraordinary friendship of Philip Calcagano and Jeane and James Dixon. And this friendship was a collaboration for the public good—for the health and well-being of hundreds, if not thousands, of children, and for future generations of children,” said Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences at Georgetown University Medical Center (GUMC).
deepen for our depart-
Through their respective institutions, the Dixons and Calcagno sought to advance research and treatment in pediatric medicine—never losing sight of their common goals.
ment of pediatrics,
In his remarks, Calcagno reminisced about the early days in the department he started, which since has grown to include more than 25 specialty areas, including pediatric and neonatal intensive care.
and indeed, our entire medical center, opportunities for research, for experimentation, for discovery—opportunities that can lead to new treatments [and] new cures.” — John J. DeGioia
He said that, for physicians of tomorrow to be prepared to meet the challenges of “evolving new health care delivery,” endowed chairs are necessary to “achieve the high quality of training and to allow the student to identify with examples of excellence and help support the fiscal balance of the university.” Georgetown President John J. DeGioia lauded Calcagno for helping “build the department into what it is today—a nationally and internationally recognized pediatrics center.” “This new chair will deepen for our department of pediatrics, and indeed, our entire medical center, opportunities for research, for experimentation, for discovery—opportunities that can lead to new treatments [and] new cures,” DeGioia said.
An Ongoing Commitment Georgetown’s ongoing commitment to pediatric care is evidenced through both its clinical care and research missions. In partnership with MedStar Health, the clinical pediatrics department has expanded its services in small bowel and liver transplantation and community pediatrics. And Georgetown pediatric care providers are out in the community, providing primary care to the District’s underserved residents through the Mobile Van Project, the Hoya Clinic in Southeast Washington and a school-based health center in Anacostia. Georgetown hosts a robust pediatric residency program and offers both clinical and research fellowships.
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Pediatric research is also a key priority. The department is home to two research centers of excellence: the Georgetown University Center for Child and Human Development, and the C.W. Bill Young DoD Bone Marrow Donor Program. Physician-scientists in the department research a variety of subjects such as infant mortality, lung diseases and fetal alcohol syndrome. Federoff emphasized the importance of endowed chairs in continuing to meet the research and clinical missions of GUMC. “To be preeminent as an academic medical center we need to continue to attract and retain the very best physician-researchers. And that is what endowed chairs enable us to do,” he said. n
Medical Students Participate in Cancer Center Art Show Georgetown University medical students are showing off abilities that fall outside the scope of their educational careers. Thirteen students from Georgetown’s School of Medicine contributed artwork to the annual medical student art show within the Georgetown Lombardi Comprehensive Cancer Center. “With their intensely busy schedules, it is extraordinary and heartening that medical students find time to create,” said Nancy Morgan, former director of the Arts and Humanities Program at Georgetown Lombardi. “If nothing else, the art show can remind them how art-making can be an enjoyable stress reliever and a way to maintain emotional balance.”
The Right Side of the Brain For one student artist, painting is therapeutic—and offers a chance to take a break from studying. “Being a medical student doesn’t leave you with a lot of free time,” second-year student Shaila Patel said. “Painting is something I want to do—no one can tell me what to put on the canvas—and I get to use the creative right side of my brain.” One of her paintings that was featured in the show, I Love San Francisco, highlights two bridges: the Golden Gate Bridge, which represents growing up in the south San Francisco Bay Area, and the Key Bridge in Washington, representing her time at Georgetown. “When I came up with the idea for the painting, I had recently walked the Golden Gate Bridge and I run across the Key Bridge all the time,” Patel explained. She completed Georgetown’s Special Master’s Program in 2012 and plans to pursue a career in pediatric medicine. Second-year medical student Charles Long had a piece of art on display depicting memories from home. His scratchboard drawing, Coming Home, recalls how he used to feel arriving home after long swim practices in high school. “I remember getting home and the only light in the neighborhood was from the moon and it was shining down on the cars in the driveway,” Long said. “It was peaceful to me to come home to that and finally getting rested up after a long day.” Long, who comes from a family of doctors, is pursuing a career in surgery. He feels a connection between artistic and surgical prowess. “I really enjoy doing procedural work and want to extend my artwork into surgery,” Long said. “I really like doing things with my hands and doing fine-detail work.” n
Charles Long and Shaila Patel pictured with their artworks.
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Howard Federoff, M.D., Ph.D., stands with 2014 Music for the Mind co-chairs and performers.
Rock ‘N’ Roll, Neuroscience Share the Stage at Music for the Mind The rock tunes that defined a generation brought joy and hope to a solemn subject at Music for the Mind, an event to support new cures and treatments for neurologic diseases. Georgetown University Medical Center (GUMC) hosted the fourth annual fundraiser at Arena Stage in Washington. Nearly 150 attendees gathered for a cocktail reception in the unique venue, which boasts a 35,000-square-foot glass wall “curtain” surrounding the building. The focal point of the evening was the performance of Smokey Joe’s Café: The Songs of Leiber and Stoller, featuring Tony award winners Levi Kreis, E. Faye Butler and Nova Y. Payton.
Seeding Young Investigators Speaking prior to the show, Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences and executive dean of the School of Medicine, said in the four years since it started, Music for the Mind has helped five young investigators transition their work to the phase where it will have the greatest influence on biomedical research and patients. “It’s through an event like this that we can support some of the best ideas that are ready to grow and to move to the next stage,” Federoff said. He cited 2011 Young Investigators Fund awardee Charbel “Charlie” Moussa, M.B., Ph.D., whose laboratory research has found that a drug already approved to treat leukemia halts the accumulation of toxic proteins linked to Parkinson’s disease in mice (Read more about this discovery on page 33). In part because of the support he received from Music for the Mind, Moussa is poised to launch a human clinical trial to study this finding further.
Collaboration Key to Success Federoff also cited the clinical partnership with MedStar Health as another factor that has bolstered the success of GUMC’s neuroscience research portfolio.
See a profile of the 2013 Music for the Mind award recipient, Irfan Y. Tamboli, Ph.D., on page 8.
Because of this alliance, GUMC has successfully launched several major regional neuroscience initiatives, including the Center for Brain Plasticity and Recovery in conjunction with MedStar National Rehabilitation Hospital and the Huntington’s Disease Care, Education and Research Center in collaboration with MedStar Georgetown University Hospital.
One of the Family Pat Harvey, whose husband died of Alzheimer’s in 2001 after four years of treatment in
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Georgetown’s Memory Disorders Program, has been attending Music for the Mind since its inception four years ago. Harvey, who is on the event organizing committee, said she will continue to come every year in the hopes that her support will spur even more exciting research. She also comes for a more personal reason: in her years of attending lab tours at Georgetown and of building relationships with the researchers and physicians, Harvey said the GUMC neuroscience community has begun to “feel like family.”
To schedule a lab tour or for more information on Music for the Mind, call 202-687-3660 or email medcenteradvance firstname.lastname@example.org.
“As long as they keep doing this, I will be here. It’s a very collegial atmosphere and it is nice being a part of it,” she said. Honorary co-chairs of this year’s event were Mark and Jeanne Shriver. The premier event sponsor was Shawn Taylor of KPB Corporation. n
Georgetown Bioethicist Tapped for Vatican Advisory Post Kevin FitzGerald, Ph.D., S.J., a Jesuit priest, Georgetown bioethicist and cancer researcher, has been appointed by Pope Francis to serve as a consultor to the Pontifical Council for Culture. FitzGerald, a research associate professor in the department of oncology and the Dr. David P. Lauler Chair for Catholic Health Care Ethics at Georgetown University Medical Center, began his five-year term July 1 as one of 13 newly appointed consultors from around the world. Established in 1982 by Pope John Paul II, the Pontifical Council for Culture is one of 12 councils established to study a variety of issues deemed of importance to the Catholic Church, and to provide guidance to the Pope on such matters. FitzGerald will be advising the Council on areas of growing global scientific interest, including bioethics, genetics, neuroscience and transhumanism, which refers to a movement that seeks to transcend the human condition through technology, artificial intelligence and other related concepts.
Religion and Science As both a Jesuit priest and a scientist, FitzGerald says he is fortunate to sit squarely “at the intersection between science and the Catholic tradition.” “Although many people think that religion and science are fundamentally at odds with one another, the Catholic perspective is that they are not at all. They are both essential lenses for viewing the important issues of our time,” he said. This appointment, FitzGerald says, builds on his decades of work to improve global understanding of the important interconnections between science, religion and culture. He has served since 2005 as a corresponding member of the Pontifical Academy for Life, which is mainly focused on research into bioethical issues as they pertain to human life.
Kevin FitzGerald, Ph.D., S.J., a Jesuit priest, Georgetown bioethicist and cancer researcher, has been appointed by Pope Francis to serve as a consultor to the Pontifical Council for Culture.
“Science and religion touch all of us in some way. Whether you are Catholic or not, the goal is to work toward a greater synergy for the good of all people,” FitzGerald said. Besides making himself available for consultations as needed, FitzGerald will be asked to participate in international conferences and research publications on topics of interest to the Vatican that fall within his areas of expertise, according to Richard Rouse, an official to the Pontifical Council for Culture, based in Rome. n
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Former FDA Chief Scientist Comes to GUMC to Launch Center Jesse L. Goodman, M.D., MPH, former chief scientist for the U.S. Food and Drug Administration and a renowned expert in infectious diseases, has joined Georgetown University Medical Center to head a new center. Goodman will launch the Center on Medical Product Access, Safety and Stewardship (COMPASS) at GUMC. The goal of the new center, which falls under the Office of the Dean for Research, is to address three broad areas of national and global public health importance: medical product safety and security across the global manufacturing supply chain; antimicrobial drug resistance; and access to lifesaving medical products. In addition to leading COMPASS, Goodman will continue his work in infectious diseases, serving as an attending physician at the Washington DC VA Medical Center and MedStar Georgetown University Hospital. He is being nominated as professor in the department of medicine at Georgetown University School of Medicine. Jesse L. Goodman, M.D., MPH
“Jesse brings a wealth
“I’m excited about the opportunity to fully engage in these critical public health issues from a robust academic perspective,” Goodman said. “Addressing these complex challenges requires innovation and a broad, multidisciplinary approach involving multiple sectors at the university and beyond. There are scientific, medical, regulatory and policy dimensions, as well as the need to effectively harness and analyze massive data sets.”
of expertise spanning
Public Health Leader
GUMC leadership describes Goodman as a “leader in public health” who combines years of policy experience with a long career in academia.
regulation and public health, and has a proven record in addressing pressing public health needs from both the academic and federal sectors,” — Howard J. Federoff, M.D., Ph.D.
“Jesse brings a wealth of expertise spanning science, medicine, regulation and public health, and has a proven record in addressing pressing public health needs from both the academic and federal sectors,” said Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences at Georgetown University Medical Center and executive dean of the Georgetown School of Medicine. “We look forward to his leadership in this vitally important area.” After joining the FDA, Goodman founded and co-chaired the first U.S. Task Force to Combat Antimicrobial Resistance and then directed the Center for Biologics Evaluation and Research. In those roles and as FDA’s chief scientist from 2009 until February 2014, he worked extensively and collaboratively with industry, academia, government and global public health partners to prepare for and respond to major public health threats, emerging infectious diseases and terrorism, including leading FDA’s response to West Nile Virus and to the 2009 H1N1 influenza pandemic. Prior to joining the FDA, Goodman was director of the division of infectious diseases and professor of medicine at the University of Minnesota, where his National Institutes of Health-funded laboratory isolated and characterized the causative agent of a new tickborne disease, known as human granulocytic anaplasmosis. He received his A.B. in biology from Harvard College, his M.D. from the Albert Einstein College of Medicine and his MPH from the University of Minnesota.
Collaborative Approach Goodman says that broad collaboration and expertise is key to COMPASS’ success, and intends to pursue both regional and global engagement of public health and government officials, other academic institutions, industry and other partners. “Right now many people are concerned but are typically seeing just a part of the elephant— there have not been broad, systematic approaches to dealing with highly complex issues
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such as antimicrobial drug resistance or medical product safety. We need to be thinking of how to address these problems across systems,” Goodman said. n
New Federal Post for GUMC’s Top Regulatory Officer Melds Law, Nursing Georgetown University Medical Center’s chief regulatory affairs officer has been appointed to the advisory council of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Sheila Cohen Zimmet, BSN, J.D. (NHS’71, L’75), senior associate vice president for regulatory affairs at the Medical Center, was invited by U.S. Secretary of Health and Human Services Kathleen Sebelius to serve on the council for a term beginning Feb. 3 and ending Nov. 30, 2017. Zimmet is also research integrity officer for the university and conflict of interest officer for GUMC, as well as adjunct associate professor in the department of pharmacology. Zimmet, who was a nurse in the neonatal intensive care unit (NICU) at Georgetown University Hospital (now MedStar Georgetown University Hospital) prior to earning her law degree in 1975, said that this appointment is “the perfect marriage of my background in health and in the law.”
Above: Sheila Cohen Zimmet, BSN, J.D. (NHS’71, L’75) Left: Zimmet, shown in her early NICU days.
“Child health and human development was my field from the very beginning of my career, so I have a particular interest in this council’s work,” Zimmet said. “My roots run deep with this, and I am looking forward to bringing my experience to bear in working towards the NICHD’s mission.” Zimmet decided to attend Georgetown Law while still a nursing student in Georgetown’s School of Nursing & Health Studies because she grew interested in the ethical and legal questions surrounding health care. She worked full time in the NICU while pursuing her law degree at night. She has previously served on the advisory council of the National Center for Research Resources at the National Institutes of Health, a body that aimed to support all aspects of clinical and translational research. According to its website, the NICHD works “to ensure that every person is born healthy and wanted, that women suffer no harmful effects from reproductive processes, and that all children have the chance to achieve their full potential for healthy and productive lives, free from disease or disability, and to ensure the health, productivity, independence and wellbeing of all people through optimal rehabilitation.” Among the issues in the institute’s purview are infant mortality rates, sudden infant death syndrome, HIV transmission from mother to child in utero, an array of congenital conditions and diseases and other life-and-death issues for newborns, young children and their mothers. n
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Medical Students Meet Their Match In the life of a medical student, there aren’t many days more important than Match Day. Every year at noon on the same day, medical students across the country find out where they will go for their residency programs. On March 21, Georgetown University School of Medicine’s Class of 2014, accompanied by friends and family, opened their envelopes that revealed the next destination in their medical careers. According to Dean for Medical Education Stephen Ray Mitchell, M.D., 51 percent of this year’s graduating students were matched with the country’s top 25 residency programs, as ranked by U.S. News & World Report. “As usual, 25 percent of you are homebodies, you’re not going anywhere,” Mitchell told the students during the Match Day ceremony. They will become residents at hospital systems within Washington. (See more Match Day statistics on page 43.) The National Resident Matching Program uses a mathematical algorithm that pairs the rank ordered preferences of both applicants and program directors to produce the best fit. This year, 200 graduating students learned where they would complete their residencies, including two undergraduate alumnae of the School of Nursing & Health Studies, Tina Zhang (NHS’10, M’14) and Emily Wang (NHS’08, M’14).
The Big Reveal Promptly at noon, Dean Mitchell instructed the room full of anxious students to open their white envelopes.
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The emotion is hard to describe, says Ryan Hubbard (M’14), who matched with his first-choice program in physical medicine and rehabilitation at the Mayo School of Graduate Medical Education at the Mayo Clinic in Rochester, Minnesota. “We have had a busy past four years, and spent a lot of time juggling tests, classes and being in the hospital, all the while trying to learn and experience as much as possible,” Hubbard said. “It’s a strong wave of emotion on Match Day when you come to the realization that you are going to be a doctor and all your hard work has paid off.” Hubbard visited the Mayo Clinic in November and says he felt an instant connection. “A lot of the qualities that are instilled in us here at Georgetown to truly set us apart as physicians—such as compassion, patient-centered care and excellence—are also embodied at Mayo. It just felt like a perfect fit,” he added. Savannah Walker (M’14), accompanied by her fiancé, learned she matched with her top-choice program in pediatrics at Vanderbilt University Medical Center in Nashville, Tennessee. “It’s close to my hometown in Kentucky and I’m just thrilled,” Walker said. “It’s an outstanding program; I’m very excited to be going there.”
Dreams of Becoming a Doctor Deciding to work in medicine was an easy decision for Hubbard, who shadowed a pediatrician and two cardiologists when he was in high school in Charlotte, North Carolina. “I was fascinated by the impact they had on their patients,” Hubbard said. “It was amazing to see and made me desire the ability to touch someone’s life in that way.” Walker, whose mother is a radiologic technologist, was inspired to become a doctor by care providers she regularly spent time around while growing up. She says her mother would talk to her about people within their rural community who struggled to get the medical care they needed. “I want to help people from where I’m from,” Walker said. “My long-term goal is to be out in the communities and to do whatever I need to do for my patients. I want to soak everything in and learn as much as I can to become the best physician possible.”
Match Day 2014 brought the usual wave of emotions—excitement, relief and joy.
Family Ties Both Walker and Hubbard will be the first physicians in their families. Hubbard’s attributes his success in large part to his parents, who he says have been supportive at every step. Both parents were at his side on Match Day. “It’s nice to see his hard work and dedication pay off in ways that we have been hoping and praying for over the last four years,” said Hubbard’s mother Iris. “We’re extremely proud of him that he set out a plan and that it has played out to where he got his first choice.” n
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Medical Student Pursues Brain Tumor Research through HHMI Fellowship A third-year Georgetown University School of Medicine student is one of 70 medical, dental and veterinary students nationwide selected to participate in the Howard Hughes Medical Institute (HHMI) Medical Research Fellows Program. Leonel Ampie (M’16) will participate in his year-long fellowship at Barrow Neurological Institute in Phoenix. Now convening its 26th class, the annual HHMI program is a $2.8-million initiative geared to increase the basic, translational or applied research training of future physician-scientists. Ampie has chosen to focus his research on glioma tumors, a type of cancer that arises in the supportive tissue of the brain or spine. “My project revolves around the belief that glioma tumors recur after removal because glioma stem cells hide within an area of the brain called the subventricular zone,” Ampie said. “These stem cells then manage to seed the brain again, leading to tumor recurrence.” Ampie is working with mentor Nader Sanai, M.D., director of neurosurgical oncology and director of the Barrow Brain Tumor Research Center. “Dr. Sanai was a Howard Hughes fellow when he was a medical student and was published in Nature because of his experience,” Ampie said. “He was very eager to mentor an HHMI student and helped me tremendously throughout the application process.”
Motivated by Family When Ampie was 13, his mother was diagnosed with stage IV ovarian cancer. He watched her fight and survive her battle with the disease. On her last day of chemotherapy, he promised her he would dedicate his life to finding a cure for cancer, he explained. © Getty Images
“When I arrived in Washington to begin school at Georgetown, I was carrying only two things: a small suitcase carrying my belongings and the other—the dream of finding that cure for cancer—still motivates me today,” Ampie recalled. After completing his fellowship, Ampie hopes to pursue a researchintensive residency, potentially in neurosurgery. “Hopefully one day I’ll be able to land a position at an academic institution where I will be able to handle the roles of both a clinician and a scientist,” he said. “All the while, still keeping the promise that I made to my mother 13 years ago.”
Next Generation of Researchers The HHMI Medical Research Fellows Program allows participating students the chance to take a break from their regular coursework to pursue biomedical research at academic or nonprofit research institutions. Applicants designate labs where they wish to pursue their research and submit project proposals of what they intend to accomplish. Ampie and the other HHMI fellows will present their work at a Howard Hughes conference in May 2015. n
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© Leslie Kossoff
Ninth Annual Women & Wine Event Raises Record Funds for Breast Cancer
Left to right: Janet Davis, Brandywine Realty Trust and Women & Wine co-chair; Karin Gifuni, 2014 Spirit of Life awardee; Barbara Schaefer McDuffie, Baker Tilly and Women & Wine co-chair; and Greta Kreuz, ABC 7 News reporter and Women & Wine honorary chair.
More than 400 women gathered at the Four Seasons Hotel in Washington for the Ninth Annual Women & Wine event benefitting the Nina Hyde Center for Breast Cancer Research at Georgetown Lombardi Comprehensive Cancer Center. Women & Wine is a women-only event bringing local businesswomen and friends together to support breast cancer research and treatment programs at Lombardi. The event, which began nine years ago with 100 attendees, raised a record high of $259,000 in 2013. The program began with a cancer briefing by Claudine Isaacs, M.D., professor of medicine and oncology and co-director of the Georgetown Lombardi’s breast cancer program, and Shawna Willey, M.D., director of MedStar Health’s regional breast surgery program and vice chair of the Department of Surgery at MedStar Georgetown University Hospital. Their updates on the latest breakthroughs in breast cancer research and treatment were followed by a question-and-answer session with attendees. Isaacs described research projects that were able to move forward during the past year thanks to philanthropic support. One of these projects, led by behavioral scientist Suzanne O’Neill, Ph.D., focused on decision-making regarding cancer risk management as it relates to genetic testing. O’Neill’s pilot study examined women ages 18 to 25 and how they made choices regarding their cancer risk management based on interactions with their health care providers. Willey followed with a discussion of intraoperative radiation therapy, a single-dose radiation treatment. “Radiation is a lifesaving thing. But maybe, as with all treatments, we are able to get smarter and more precise about which patients need what treatment,” stated Willey. The evening included a cocktail hour and silent auction. Local companies and individuals also donated the auction items in support of breast cancer research at Georgetown Lombardi. After dinner, the evening’s emcee, Greta Kreuz of WJLA-TV, presented the 2014 Spirit of Life Award to Karen M. Gifuni, Georgetown Lombardi supporter and committee member. The award is given each year to a person who exemplifies character and leadership in promoting breast cancer research and awareness. n
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Nursing, Medical Students Train Together for Emergency Preparedness Medical and nursing students don’t often have the opportunity to learn together at the patient’s bedside, but thanks to a unique pilot education project that emphasizes interprofessional education, Georgetown students were able to do just that.
“Working with the nursing students allows us to better understand all of the roles on a health care team. With a better understanding of everybody’s role, there is an opportunity to
Students from Georgetown University School of Medicine and the School of Nursing & Health Studies (NHS) teamed up in simulated emergency care situations to treat simulated patients in cardiac arrest and perform major trauma resuscitation. The sessions took place at the O’Neill Family Foundation Clinical Simulation Center, a learning and research facility housed at NHS. The simulator patients replicate physiological conditions and symptoms, providing a realistic training environment. “It’s important for medical students to be exposed to working with nursing students at the patient’s bedside during a simulation because it sets us up for the kind of environment we will be working in when we graduate,” said Nicole Grande (NHS’15), one of the participating nursing students. Typically, nursing and medical students learn their roles in patient care individually. Yet the silos that typically exist in health professions education are not reflected in the real-world settings. “By training with the nursing students, it forces you to consider all of the different aspects of patient care, to make sure the patient is being comprehensively cared for,” said medical student Jeffrey Nusbaum (M’14).
The integration of health professions supports the goals of comprehensive care and the Georgetown ideal of cura personalis, a Jesuit concept that means “care of the whole person”.
among the team and accomplish the goal
“Working with the nursing students allows us to better understand all of the roles on a health care team,” said medical student Michael Narvaez (M’14). “With a better understanding of everybody’s role, there is an opportunity to maximize efficiency among the team and accomplish the goal of caring for the whole person.”
of caring for the whole
Improving Interprofessional Education
person.” — Michael
The pilot project is co-led by David Milzman, M.D., professor of emergency medicine and assistant dean for student research at the School of Medicine, Wendy Thomson, Ed.D., MSN, director for simulation education in NHS, and Kim Bullock, M.D., associate professor in the department of family medicine. It is part of the annual Curricular Innovation, Research, and Creativity in the Learning Environment (CIRCLE) Grant Program funded through Georgetown University Medical Center.
The investigators received the grant in spring 2013 and the pilot project work began that fall. They aim to create a new education model to foster team-oriented professional identities and improve interprofessional education. “We decided to look at the usual training where nursing students and med students train independently of each other and then have them do it collaboratively,” Milzman said. “The students have enjoyed it and the professors have enjoyed it because we see that it truly works better.” The idea is that if nursing, medical and other health professions students learn jointly in clinical settings, then as graduates, they will improve patient outcomes by working more collaboratively, communicating better with each other and fostering a health care delivery system that assures quality and patient safety.
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“By giving them simulated experiences, they’ll remember what to do or how to react when they’re in a real situation,” Thomson said. “They get to feel what it means to be a nurse, what it feels like taking care of a patient, making critical decisions and working collaboratively with a physician.”
Nursing and medical students get hands-on experience with a simulated emergency situation.
Continuing Research The pilot project is nearing completion, but the investigators still have work to do. “We’ll be looking at how to improve teamwork,” Milzman said. “There are steps in developing teamwork and evaluating how health professionals work together.” Thomson said they will be looking to see if simulation makes a difference in the students’ learning and their ability to transition from school to working in a hospital or clinic. “I’d like to try to partner with hospitals to see if they can see a difference in nurses and doctors who have been immersed in simulation,” Thomson added. The investigators hope this pilot project will kick-start collaborative teaching between the two schools on Georgetown’s campus. n
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Medical Students Attending Business School in Greater Number Being a great doctor means more than outstanding clinical skills and a terrific bedside manner. Health care is a multibilliondollar industry and sharp business acumen is a smart asset for physicians. Omar Rahman (M’17, MBA’17) and Chase Corvin (M’17, MBA’17) understand this well. After three years in medical school, both will take a year off to gain an entirely new perspective on medicine—by attending business school. Rahman and Corvin are in the midst of obtaining their MBA at Georgetown’s McDonough School of Business as part of their five-year dual M.D./MBA program. Having been grounded in Georgetown University Medical Center’s Jesuit principle of cura personalis, they hope this experience will add “care of the whole health system” and even “care of the whole world” to their personal mission statements. © Getty Images
The MBA portion of their studies, they said, helps shift the perspective from an individual patient to thinking strategically about the overall system— and the business—responsible for that patient. “Medical school teaches you how to take care of an individual patient, but the larger macroscopic problems in our health care system aren’t really addressed,” Rahman said. For this reason, more medical students nationwide are earning combined M.D./MBA degrees, according to the Association of M.D./MBA Programs. To date, 57 medical schools and universities offer such a joint degree.
Expanding Business Literacy to Classmates Rahman, Corvin and their M.D./MBA counterparts are so energized by their studies that they have formed an organization—Business and Leadership in Medical Practice, or BLIMP—to share what they are learning in business school with their medical school classmates who are not enrolled in the dual degree program. Rahman and Corvin, the current president and vice president, respectively, founded BLIMP along with their medical colleagues Alexander Butler (M’16), Jack Steele (M’16) and David Gostine (M’18, MBA’18). With the motto “Keeping Health Care Afloat,” BLIMP serves as a platform to allow medical students who do not seek an MBA degree to a part of the conversation about how business literacy can improve American medicine. “We want BLIMP to be a forum about how we can improve the delivery of health care as a cost-effective system that focuses on quality of care,” Corvin said. “Physicians need to be a major part of this effort—and with fewer than 4 percent of hospitals now being run by doctors, medical students must prepare themselves to take on these roles.”
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Georgetown has offered the dual degree since 2000. There have been seven M.D./MBA graduates in the last five years, with another seven anticipated by 2017. “An MBA program allows med students to take a deep dive into areas such as stakeholder theory, change management, operations and other topics that are critical to running successful medical institutions,” said Lauren U. Grainger, director of academic affairs for the MBA program office at McDonough School of Business. To discuss all that an MBA can offer medical students, BLIMP holds journal discussions and events. One featured a panel of experts on how the Affordable Care Act will affect medical students as future health care leaders. Stephen Ray Mitchell, M.D., MBA, dean for medical education, headlined another recent event. “More than 60 medical students were in attendance, and that was a welcome surprise,” said Mitchell, who earned his executive MBA in 2013. “We discussed why leadership and a business perspective are important to their future practice. For me, the usefulness of the degree wasn’t so much in managing finances as much as it was about thinking strategically, incorporating marketing, communication and innovation.”
“Physicians need to be a major part of this effort—and with fewer than four percent of hospitals now being run by doctors, medical students must prepare themselves to take on
Living up to Both Degrees
these roles.” — Chase
Andrew Gostine, who earned his M.D./MBA from Georgetown in 2013, said his time at the business school was empowering.
Corvin (M’17, MBA’17)
“Business is very different from medicine. I think the skills I learned in business school are, in many ways, better suited for developing solutions to the problems that plague health care,” said Gostine, an anesthesiology resident at Northwestern Memorial Hospital. He recently started a consulting business and is pursuing a master’s degree in predictive analytics. Among other projects, Gostine wants to develop prediction algorithms, using medical records and genetic information, to tailor the practice of medicine to individual patients. “For example, in my residency I’m learning hundreds of different combinations of drugs I can use to care for critically ill patients with similar diseases. But it’s unlikely that they all provide the same outcomes. With advanced statistical software, we can track these outcomes and predict the safest treatment for each patient,” he explained. He is working on these goals while pursuing his dream—to be an anesthesiologist in intensive care units, working on the most complicated cases. “I hope to live up to both of my degrees,” Gostine said. “The combination offers me a different perspective at a time when health care is changing rapidly.” n
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In New Leadership Role, Student Gives Voice to Young Patients with Cancer A Georgetown University Medical Center graduate student— who is president of his class—has assumed a new leadership role with a national cancer nonprofit organization that seeks to improve the lives of teens and young adults with cancer. Daniel Bral, who graduated with his master’s degree in physiology and biophysics in Georgetown’s complementary and alternative medicine (CAM) program, is the appointed chair of Teen Cancer America’s Young People’s Advisory Committee. Teen Cancer America was co-founded by Roger Daltrey and Pete Townshend, of the rock band The Who, who were inspired by a similar program they had established in the United Kingdom. Having been diagnosed at age 11 with Non-Hodgkin lymphoma, a cancer of white blood cells, Bral brings important contributions to the committee, according to the organization’s leadership. Daniel Bral (G’14)
“I am sure he [Daniel] will be a great asset to Teen Cancer America in his leadership role.” — Aviad Haramati, Ph.D.
“With Daniel leading the advisory committee, Teen Cancer America can be sure that the interests of the young people it serves will always be at the forefront of our developments,” said the organization’s executive director, Simon Davies. The Young People’s Advisory Committee helps advocate for teens and young adults across the country who are facing cancer, raising their needs and concerns to the board of directors. Battling cancer during teenage years brings a set of unique challenges. While teens typically strive for independence, dealing with an illness such as cancer requires a heavy dependence on others. “There is a lot going on at that age that needs to be attended to and medical professionals should be cognizant of it,” Bral said. “Puberty, for example, is a huge thing that we can’t overlook. It’s a hard experience and teens are already going through a difficult point in their lives with battling cancer.”
Creating a Calm Environment Bral first met Davies through their work in establishing the Daltrey/Townshend Teen and Young Adult Cancer Program at Ronald Reagan UCLA Medical Center, which works to improve the quality of care for teens and young adults with cancer. The Who’s Daltrey and Townshend co-founded the unit. Beginning in 2012, Bral gained valuable experience by helping plan and design UCLA’s young adult unit. He attended meetings with architects and interior designers and offered feedback based on his own memory of being a teen fighting cancer. For example, Bral recalls how the design for the walls at UCLA originally planned to use tiny dots, a style similar to comic books, and bright colors such as orange and yellow. When the samples were printed out, Bral and other survivors provided feedback that the image pattern and colors could exacerbate nausea for patients undergoing chemotherapy and remind them of the chemotherapy and their illness. “That’s not what we want to do,” Bral explained. “We want to create an environment that is calming and cultivates a healing environment.”
Pursuing a Childhood Dream In addition to his new duties with Teen Cancer America and his position as class president, Bral is working toward his childhood dream of becoming a doctor. Upon completing his master’s degree, Bral hopes to attend medical school and someday to practice integrative medicine. “As a child, I wanted to discover how things worked,” Bral said. “I would take apart radios,
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televisions and whatever I could get my hands on. I just didn’t know how to put them back together.” This curiosity has fueled his desire to pursue a career in medicine and learn more about the body, and his Georgetown education provides the ideal vehicle to get there, he said. “Being in a physiology program I really get to learn about the way the body works, what happens when things go wrong and learn about the complementary and integrative medical approach to helping with the healing process,” Bral added. Though only in his second semester at Georgetown, Bral has made an impression on his classmates and teachers, including on Aviad Haramati, Ph.D., professor of biochemistry and molecular and cellular biology, who co-directs the CAM program. “Daniel is a very bright, inquisitive and insightful student who came to our CAM program to learn about the state of the science for various alternative and integrative approaches to treating chronic illness,” Haramati said. “As the class president, he leads by example, displaying both objectivity and empathy. I am sure he will be a great asset to Teen Cancer America in his leadership role.” n
Student-Driven Triathlon Supports Hoya Clinc Thirty-two competitors swam, biked and ran for a cause during the 14th annual IronMed Charity Triathlon, which raised more than $10,000 to benefit the Hoya Clinic. The triathalon and a 5K run were held on Georgetown’s campus. The Hoya Clinic is a Georgetown student-run clinic that provides free primary health care to Washington’s homeless and uninsured population. Jessica Howard (M’16) is the co-coordinator of the IronMed event and notes that Georgetown medical students feel very connected to this fundraising event that supports the clinic. “The Hoya Clinic forms such an iconic part of each medical student’s experience here at Georgetown, and is truly a reflection of cura personalis, or ‘care for the whole person’,” Howard said. “Keeping the clinic open is not only important for the people it serves, but also to help train the Georgetown medical students to become the best clinicians they can be.” Race day events included the individual sprint triathlon, the team triathlon and the IronMed 5K run. Triathlon competitors completed a 750-meter swim, a 12-mile bike ride and a 5k run. The teams consisted of three athletes each, and each athlete completed one leg of the race.
A Worthy Cause This is the second year Howard and her co-coordinators Sean Mofidi (M’16) and Susan Walters (M’16) have been involved with IronMed; last year they served on the planning committee and helped solicit donations for prizes and gift certificates for the top racers in each category.
© Getty Images
“We all came to love the Hoya Clinic early on during our first year in medical school,” Mofidi said. “It’s a special place and knowing that IronMed was created to benefit the Hoya Clinic was a key factor in our decision to become involved with it.” The funds raised are used to purchase items and implement programs that benefit Hoya Clinic’s patients. A portion of the funds goes toward the Hoya Clinic Longevity Fund, which ensures Georgetown medical students, nurses and physicians can continue to provide necessary care to underserved patient populations in D.C. Volunteer physicians, nurses and medical students from Georgetown’s School of Medicine and MedStar Georgetown University Hospital staff the nonprofit clinic, located in southeast D.C. n
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Georgetown Goes Bald for a Cause on St. Baldrick’s Day Georgetown University Medical Center faculty, staff, students, parents and siblings came together for St. Baldrick’s Day, many of them going bald to show pediatric cancer patients that they aren’t alone in their fight. The event raises funds for the St. Baldrick’s Foundation, with a portion of proceeds benefiting pediatric cancer research at Georgetown Lombardi Comprehensive Cancer Center. More than 60 participants shaved their heads to demonstrate solidarity with children fighting cancer who lose their hair during treatment. St. Baldrick’s funds childhood cancer research and gives kids around the country access to the latest in research and clinical trials, said medical student Ashley Sharp (C’12, M’16), who organized the event along with fellow students Shaila Patel (M’16) and Abby Keogh (M’16). “At Georgetown, St. Baldrick’s provides research grants, including funding for students to work in pediatric oncology research labs over the summer,” Sharp said. The organizers set a fundraising goal of $20,000. By the day of the event, they had already surpassed their goal, bringing in more than $35,000.
Left: Colin Gibson, a student in Georgetown’s Special Master’s Program, and Danny McCorry, a first-year medical student, shave their heads during the St. Baldrick’s Foundation fundraiser. Right: Maria Braileanu (M’15) cut off about a foot of hair during the March 28 St. Baldrick’s Foundation fundraiser organized by Georgetown School of Medicine students. The event raised more than $35,000, a portion of which will also benefit pediatric cancer research at Georgetown Lombardi Comprehensive Cancer Center.
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“At Georgetown, St. Baldrick’s provides research grants, including funding for students to work in pediatric oncology research labs over the summer.” — Ashley Sharp (C’12, M’16) Georgetown students go bald to show solidarity with children with cancer.
Event highlights included a musical performance by Joseph Timpone, M.D., associate dean and director of the Office of Student Research at Georgetown’s School of Medicine, a bake sale, a bone marrow drive and a silent auction. Members of Georgetown’s men’s soccer team joined in on the fun and shaved their heads as well. Jack the Bulldog, Georgetown’s iconic mascot, also made an appearance. A group of patients and survivors gave their thanks and remarks to the St. Baldrick’s Foundation, including a current Georgetown College student. Bassam Sidiki was diagnosed with cancer during his senior year of high school in February 2011. He took a year off and then came to Georgetown, he said. “Eventually I want to go to medical school because I want to be able to treat patients who are going through what I’ve gone through,” Sidiki added. “I’m happy that St. Baldrick’s is doing things like this. It helps bring awareness to childhood cancer and hopefully the fundraising will help find a cure.”
Drawn by Passion Sharp became familiar with St. Baldrick’s Day in her first year as a medical student when she was undergraduate liaison for the event. She was immediately drawn to it because of her passion for oncology, as well as the event’s compassionate mission and engaging platform, she said. “I would be hard-pressed to find another event that brings out such selfless, spontaneous, inspiring actions in a community,” Sharp added. n
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P h i l a n t h r op y
Student Spotlight: Julia Carlson (M’16) When Julia Carlson (M’16), of Charlottesville, Virginia, came for her interview at Georgetown, she immediately felt a tangible sense of community. “I wanted to attend a school that felt supportive— not just from fellow students, but throughout the faculty and administrators,” she said. Georgetown is that place for her. Carlson is working to become the strongest clinician she can be. She appreciates that the coursework at Georgetown’s School of Medicine supported that goal by offering “a very early doctoring curriculum” in which students go into hospitals at the beginning of their medical education. Julia Carlson with emeritus faculty member Donald Knowlan.
“Their support allows students to focus more on careers of service and less on medical school debt.” — Stephen Ray Mitchell, Dean for Medical Education
Her decision to pursue a career as a clinician was driven both by her desire to help others and the sense of fulfillment she gets from daily interactions with patients. Carlson added that without financial aid, she would have been unable to attend Georgetown. “Receiving financial aid gave me the ability to attend a ‘dream school,’ and I try to take advantage of every opportunity offered because of the gift I was given. I will be a better doctor tomorrow because of what I was given today.” n
Supporting Generations of Medical Students The J.T. Tai & Co. Foundation
Since 1993, the J.T. Tai & Co. Foundation has provided scholarships for hundreds of medical students at Georgetown University. The late J.T. Tai, a Shanghai-born antiques dealer, started the foundation, and today, YC Chen, his friend and business partner for more than 40 years, maintains and oversees the daily operations. According to Chen, the now-deceased Tai always recognized the high costs associated with medical education and saw scholarships as an opportunity to make a difference in the lives of young people hoping to pursue careers as physicians. The foundation, she said, has always had a special interest in supporting the medical field because Tai believed scholarships are “an important and effective way of helping people.” “He also understood that whether you’re old or young, rich or poor, everyone gets sick. Helping the next generation of doctors is something he was very passionate about doing,” Chen explained. Having supported so many students over the years, she has also formed close relationships with a number of current and former students. These relationships, Chen said, are the most rewarding part of her work with the foundation. “Students come and visit, and we meet for lunch or have coffee,” she added. “They will tell me about their lives, and I love that.” Stephen Ray Mitchell, Dean for Medical Education is grateful for the generosity shown by the foundation over the years. “The Georgetown educational experience is centered in cura personalis—care for the psychological, spiritual, social, as well as physical, well being of the person. Their support allows students to focus more on careers of service and less on medical school debt.” Making Georgetown accessible to the very best students, regardless of finances, is integral to the university’s mission and the highest priority of the For Generations to Come campaign. n
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A New Day for Drug (Re)Discovery
By Patti North
ow many times have we heard about a new drug that shows promise in treating a disease—an announcement invariably accompanied by the disclaimer that even if it pans out, it will be years— perhaps decades—before it will be publicly available? For many of those who hear such news, it is bittersweet—sweet for the hope it may offer future patients and bitter because it may be too late to help a loved one who is already affected or has even died of the disease. Illustration by Michael Glenwood
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A New Day for Drug (Re)Discovery
he path to market for a new drug is a precarious one. Of more than 100,000 compounds screened, perhaps 10,000 will advance to preclinical studies. Of those, 100 may make it to clinical trials and perhaps one might receive FDA approval. Of the drugs that may eventually go to market, only two out of ten return revenues that match or exceed the cost of the research and development that brought them into fruition in the first place. And those so-called blockbuster drugs must generate enough revenue to recover the cost of the vast majority of other drugs that fail along the way.
Many things can derail a drug as it progresses toward FDA approval, but insight can be gained by understanding how drugs are developed. Because no matter what is being tested, the protocol is nearly identical. There are 27,000 molecules approved for pharmaceutical use and more than 20,000 human proteins. When a molecule binds with a disease-causing protein, you have the potential for a drug. First identified by German chemist Emil Fischer in 1894 as the â€œlock and keyâ€? model, testing for matches is a laborious and time-consuming process that has changed little since the 19th century, except it is now carried out by robots instead of humans. Once a match is found, it may lead to the compound being tested in animalsâ€”first for toxicity, then for effectiveness, and finally with larger sample sizes and amounts to find the safest and most effective dosage. If it is determined to be safe and effective in animals, the entire process is repeated with humans. [See Figure 1]
Phase I Safety Human
Phase II Efficacy
Preclinical Animal Testing
1,000 or More Patients
The Path to FDA Approval
Protein/X-ray c Potential Drug
FDA Investigation and New Drug Application Filed
Method/Use Patent for Repurposed Drug Composition of Matter Patent for New Drug
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Scientists at Georgetown University Medical Center and others in the research community believe there has to be a better way...or at least another way. The FDA has already approved 3,700 drugs for use in humans and more than 10,000 are in use internationally. Studies are starting to suggest that many of these drugs may be effective in new ways, perhaps even in treating some of our deadliest diseases.
Teaching Old Drugs New Tricks Repurposing drugs is not a new idea. Probably the most famous example of a repurposed drug is sildenafil citrate, which was developed in 1989 for treating high blood pressure and angina. It was not until the first tests on humans that a noticeable side effect was reported by a substantial number of male subjects. Though sildenafil citrate ultimately was deemed ineffective as a cardiac medication, today it is sold in the U.S. under the brand name Viagra—one of the most successful drugs of all time with sales exceeding $2 billion. The Viagra story, while dramatic, is illustrative of the process by which drugs commonly come to be repurposed —that is, its “secondary” use was discovered serendipitously as a side effect. A more sophisticated model involves targeted matching based on known mechanisms of action.
“I did not expect to see such effectiveness. I put seven researchers working on this for a year in my lab. When the data was analyzed— all the pieces fit together.”
— Charbel Moussa Thinking Outside the Box The Georgetown University Medical Center Laboratory of Dementia and Parkinsonism, headed by Charbel Moussa, M.B., Ph.D., discovered that small doses of a drug called nilotinib—used for years to treat leukemia— can arrest the growth of toxic proteins in the brains of mice with Parkinson’s and Alzheimer’s disease. Dr. Moussa’s theory focused on the way the drug “cleans” the cells of patients with leukemia by forcing their cancer cells into autophagy—a biological process that hastens their death by a kind of self-cannibalization. He thought nilotinib might work in the same way to clear the abnormal build-up of proteins in brain cells affected with Parkinson’s, Alzheimer’s, ALS, Huntington disease and other neurodegenerative diseases. “You have to think outside the box,” he said. “Can I make this mechanism work in the body in a different way”? The first hurdle was finding a drug that would penetrate the blood–brain barrier. Humans are born with all of the brain cells, or neurons, we will ever have, and the brain protects itself from many drugs that can easily enter other parts of the body. Of the 18 drugs that Dr. Moussa tested, only two entered and were effective in the brain—nilotinib and bosutinib. Of these, nilotinib was selected for further testing. The preclinical results were so promising, he feared they were too good to be true. “I did not expect to see such effectiveness,” Dr. Moussa said. “I put seven researchers working on this for a year in my lab. When the data was analyzed—all the pieces fit together.” He hopes it will work as well in humans as in mice. Imminent clinical trials will begin to test the effects of low doses of these drugs on biomarker changes and behavioral modification in patients with Parkinson’s disease and/or dementia.
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A New Day for Drug (Re)Discovery
Another Way One of the principal advantages offered by repurposed drugs is the accelerated path they can take to therapeutic use in patients. Since these drugs are already known to be safe in humans, researchers can advance quickly to study their effectiveness, helping patients and saving drug companies time and development expense. Yet our methods for determining which of the approved drugs may be effective on a particular disease have depended largely upon trial and error or even luck—until now. Sivanesan Dakshanamurthy, Ph.D., associate professor of oncology who works in the Experimental Therapeutics Program at Georgetown Lombardi Comprehensive Cancer Center and directs its developing Computational Chemistry Shared Resource, has developed a novel and large-scale approach to matching known drugs with protein targets associated with disease. Dr. Dakshanamurthy and his colleagues developed a rapid, computerized system that maps the structure of an approved drug and tests whether it fits into human protein crystal structures.
“There are 80,000 industrial chemicals used for construction and other commercial purposes. Probably, 70 percent are toxic, but the FDA is more concerned with drugs that you swallow, rather than those humans are exposed to in other ways.”
— Sivanesan Dakshanamurthy
The team led by Dakshanamurthy developed a comprehensive computerized prediction method called “train, match, fit, streamline,” or TMFS, which measures 11 different variables, including the shape and topology of the molecule, chemical similarity and how well the agent binds to the protein. In this, they are essentially employing the reverse of conventional methods. Instead of adopting a premise that a known drug may work on a known target and testing it, a high-speed computer looks for structural matches among all approved drugs and all targets represented by the National Institutes of Health (NIH) database of pharmaceutical structures and the National Center for Biotechnology Information protein database.
Unprecedented Accuracy The results were stunning—with 91 percent accuracy, the computer was able to match the drug to a protein known to be its target. It also pointed to new uses for existing drugs. For example, TMFS predicted that the anti-hookworm drug mebendazole would interact with a group of proteins called kinases which are implicated in certain melanomas and pancreatic cancers. Recently concluded animal studies have since validated the inhibiting effect of mebendazole on these cancers.
The group also discovered that the topology and chemistry in Celebrex, a well known prescription medicine for pain and inflammation, would allow it to bind to cadherin-11, a molecule associated with both rheumatoid arthritis and some particularly challenging cancers. Stephen Byers, Ph.D., a researcher who studies the function of cadherins in breast and colon cancers, then proved through laboratory experimentation that Celebrex does indeed bind to cadherin-11, inhibiting its function.
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Dakshanamurthy’s team also predicted that tamoxifen, widely used to treat and prevent some breast cancers, would interact with various proteins related to multiple disorders, including Alzheimer’s disease and prostate cancer. To date, all four of the drugs the team predicted would bind to a particular protein have done so. “It’s basically a search engine like Google,” Dr. Byers said. “But instead of looking for words and phrases, it looks for proteins and molecules.” And while researchers elsewhere are working on their own computational models, Georgetown’s is unprecedented in its accuracy. “Eventually all drug discovery will begin computationally,” Byers predicted.
A Cautionary Tale Repurposed drugs are, by definition, “dirty” drugs in the sense they interact with multiple targets. The very characteristic that may make a particular drug effective may also result in undesirable side effects. Milton Brown, M.D., Ph.D., who heads the Georgetown Lombardi Comprehensive Cancer Center’s Drug Discovery Laboratory and is a co-author of the study, recently published by the Journal of Medicinal Chemistry, urges caution. “There is a reason drugs fail. Finding new uses for old drugs does not eliminate the toxicities that exist with old medicine. Newer drugs are more selective and have a better safety profile. We have to strike a balance.” On the other hand, repurposed drugs may give us the opportunity to find treatments that have so far eluded science. “Take the cystic fibrosis gene—it’s well known to be mutated,” said Dr. Byers. “We know what the problem is, but we can’t fix it. They can’t replace the gene yet, but cystic fibrosis is part of a particular pathway. There are potentially other proteins in the pathway that could be targeted and affect the disease process.” Byers sees the promiscuity of these drugs as a plus. “Just because there is a wreck on 95, it doesn’t mean you can’t get to Florida,” he added.
“There is a reason drugs fail. Finding new uses for old drugs does not eliminate the toxicities that exist with old medicine. Newer drugs are more selective and have a better safety profile. We have to strike a balance.”
— Milton Brown
Another obstacle concerns the relative lack of crystal structures with which to make matches. There are 11,000 unique crystal structures in the protein database. The computing itself is very fast, but it takes time to grow crystals—only about 100 are added to the database every year. Further compounding the challenges is the fact that some crystals cannot be grown. There may be important transmembrane proteins on the surface of the cell that are difficult to crystallize. In some cases, part of it can be crystallized. Alternatively, the computer will look for one that is similar enough to allow investigators to predict what such a protein might do.
A Pharma-Economic Conundrum One of the most promising aspects of repurposing drugs is that they may make it easier for patients to afford treatment. Mebendazole, for example, costs pennies per dose to manufacture, while new promising experimental drugs for melanoma, for example, are phenomenally expensive—as much as $8,000 to $10,000 per month.
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A New Day for Drug (Re)Discovery
The prospect of more affordable drugs is good news, particularly for developing countries where many drugs are unavailable due primarily to their expense. On the other hand, the patent for mebendazole expired 30 years ago, and today, it is manufactured as a generic by a single Canadian company. “A lot of repurposed drugs are off-patent, so drug companies can’t make money. That’s what we’re struggling with now,” said Dr. Byers. “What is the business model?” One answer might be for new “use patents” to be issued. Such patents protect a therapeutic use for a small molecule or biologic, but they are not considered to be strong enough to afford much protection to the holder. Of course, the FDA does not prohibit physicians from prescribing drugs off-label, meaning for other uses, including patented uses, though it would mean that patients would benefit more sporadically. Another answer might be governments who are not obligated to their shareholders to be profitable, but are interested in cost-effective and safe treatment of disease on a population scale. Consequently, the U.S. government has taken on a role in advancing drug repurposing. For example, the FDA has recently joined with NIH to establish the NIH-FDA Leadership Council, which could serve as a forum for exploring strategies and driving progress.
On the Computational Horizon
“We know what the problem is, but we can’t fix it. They can’t replace the gene, but cystic fibrosis is in the pathway. There are many proteins that are in the pathway that could be targeted and affect the disease process. Just because there is a wreck on 95, it doesn’t mean you can’t get to Florida.”
— Stephen Byers
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While working to bring this project to its ultimate fruition by matching and testing all crystal structures of drugs and proteins, Dakshanamurthy is now embarking on another massive hunting trip: he is working on a toxicity prediction model for industrial chemicals. “There are 80,000 industrial chemicals used for construction and other commercial purposes,” he said. “Probably, 70 percent are toxic, but the FDA is more concerned with drugs that you swallow, rather than those humans are exposed to in other ways.” He explained that each year, up to 4,000 chemicals are being released—his model could help predict which might be toxic and help prevent harm to industrial workers before they are exposed to contamination. Summing up his hopes for the potential this type of work holds, he said: “My dream is to provide something that will be useful—a drug or a method—that will be useful to everybody—before or after they become patients.” n
Center for Cell Reprogramming
CENTER FOR CELL REPROGRAMMING Redefining Personalized Medicine By Renee Twombly and Lauren Wolkoff
A revolutionary new way of growing cells in the laboratory is drawing a great deal of attention and is attracting scientists from across the country, even internationally, to Georgetown University Medical Center (GUMC) to collaborate and learn the technique. The method, informally known as the Georgetown Method, is referred to as conditional reprogramming. Visiting researchers are meeting with GUMC scientists under the rubric of the new Center for Cell Reprogramming, which was established at Georgetown in March 2013. The Center is a global research hub that has pioneered a successful new model for taking healthy or diseased cells from an individual and growing them indefinitely in the laboratory â€” something scientists have tried to do for decades. The Georgetown Method is clearly redefining personalized medicine and regenerative medicine.
Image provided courtesy of Scott Randell, PhD
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Center for Cell Reprogramming
“We already have collaborators from around the world driving this technology forward,” said Richard Schlegel, M.D., Ph.D., who directs the Center. “The next step is to integrate the work of all these groups of investigators so that we can move this field forward as quickly as possible,” added Schlegel, who is chairman of the department of pathology at GUMC and a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center.
The ‘Georgetown Method’
“This new technology could provide a transformational, dynamic platform for personalized cancer therapy.” — Louis M. Weiner, M.D., director of Georgetown Lombardi
Of course, the topic foremost on everyone’s mind is the speedy development of the “Georgetown Method,” a term that has gained traction after an editorial published in the American Journal of Pathology in 2012 recognized the potential of this revolutionary discovery.
Known in the science world as conditionally reprogrammed cells (CRCs), the method was first discovered and described by Schlegel and Xuefeng Liu, M.D., associate professor of pathology at GUMC. “Already, this approach has shown great potential for personalizing cancer therapies,” said Christopher Albanese, Ph.D., a molecular oncologist at Georgetown Lombardi and one of the Center’s founders. “However, it also shows promise for in-depth investigations into the basic biology of cellular division …, for tissue regeneration, and for the treatment of non-cancer-based diseases such as cystic fibrosis and diabetes.” As stated in its mission, the Center hopes to “promote interactions, communication and collaborations among research programs involving stem cells and stem-like cells within Georgetown University and with extramural investigators and institutions, with the net effect being the enhancement of productivity, impact and fundability.” Already, the center has more than 15 collaborators throughout Georgetown Lombardi and GUMC, and equally as many from around the country—including investigators from Yale University School of Medicine, MD Anderson Cancer Center, Massachusetts General Hospital and the National Institutes of Health, among others. These collaborative efforts are designed to provide a unified front for interacting with pharmaceutical and private foundations to fund these exploratory sciences. At Georgetown, investigators are using CRCs to pursue biology-based studies in prostate cancer, breast cancer, thymoma, head and neck cancers, and they will be used to support clinical trials within the MedStar Georgetown Cancer Network. External collaborators—including laboratories as far as Korea and the United Kingdom,
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among other international sites—are investigating the utility of CRCs for treating a variety of diseases, and the National Cancer Institute is using CRCs in studies of head, neck and genitourinary cancers. Georgetown has a patent pending on the method, but scientific investigators can use it freely. Georgetown is currently employing various strategies, including formation of a spin-off company, Propagenix, to “The advantage is that we can grow these cells out facilitate scale-up and validation of the technology for various commercial under what we call reprogramming conditions so they applications. “This new technology could provide a transformational, dynamic platform for personalized cancer therapy,” said Louis M. Weiner, M.D., director of Georgetown Lombardi. “Others share our view,” he added, referring to Doug Melton, Ph.D., co-director of the Harvard Stem Cell Institute.
will grow very rapidly and very efficiently.” — Richard Schlegel, M.D., Ph.D.
In a 2012 news story about Schlegel’s cell reprogramming approach, Melton told the Associated Press, “What could be more personalized than taking this person’s cell, growing it in culture, finding a drug to treat them and then treat them?” Melton added that the Georgetown Method “gives an answer quickly enough that it could save lives.”
A new category of stem cells Researchers have long sought ways to study the mechanisms of healthy and diseased cell growth in cancer and other diseases. A stem cell is the early stage of a cell’s life before it develops its specialized function, such as a muscle cell, a red blood cell or a brain cell. Before the Georgetown Method, these cells were only obtainable from embryos (embryonic stem cells), or by genetically altering a cell to a stem-like state (induced pluripotent stem cells). CRCs represent a new category of stem cells. While the potential implications of this new technique go far beyond cancer, the foundational studies were conducted in cancer cells. Before Schlegel’s breakthrough in December 2011, no one had been able to keep both normal cells and cancer cells alive in the laboratory. Immortalized tumor cell lines did and still do exist, but they have changed so much over the decades that researchers say they do not resemble natural cancer cells any more.
Richard Schlegel, M.D., Ph.D.
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Center for Cell Reprogramming
“The advantage is that we can grow these cells out under what we call reprogramming conditions so they will grow very rapidly and very efficiently,” he said. Schlegel and Liu discovered that adding two different substances (known as a Rho kinase inhibitor and fibroblast feeder cells) to cancer cells or to normal cells pushes them to morph into stem-like cells that stay alive indefinitely. When the two substances are withdrawn from the cells, they revert back to the type of cell they once were.
“CRCs really could offer a fundamental change in the way drug treatments are selected for each individual patient.” — Christopher Albanese, Ph.D.
Unlike embryonic stem cells, CRCs do not form tumors as they grow, nor do they undergo genetic mutations that might make them difficult to study in the longterm. And unlike induced pluripotent stem cells, CRCs retain the characteristics of their native tissue; for example, cells taken from a breast cancer patient and grown as CRCs retain the breast tissue characteristics. Hence the potential for cancer therapy testing and for regenerative medicine. “Through our further development of the CRC approach, we would like eventually to be able to correct some very debilitating diseases. In diabetic patients, for example, if we can rapidly propagate the pancreatic islet cells that produce insulin and then place them back into the patient, we wouldn’t have to worry about rejection from putting alien cells into a patient,” Schlegel said.
Demonstration of personalized cancer medicine
Christopher Albanese, Ph.D., said this method offers a “fundamental change in the way drug treatments are selected for individual patients.”
The advance is seen in the field as an exciting demonstration of personalized cancer medicine. In fact, a case study authored by Schlegel and his team, published in the New England Journal of Medicine in 2012, showed how CRCs derived from normal and tumor cells of a 24-year-old man with a rare type of lung tumor allowed physicians to pinpoint an effective therapy. The man’s tumor cells were used to screen potential treatments and in this way, the scientists were able to see which therapies were active against the tumor cells and less harmful to the normal cells. “Our first clinical application utilizing this technique represents a powerful example of individualized medicine,” Schlegel said at the time. But he cautioned, “It will take an army of researchers and solid science to figure out if this technique will be the advance we need to usher in a new era of personalized medicine.” That army is now mobilizing — and is knocking at Georgetown’s doors.
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Post-doctoral fellow Nancy Palechor-Ceron, Ph.D., and Schlegel look at cells under a microscope.
“CRCs really could offer a fundamental change in the way drug treatments are selected for each individual patient,” said Albanese. Of course, much work needs to be done before the Georgetown Method can be approved for marketing by the U.S. Food and Drug Administration, he added. “But with so many researchers excited about the potential of CRCs, validation should come soon. And, with the remarkable range of applications for CRCs, the sky is the limit.”
“Our first clinical application utilizing this technique represents a powerful example of individualized medicine.” — Richard Schlegel, M.D., Ph.D.
Georgetown University has filed a patent application for the technology described here on which Schlegel and Liu are inventors; the patent currently is under exclusive option to a startup company, in which the University and Schlegel own equity, for commercial development. In addition, Georgetown and the University of Miami jointly have filed a patent application on related technology on which Schlegel and Albanese are among the inventors. The research described is funded partly by support from Georgetown University’s Department of Pathology. Other support for the research is provided by the National Institutes of Health (R01 OD011168), a Department of Defense Congressionally Directed Medical Research Program award (Prostate Cancer Research Program) and the National Cancer Institute (P30-CA051008 and CA129003).
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C l as s N o t e s
1950s 1960s 1970s For more information on the Georgetown University Alumni Association Awards and to see the list of 2014 John Carroll Award recipients, please visit alumni.georgetown.edu.
Mary Lucille Wiss (M’53), 88, passed away on August 2, 2014. She was a member of the Sisters of Charity of Nazareth. Wiss was the first female surgeon in Kentucky certified by the American Board of Surgery, and the first female president of the Kentucky Chapter, American College of Surgeons. She is survived by her beloved Christian sister of 48 years, Mary Pauline Fox, Lucille Howell; her brother, John Wiss, two sisters, Martha (Bill) Blakeman and Margaret (Dexter) Thornton; and several dozen nieces and nephews.
Raoul Wientzen (C’68, M’72) has published his first novel, The Assembler of Parts (2013, Arcade Publishing). Kirkus Reviews named the book one of the Best Books of 2013 and one of the Best Debut Fiction Works of 2013. Wientzen’s novel is available for purchase at bookstores and through Amazon.
John Carroll Award recipient, Medical Alumna, Regina Torsney-Durkin, M.D. (C’73, M’77) Regina Torsney-Durkin, (C’73, M’77) M.D., was honored during John Carroll Weekend 2013 in London for her lifelong achievements that exemplify the ideals and traditions of Georgetown University and its founder.
Marc Linson’s (M’74) youngest daughter Elyse Anna had been accepted to the Georgetown University School of Medicine, Class of 2017. Joseph A. Zenel (C’76, M’80), M.D., FAAP, of Sioux Falls, South Dakota, was named editor-in-chief of the American Academy of Pediatrics’ continuing medical education journal Pediatrics in Review (PIR). Zenel most recently served as deputy editor and associate editor of PIR. He is professor in the division of general pediatrics and director of the pediatric residency program, department of pediatrics at Sanford Children’s Hospital, University of South Dakota, Sanford School of Medicine. James M. Doyle, (M’92) M.D., has been board certified in pediatric anesthesiology, a distinction only recently been offered by the American Board of Anesthesiology. He works as a physician at Southeast Anesthesiology Consultants (SAC). Since this recognition, SAC is now recognized as a top pediatric anesthesiology provider in the region. Gayle Galletta (C’91, G’92, M’97) moved to Norway with her husband and three children. She was offered a position at Akershus University Hospital, just outside Oslo, to help establish emergency medicine as its own specialty. Stacey Epps, M.D.(M’97, R’00) has been named executive medical director of the Bon Secours Neurosciences Institute. Epps is also the chairman of the Department of Neurosciences at Bon Secours St. Francis Medical Center and vice president of the Epilepsy Foundation of Virginia. He is also a diplomat of the American Board of Psychiatry and Neurology.
2000s Page 42
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Mark Marinello (M’03) and Melissa Marinello (M’05) are proud to announce the birth of a baby boy, Ryan Parker Marinello. He was born on May 15, 2013, in Richmond, Virginia, and weighed 8 lb., 3 oz. Big brother James (3) and big sister Emily (2) are thrilled to have a baby brother. Melissa is a general surgeon and Mark is medical director of the pediatric intensive care unit at the Children’s Hospital of Richmond at Virginia Commonwealth University. n
School of Medicine Match Stats 2014
Three Medical Alumni Receive the 2014 Georgetown University Alumni Association Founders Alumni Awards Stephen C. Luck, M.D. (G’86, M’90), Marissa McDonnell, M.D. (C’87, M’93, R’97) and John Patrick Nairn, M.D. (G’84, M’88) were awarded Founders Alumni Awards during the 2014 Alumni Service Recognition Awards Banquet. Luck is involved with the white coat ceremony, World of Choices, student shadowing and the Dine with a Doc program. He also served as president of the Georgetown Clinical Society in 2011. McDonnell has been a member of the Medical Alumni Board since 2008 and is chair of the communications committee. She is involved with the Dine with aDoc program and has served as a mentor through the M.A.T.C.H. program. Nairn is on his second term on the Medical Alumni Board. He is involved with the Georgetown Scholarship Program and is a member of the Georgetown Parents Leadership Council. n
Visit alumni.georgetown.edu for more class notes or to submit your own.
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A l u m n i P r of i l e
Two Circuitous Paths to Medical School, 30 Years Apart Elinor Bond “E.D.” Martin, M.D. (M’79, R’83), took a nontraditional path to medical school: She was a Navy wife and a mother of two when she applied to Georgetown, many years older than the typical first-year student. In honor of her inspiring career and the countless lives she has touched, the Martin family established the Elinor Bond Martin, M.D., Endowed Scholarship for the School of Medicine. “I wanted to honor my wife by having the scholarship in her name—to do it in a way that carries on her ethos of being a doctor because her great gift was empathy with patients,” her husband, David Martin, said. The family has requested that the scholarship recipients be someone who had interrupted their studies—either to raise a family or for military service —before coming to medical school, both situations E.D. encountered before coming to the Hilltop.
A Winding Road Before ending up in Washington, the Martins, who would go on to have four children, were stationed in Hawaii as part of David’s tour of duty. When he retired from the Navy in 1969, the family settled in New York City, where Elinor first got an inkling she might like to attend medical school.
“I wanted to honor my wife by having the
scholarship in her name—to do it in a way that carries on her ethos of being a doctor because her great gift was empathy with patients.” — David Martin
“It turned out that she was better at diagnosing our children [when they were sick] than the doctors we would go see,” David Martin explained. “She was the human equivalent of a ‘dog whisperer,’ you might say.”
However, not only did E.D. lack the prerequisite coursework to apply to medical school, she had yet to earn her undergraduate degree. She had left Vassar College her junior year to join David as his military service was beginning. In New York, she enrolled at Columbia University, only to put her studies on hold once again when David got a job offer in Washington, D.C.
Once in Washington, E.D. enrolled in and graduated from George Washington University and began applying for medical school. Georgetown was her first choice. Rejected the first time because of low scores on her entrance exam, she persisted and got in the following year. She graduated in 1979, remaining at Georgetown throughout her career, until she was forced to retire early for health reasons.
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Jordan Trezza, left, enjoys spending time with the Martins, pictured here at their Maryland home.
A Perfect Match Jordan Trezza (M’14) was the first “Each step I have taken has given me a deeper recipient of the Martin Scholarship. Some 30 years after E.D., he found himself on understanding and appreciation for the science and a different—but equally indirect—path. After graduating from the U.S. Air Force study of medicine—furthering my passion, desire Academy, Trezza served in the military for nearly six years. He’d always been and interest in the field.” — Jordan Trezza (M’14) interested in medicine—having taught first aid to troops on base and completing an Emergency Medical Technician course in his free time—but it was during his deployment to Iraq that he began to think about medical school. Trezza was given the opportunity to volunteer in the base hospital emergency room, and what he witnessed there—the injuries, the chaos, the whirlwind nature of emergency medicine—made him sure that pursing a medical career was the right thing to do. “Each step I have taken has given me a deeper understanding and appreciation for the science and study of medicine—furthering my passion, desire and interest in the field,” he said.
‘It Seemed So Magical’ Over the years, the Martin family has developed a special bond with Trezza, inviting him into their home for Thanksgiving and family gatherings. “We found connections that made me believe we would be bonded for life: From my military station in Minot, North Dakota—where the Martin family was once stationed— to my chosen medical specialty of reconstructive surgery, which is the same as the Martin’s eldest son, I felt they had welcomed me into their lives as readily as they have entered mine,” said Trezza. “It was this total link up of our lives with this young man. It just seemed so magical,” David Martin added. There are other parallels, too. Most notably perhaps is that Trezza and Martin are both known for their selflessness and embodiment of cura personalis. Martin’s former patients
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A l u m n i P r of i l e
recall how she always combined routine patient care with an extra dose of understanding. “She didn’t just check their blood tests or wounds, she actually asked them how they were and what was going on with her family members,” her sister-in-law, Martha Martin, M.D. (M’79), recalled. “She really had a remarkable way with patients.”
“I hope they know the depth of feeling and gratitude I have for their generous aid and support. To be the recipient [of this scholarship] is an honor for which I am truly grateful, and having had the opportunity to meet [E.D.] Martin and her wonderful family and to learn of her exemplary work and commitment to her dreams, has served to further inspire me to be worthy of their acknowledgement.” —
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Likewise, when Trezza was asked to recall his favorite medical school experience to date, his mind goes to the moments when he has been able to care for others. “My favorite memories have been while attending ambulatory care at the emergency room at Washington Hospital Center and Hoya Clinic, where I not only see my studies put into practice, but I also get to help patients in the real world,” he said. Both parties—donor and recipient—feel an overwhelming sense of mutual gratitude. David Martin believes creating this scholarship to honor someone he loves has been “extremely rewarding” and said it has the added benefit of helping a young person become a doctor. “I’ve never done anything so satisfying in my life as set up that scholarship,” David said.
Trezza feels similarly from his perspective as a scholarship awardee. “I hope they know the depth of feeling and gratitude I have for their Jordan Trezza (M’14) generous aid and support. To be the recipient [of this scholarship] is an honor for which I am truly grateful, and having had the opportunity to meet [E.D.] Martin and her wonderful family and to learn of her exemplary work and commitment to her dreams, has served to further inspire me to be worthy of their acknowledgement.” n
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Daughter of God, Woman for Others Sister Grace Miriam Usala (MS’14, M’16) is using Georgetown’s unique MD/MS program in systems medicine as a platform for improving lives through more precise diagnoses. As the daughter, niece and granddaughter of physicians and scientists, Sister Grace Miriam Usala, RSM, became interested in medicine at a young age and was always an avid admirer of those who serve society. “My grandmother—a precocious woman who diagnosed and treated the juvenile diabetes of her eighteen-month-old son before the era of the home glucometer—and my father—an endocrinologist who diagnosed and treated the adrenal hemorrhage of my mother after complications from pneumococcal pneumonia—inspired me to help others,” said Usala. Today, she is studying medicine at Georgetown University while simultaneously growing in her Catholic faith and her role as a daughter of God.
Sister Grace Miriam Usala (MS’14, M’16)
From Habit to White Coat Before enrolling in medical school, she earned her degree in chemistry at Bryn Mawr College. It was during those undergraduate years that Usala decided to pursue religious life, entering the Religious Sisters of Mercy of Alma, Michigan, three months after her 2007 graduation. Becoming a Catholic nun is a lengthy process that requires both a calling to serve God and years of religious formation. She is currently in her seventh year as a sister and is preparing to make a perpetual commitment to the community next year. Usala’s journey began at the primary house of the religious order (the “Motherhouse” ), where much of her time was spent in prayer, study and the charitable works of the Institute. As part of her initial formation, she cared for the sick. During this time, Usala discovered she had a passion for medicine that was fueled by her desire to extend the mercy of God to others. After fulfilling her term as a novice—the first step to becoming a nun—her religious superiors assigned her to pursue a professional area of study that would allow her to serve the Church and to utilize her talents. “My superiors believe I have a certain scientific acumen and have asked me to complete medical school. I am being trained to provide patient care, and possibly to serve as a medical investigator and ethical consultant,” she explained. Acting in accord with her vow of obedience, Usala applied and was accepted into Georgetown’s medical degree program in 2010.
Discovering a New Discipline Systems medicine is changing the way patient care is being delivered in the United States, and Georgetown is one of the few schools in the country offering a degree in this interdisciplinary field. The curriculum requires medical students to step out of their academic and clinical training for one year to learn how the interplay among genetics, the environment and other factors may contribute to disease complexity and predict progressive illness.
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S t u de n t P r of i l e
Usala was introduced to the concept, as well as to Georgetown’s master’s program in systems medicine, during her sophomore year at a lecture given by Howard Federoff, M.D., Ph.D., executive vice president for health sciences and executive dean of the School of Medicine. Prior to the lecture, Usala was already thinking about how to improve the practice of medicine: “Doctors are treating illnesses as they occur, sometimes without thinking about how different diseases could be linked to one another,” she said. “We should have a more integrated understanding of illness.” Usala was attracted to the idea of studying systems medicine because it was an opportunity to learn how to predict disease prognosis and, perhaps prevent disease from progressing to functional impairment. Although she seemed like the perfect candidate for the program, her vow of poverty made her reluctant to pursue another year of study and incur additional cost; however, thanks to the generosity of donors, Usala received stipends and a scholarship to pay for the extra year tuition fees required to complete the dual degree program. In addition to financial support, she is also grateful for the excellent mentorship she received during the past year as she completes her studies.
Connecting the Dots With technology evolving at a rapid pace, particularly in the biotechnology field, and with the advent of electronic medical records, there is a large quantity of data now available for analysis. “Systems medicine is about looking at the data and making sense of it, connecting the dots,” Usala explained.
“Every oncologist and pathologist, and many other types of physician-scientists, will need better training to understand disease from a systems perspective in the near future. For the good of our patients, physicians like me will need to make sense of — Sister
As part of her master’s studies, Usala investigated whether patients with low serum sodium—called hyponatremia—are at an increased risk for osteoporosis and fragility factures. After analyzing thousands of health records from the MedStar Health Research Institute’s electronic database, Usala was surprised by her findings, which she presented at the Endocrine Society’s 96th Annual Meeting in Chicago.
Hyponatremia is the most prevalent electrolyte disorder in clinical practice and physicians have considered it a benign condition for decades, this data when it crosses our desks.” she explained. Through her research, she found that hyponatremia could be a significant Grace Miriam Usala risk factor for fracture, both chronically, by inducing osteoporosis, and acutely, by causing gait instability and increased falls. Today, the most common way of treating hyponatremia is to restrict how much water a patient can drink. “There are new drugs available, but they’re expensive,” she added. Usala hopes that, with the data gathered, someone may eventually conduct a randomized controlled trial to see if patient outcomes can improve by reversing hyponatremia. “If research can show improved outcomes for patients by correcting hyponatremia, we may be able to prevent fractures with a drug that, when it becomes generic, is affordable,” she added. Since osteoporosis is a complex ailment that affects approximately 200 million people worldwide, she’s excited that her work may bring the scientific community one step closer to getting to a trial that might improve people’s lives, leaving them less susceptible to further injuries. “Every oncologist and pathologist, and many other types of physician-scientists, will need better training to understand disease from a systems perspective in the near future. For the good of our patients, physicians like me will need to make sense of this data when it crosses our desks,” said Usala. Now in her third year of medical school, Usala looks forward to applying systems medicine principles to her practice of medicine. n
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