INDIANA UNIVERSITY SCHOOL OF MEDICINE · WINTER 2016
REVOLU T I ONI Z I NG
CORD-BLOOD TRANSPLANTS R EF L ECT I NG
WITH AN IU EBOLA SURVIVOR R EI M AGI NI NG
MEDICAL EDUCATION IN INDIANA
Designing a cure for
FOR ALL WHO ENVISION A HEALTHY FUTURE
s part of a university wide philanthropic campaign, Indiana University will match certain newly established endowments, doubling the impact of these gifts. The university launched the public phase of “For All: The Indiana University Bicentennial Campaign” in September with a goal of raising $2.5 billion. The campaign HOW DOES THE MATCH WORK? Typically, an endowment invested through the IU Foundation generates about 4.5 percent in income that is available to be spent each year. Through the match, qualified gifts will receive an additional annual payout of 4.5 percent of the initial value of the endowed fund, in perpetuity.
concludes at the end of 2019, just as the university prepares to celebrate its 200th anniversary. The endowment may benefit any area at the School of Medicine. For example, it may be directed to support research related to a particular disease, a specific department, or faculty and students at any one of the school’s nine campuses throughout the state. WHAT TYPES OF MEDICINE ENDOWMENTS ARE ELIGIBLE? CATEGORY GIVING LEVEL Chairs........................................................................$2 million or more Professorships..........................................................$750,000 or more Scholar/Investigator Professorships.......................$500,000 or more Scholarships.............................................................$100,000 or more
EXAMPLE: A $100,000 scholarship will generate the following payout: $4,500 ▶ Annual payout on the $100,000 principal $4,500 ▶ Annual match from IU (same amount each year) $9,000 ▶ Total amount to support IU medical students annually All gifts and pledges for eligible endowments made during the period April 1, 2013 – December 31, 2019 qualify for the match so long as match funds exist. Each household or organization may enjoy up to a $5 million maximum for all matching programs. Endowments established by multiple donors do not qualify for the match. Only individual, household, corporate or foundation donors are eligible for matching funds. To learn more about the Bicentennial Match Initiative and establishing an endowment, please contact: Elizabeth Elkas Associate Dean for Development 317-274-5262 or email@example.com
CONTENTS WINTER 2016
IUSMNEWS 34 ‘RIGHT INTO THE FIRE’
Dr. Jerome Adams’ first year as Indiana’s health commissioner didn’t come with much of a grace period as his agency confronted an HIV outbreak in Southern Indiana.
36 ANNUITY ADVANTAGE
Considering a planned gift to the School of Medicine? A charitable gift annuity is the gift that gives back, and it can also be used to support someone you love.
MAKING ROUNDS Over the past year, Dean Jay Hess has recruited a new group of leaders ready to carry the IU School of Medicine into the future.
INDIANA UNIVERSITY SCHOOL OF MEDICINE
▶▶▶ The Vera Bradley Foundation for Breast Cancer presented a $2.5 million check to support
breast cancer research at the IU Simon Cancer Center during its Tickled Pink event in October. The foundation has committed a total of $35 million to end suffering caused by the disease. Pictured here are Vera Bradley co-founder Patricia R. Miller, IU Simon Cancer Center Director Patrick J. Loehrer Sr., M.D., Vera Bradley co-founder Barbara Baekgaard, and Vera Bradley Foundation Executive Director Lynda Houk.
Editor Karen Spataro Associate Editor/Designer Matthew Harris
MAKE A GIFT To learn how you can make a gift to support medical research, education or the program of your choice at the IU School of Medicine, visit medgifts.iu.edu or contact Elizabeth Elkas, Associate Dean for Development, at 317-274-5262 or firstname.lastname@example.org.
CONTACT US This publication is produced by the Office of Gift Development to keep alumni and donors informed about the power of philanthropy. To comment, contact Karen Spataro at 317-278-1986 or email@example.com. DISCLOSURE The Indiana University Foundation solicits tax-deductible private contributions for the benefit of Indiana University and is registered to solicit charitable contributions in all states requiring registration. For a full disclosure statement, see http://go.iu.edu/89n.
A MEDICAL SCHOOL FOR THE FUTURE
The School of Medicine has confronted a physician shortage by expanding class sizes, re-imagining its curriculum and diversifying clinical settings to not only train more doctors, but prepare them for the future of health care.
A BATTLE WORTH WAGING
Peer Baekgaard escaped death in World War II, yet he couldn’t evade the ravages of Alzheimer’s disease. Now Barbara Baekgaard (pictured on cover), the co-founder of Vera Bradley, and her family are supporting research to keep others from enduring a similar fate.
LIFE IN THE BLOOD
Thirty years ago, Dr. Hal Broxmeyer helped develop cord-blood transplants. Today he’s doggedly running a laboratory that is striving to make the procedure better.
More than a year after winning his battle with the Ebola virus, IU School of Medicine alumnus Kent Brantly remains committed to serving those less fortunate.
CATCHING THE ENEMY
Often, pancreatic cancer is diagnosed too late. Now, IU scientists are devising ways to screen at-risk patients, catch it earlier and design better treatments to halt one of the deadliest types of cancer.
VOICING A TENOR OF HOPE
Mary Beth Gadus has overcome breast cancer three times in 27 years. Over that time, mere hunches by researchers turned into critical treatments. Inspired, Gadus and others have banded together to fund scientists as they develop potential therapies.
4 Duong, IUMEDICINE WINTER 2016 Peter Ph.D., director of the Terre Haute campus and interim associate dean for admissions, draped a crisp white coat on the shoulders of Christy Waterman at a ceremony in August. Waterman is one of 355 members of the IU School of Medicine Class of 2019 and is studying at the campus in West Lafayette.
WINTER 2016MEDICAL IUMEDICINE EDUCATION 5
A MEDICAL SCHOOL FOR THE FUTURE The nation’s largest enrollment. Nine campuses. And a diversity of clinical settings. It’s how the IU School of Medicine is stemming a physician shortage across the state and training physicians for the future of health care. By KAREN SPATARO he Indiana University School of Medicine welcomed its largest class ever this year as part of a steady expansion aimed at stemming a projected physician shortage throughout the state. The growth of the entering class—to 355 students—now makes IU the largest medical school in the country. “We train more than half of all physicians in Indiana, so we have a huge stake in making sure there are adequate numbers of professionals in the right specialties, with the right skills,” said Dr. Jay Hess, dean of the IU School of Medicine and vice president for university clinical affairs. “As our population ages, more people develop chronic diseases, and treatments become increasingly complex, our state will need more physicians. Increasing our class size is an important part of the solution.” The expansion is possible because of the school’s unique statewide system of nine campuses. Rather than squeeze students into classrooms and clerkships in Indianapolis, the majority of the growth is occurring at the school’s other locations in Bloomington, Evansville, Fort Wayne, Gary, Muncie, South Bend, Terre Haute and West Lafayette. For decades, those campuses have played a critical role in training students during the first two years of their medical school careers, when the curriculum focuses on basic sciences. More recently, the sites have expanded to offer clinical rotations that introduce third- and fourth-year students to patient care and expose them to different medical specialties. To accomplish that, the school is partnering with more than 50 health systems and nearly 3,000 community physicians across the state who welcome students into their practices and dedicate significant time to training the next generation of doctors. To Dr. Peter Nalin, the executive associate dean for educational affairs, the set-up is a win for
both the students and the communities. “Today there’s a wide spectrum of health care that is delivered in rural, suburban, and metropolitan areas,” Nalin said. “Students who get exposed to those environments in their training will be wellsuited for their experiences in residency and understand where they’re needed in the physician workforce of tomorrow.” Research also shows that students who spend part of their time at a regional campus and develop relationships are more likely to return to practice there or in a similar community—helping to meet the health care needs of Hoosiers in every corner of the state.
A RANGE OF EXPERIENCES
Annually in August, about two-thirds of the entering medical student class arrives at one of the eight regional campuses throughout Indiana. This year, roughly another 125 third- and fourth-year students are also completing clinical rotations there. Students who have completed clerkships at regional campuses say they receive a stellar education that prepares them well for residency. Dr. J.J. Cox graduated from the IU School of Medicine in May after spending the majority of his time at the program in Gary, located on the campus of IU Northwest. He grew up in Portage, the son of an electrician and an office manager, SUPPORT A REGIONAL CAMPUS To learn how you can support medical education at a regional campus, contact: Evansville | Catherine Zimmermann 812-465-1040 or firstname.lastname@example.org Fort Wayne | Gina M. Bailey 260-481-6731 or email@example.com Northwest | Dawn Yerger 219-981-4241 or firstname.lastname@example.org South Bend | Gail Mancini 574-631-5625 or email@example.com Terre Haute | Elizabeth M. Nesius 812-237-2776 or firstname.lastname@example.org For information about giving to the Medical Sciences program in Bloomington or campuses in West Lafayette or Muncie, contact: Caitie Deranek Stewart 317-278-2133 or email@example.com
and studied chemistry at IU Northwest. When it came time to apply to medical school, the idea of staying in that part of the state made sense. “I’m from the area, and I can definitely see myself going back to the area to practice, so why not do my rotations there and meet some of the physicians I am going to be working with—my future colleagues,” said Cox, who is now a firstyear resident in obstetrics and gynecology at Mercy Hospital in St. Louis. He got a lot out of the smaller setting. During clinical rotations, it was usually just him and the attending physician—no other medical students, residents or fellows. As a result, he received a great deal of one-onone attention and lots of opportunity to interact with and care for patients. During his surgery rotation, he shadowed four surgeons and scrubbed in on nearly every procedure. Jennifer Addo, another student from the Northwest campus who is currently pursuing a master’s in public health from Harvard University, said she thrived in that environment. “It’s you and the physician and you don’t have to compete with other students to get time in the OR,” said Addo, who was recently selected as an American Medical Association Foundation Physicians of Tomorrow Award recipient. “That also pushes you to step up your game. You can’t hide behind someone who’s a gunner. You have to know the answers. It challenges you to be a better student.” Dr. Patrick W. Bankston, an associate dean of the School of Medicine and director of the Northwest campus, said partnerships with numerous health care systems ensure students at regional campuses are introduced to a diverse patient base. His program is affiliated with several hospitals in communities that range from inner-city Gary, with a high Medicaid population, to Munster, a bedroom community of Chicago. That range of experiences gives students a very good sense of what it might be like to practice a
J.J. Cox, M.D.
particular specialty on a day-to-day basis. “This is community medicine,” Bankston said. “Certainly at a tertiary care setting, you’ll see things you won’t see in a community setting. But in a community setting, you’ll see things that happen commonly, and that is the kind of medicine most students will practice.” Students assigned to regional campuses also have the option to complete electives in Indianapolis or elsewhere in the country. To broaden his experiences, Cox took electives in gynecologic oncology and maternal fetal medicine in Indianapolis, giving him exposure to an academic medical center. “Everyone always wants you to tell them which is better,” Cox said of the difference
Peter M. Nalin, M.D.
New buildings enhance medical education As the role of the regional campuses continues to expand, the Indiana University School of Medicine is committed to ensuring students receive the same high-quality education, regardless of where in the state it takes place. That includes building new facilities. The school’s program in West Lafayette has been in its new state-of-the-art facility on the Purdue campus for a little more than a year. Preliminary plans are also underway for a new health sciences campus in Bloomington. Just this fall, the university broke ground on a multi-institutional research and education campus in downtown Evansville. The center, scheduled to open for the 2017-2018 school year, will house the IU School of Medicine’s
programs in the city and is a partnership with the University of Southern Indiana and the University of Evansville. “The various health science programs offered by the participating schools will redefine the future of health care not just for our region, but for the entire state of Indiana and the nation,” said Dr. Steven Becker, director of the IU School of Medicine-Evansville. “The medical campus will tap the knowledge and experience of local physicians, who are immensely skilled and widely respected in their professions, to provide most of the clinical training. We know that most doctors who are trained here will stay here, creating a pipeline of future health professionals for our region.”
across Indiana who partner with us year after year to teach our medical students.” Among those volunteers is Dr. Rebecca Wolinsky Galante, a 1984 graduate of the IU School of Medicine and an internist in Munster. She has been a volunteer faculty member at the Northwest campus in Gary since 1992. Through an introduction to clinical medicine course, she teaches first-year medical students such basics as how to introduce themselves to patients, where to stand in an exam room, and how to take a proper history. “I love being part of the IU School of Medicine,” said Galante, who recently joined the board of directors of the IU School of Medicine Alumni Association. “It’s really nice to interact with the students, to help them understand the process of becoming a doctor and how important it is to have respect for your patients.” Dr. David Van Ryn, an emergency physician at Elkhart General Hospital, is the clerkship director of emergency medicine for the South Bend campus. The hospital offers both electives and core Jennifer Addo
between studying in Indianapolis and at a regional campus. “There is no answer to that. Both are very good options.”
The expansion of clinical rotations throughout Indiana doesn’t just provide students more options. The school’s statewide system is unique in that it permits as many hospital systems as possible to participate in medical training. And it gives IU alumni and other community physicians the opportunity to be involved in medical education in meaningful ways. “We have a tremendous spirit in Indiana of giving back and teaching forward to the next generation of physicians,” said Nalin, the Dolores and John Read Scholar in Medical Education. “We’re grateful for the alumni and practicing physicians
IU President Michael McRobbie (left) at the Evansville groundbreaking
clerkships in various disciplines, including pediatrics, internal medicine, orthopedics, emergency medicine and others. “The long-game is that it’s a recruiting tool,” he said. “The more students are exposed to a community, the more they are exposed to mentors and colleagues, the more likely they are to say, ‘That was a healthy environment, it’s a healthy place, and I’m going to look at coming back there.’” Like Galante, Van Ryn described having students around as energizing, and said it also makes him and his colleagues better at their jobs. “You see people on your medical staff just blossom,” said Van Ryn, a 1981 graduate of the IU School of Medicine. “They feed off the inquisitive nature of the students. I think an awful lot of us have always looked for an opportunity to give back to the school and do some educating. There are a lot of people who would not be comfortable or happy in a full-time faculty role, but some part-time teaching is just beautiful.” When the statewide system for medical education was being created in the late 1960s and early 1970s, it was planned to be “a medical school without walls, both in space and in time.” The hope was to use all available resources throughout the state for medical education. Today, the School of Medicine is closer than ever to living out that vision, and it’s a beautiful thing for all involved—most especially for the patients IU medical students will one day serve.
+ ALZHEIMER’S DISEASE
A BATTLE WORTH WAGING
Photo: Provided by Vera Bradley
By Karen Spataro
The Barbara and Peer Baekgaard Chair in Alzheimer’s Disease Research helped the IU School of Medicine recruit Liana Apostolova, M.D. (left), who studies the genetic underpinnings of the disease.
Peer Baekgaard defied death during World War II. Yet Alzheimer’s disease was a foe he couldn’t outrun. Now, Barbara Baekgaard and her family are helping the IU School of Medicine make it a fight patients can win.
eer Baekgaard had a knack for cheating death. As a young man growing up in Denmark during World War II, he joined the Danish Underground and helped Jews flee to freedom. He was eventually captured by the Nazis, shipped by train to a prisoner-of-war camp, and sentenced to die. On one occasion, Peer and his five cell mates complained to a seemingly friendly guard that their cramped quarters meant they had to sleep in shifts. The guard asked for volunteers. Three of the prisoners stepped forward, thinking they would be moved to another cell. Instead, they were shot at point-blank range. Peer would defy death other times. The paperwork listing each prisoner’s sentence was destroyed during a British air raid, providing him an unlikely stay of execution. A few months later, he and his fellow prisoners found the gates to their P.O.W. camp left open. They snuck out, hid in fields and brush during the day, and made the long trek back to Copenhagen at night. They only learned the war had ended when they arrived home. While Peer survived the atrocities of World War II, he later faced another type of evil that he couldn’t beat: Alzheimer’s disease. He died on July 1, 2007, robbed of his strength, independence and quick mind. “He had survived so much and then to have this hit him, it just seemed so unfair to me,” said Barbara Baekgaard, who married Peer in 1990. “I would rather have had him drop dead of a heart attack than have him suffer like he did.”
Now, Barbara is fighting back against the disease that took FIGHTING BACK Peer from her. She and her Peer Baekgaard’s battle with four children have established Alzheimer’s started with little a $2 million endowed fund at slip-ups, like going to the the Indiana University School wrong hotel to meet his wife on a vacation. Now, Barbara of Medicine to help put an Baekgaard, the co-founder of end to suffering caused by Vera Bradley, and her family Alzheimer’s. As part of the have made a $2 million gift to Indiana University Bicentennial the School of Medicine to help Campaign, income from the researchers halt the disease. fund will be matched each year, doubling the dollars available for research. The gift is already being put to good use. The Barbara and Peer Baekgaard Chair in Alzheimer’s Disease Research played a critical role in the recruitment last year of Dr. Liana Apostolova, an Alzheimer’s specialist from UCLA. Apostolova focuses on understanding the genetic underpinnings of Alzheimer’s disease and deploying high-tech imaging to study how it unfolds in the brain. “I want to know that someday no one will have to worry about this disease,” said Barbara, who is co-founder of Vera Bradley, the Indiana company best known for its colorful quilted handbags. “I want them to find out what causes it, or how to delay it, or ideally how to cure it. Certainly that would be my goal.” It’s a bold challenge, but IU physicians and scientists are pledging to rise to the occasion. “Supported by the generosity of people like Barbara and her family, we are building a team that is working tenaciously to understand how Alzheimer’s disease develops and how we can slow or block its progression,” said Dr. Jay Hess, dean of the IU School of Medicine. “These people are passionate. They won’t be satisfied until we’ve stopped the disease in its tracks.”
‘THE LONG GOODBYE’ After the war, when Peer was an exchange student in California, an agent had him screen test for the role of Tarzan. He returned
to Denmark and never got the part, but decades later, the chiseled good looks and broad smile that got him noticed in Hollywood won the attention of his future wife. When Peer and Barbara’s paths first crossed in the late 1980s, he was already a successful businessman, having immigrated to the United States years before. Vera Bradley was just beginning to take off. The two served on a board together. Barbara remembers walking into her first meeting and being instantly struck by the commanding man across the room. “I think I’m going to like serving on this board,” she recalls thinking. They wed three years later, the second marriage for both. As business leaders, Barbara and Peer maintained dizzyingly busy schedules. He remained in Chicago during the week to run Baekgaard Ltd., a company that specialized in men’s gifts and accessories. Barbara spent weekdays in Fort Wayne, Indiana, building Vera Bradley and personally overseeing the many designs that grace the company’s purses, luggage and other products. In hindsight, those separate schedules allowed Peer to conceal the early signs of his illness, Barbara acknowledges. She first noticed something was amiss in the early 2000s during a trip to Atlanta. They flew in separately and were scheduled to meet at the hotel. He went to the wrong one. “That seems so minor to most people, but he was so sharp,” Barbara said. “It was so out of character.” Over time, she noticed more and more little slip-ups. Not long after, Barbara visited the IU School of Medicine for a meeting of the cancer center fundraising board. (Under the leadership of Barbara and Vera Bradley co-founder Patricia Miller, the company foundation has committed $35 million to breast cancer research at IU.) She mentioned her worries about Peer to
Photos: Provided by the Baekgaard family
“I want to know that someday no one will have to worry about this disease. I want them to find out what causes it.”
a friend at the school and arranged to bring him for an evaluation with Dr. Martin Farlow, a nationally respected IU neurologist. Even though she knew something was wrong, the diagnosis of Alzheimer’s disease left her floored. She vividly recalls being unable to control her tears. “My parents lived into their 80s, their minds were perfectly sharp,” Barbara said. “I wasn’t aware of Alzheimer’s. I truly didn’t know anyone who had it. This was just a shock, and of course I started reading about it, and I realized it’s the long goodbye and the road to nowhere. There was nothing I could do to change this.”
HOPE THROUGH RESEARCH Current treatments for Alzheimer’s disease can do little to slow its march, and like Peer, patients inevitably succumb to their disease. Barbara and her family recognize that research is the only hope to change the outcome. Joanie Hall, Barbara’s oldest child and a trustee of the family foundation, said supporting the program at IU is a natural fit. “Our main goal is to do things my mom can be proud of,” she said of the family foundation. “She fell in love with IU through the Vera Bradley Foundation and through the team there when Peer was diagnosed. We’re giving back for all the kindness she was shown, and we’re looking for a way to make life easier for Alzheimer’s patients and their caregivers—to stop it, cure it, cut it off in its path.” That’s where Apostolova comes in. As the first holder of the Barbara and Peer Baekgaard Chair, she joins a team of dozens of IU researchers from diverse backgrounds looking at what goes
wrong in our genes to give rise to Alzheimer’s, how those changes affect our brains, and how we can develop new treatments to intervene. Specifically, she is seeking to: • Establish sensitive tools for diagnosing the disease as early as possible, when therapy has the greatest potential to make an impact. • Understand the way people’s genes predispose or protect them from Alzheimer’s. • Learn how specific genetic glitches change the brain, and what physical and cognitive symptoms result from each mutation. All of this is crucial to developing new drugs and other therapies. This past summer, shortly after arriving at IU, Apostolova traveled to Fort Wayne to meet Barbara and learn about Peer. She left promising to help build a world-class research program and to make progress in Peer’s memory. “I would never trade what I do for anything else,” Apostolova said. “I truly feel very passionate.” For her part, Barbara feels confident that Peer would be proud to have his name connected to Alzheimer’s research. When he was a patient, he agreed to participate in clinical research studies, even though some of the tests were painful and offered no benefit to him. “He knew he couldn’t be cured but he wanted to help,” Barbara said. “We just want to know that some good will come from this.” Back during the war, on his 23rd day at the P.O.W. camp, Peer scribbled a long note to his mother describing life as a prisoner— his measly rations of bread, butter and soup, the sounds of planes flying low overhead, and his yearning for everyday items like a washcloth, a pencil and Ovaltine. “Can it go on much longer now with this God-awful war, what do you think?” he wrote. Today, the Baekgaard name is associated with another war. While the enemy is different, it is also brutal and cruel. With the help of Barbara and her family’s generosity, we can hope that the end may soon be in sight.
ALZHEIMER’S DISEASE / RESEARCH
Getting A Head Start To keep Alzheimer’s disease from stealing memory, IU scientists are working to find hints of its presence and new ways to halt its insidious effects. By KAREN SPATARO To Dr. Andrew Saykin, Alzheimer’s disease is a race against time. He and other researchers now believe that most forms of dementia begin to develop at least two decades before someone arrives at a doctor’s office worried about misplaced keys or slipping memory. By that point, the damage could be irreversible. “It could be 20 or 30 years too late,” said Saykin, director of the Indiana Alzheimer Disease Center at the Indiana University School of Medicine. “To actually do something where you can intervene, whether it’s a new drug, diet, exercise or other environmental kinds of interventions, all that has to happen decades earlier.” That’s no small challenge given the complexities of a disease that robs more than 5 million Americans of their memory and dignity. Still, Saykin sees cause for optimism. With a crop of nationally recognized experts, an arsenal of new high-tech tools, and the support of generous donors, he is confident IU will contribute to research breakthroughs that pave the way for earlier detection and treatment, and—ultimately— prevention. He knows the clock is ticking. “We are working day and night on the biology of Alzheimer’s,” he said.
CLUES IN OUR GENES
Alzheimer’s disease is somewhat of a misnomer. Rather than a uniform disease, it’s probably a series of related diseases that arise when something goes wrong with a patient’s genetic code. To cure or slow it, scientists need to figure out which genes put people at risk—or protect them. In most dementias, there’s not one culprit gene, but several genes with subtle variations that conspire together. Add to that questions about the role of the environment, a patient’s immune system, diet and lifestyle choices, and it’s clear there is no simple solution. “There is not going to be one drug to get rid of Alzheimer’s disease,” said Dr. Tatiana Foroud, chair of the Department of Medical & Molecular Genetics. While complicated, technology is helping researchers make sense of the illness. Today’s sequencing capabilities allow scientists to study every single position along an individual’s DNA to identify and Tatiana Foroud, Ph.D. evaluate changes that might have led to Alzheimer’s disease. IU plays a critical role in this work. Foroud runs the National
and night on
the biology of Alzheimer’s,”
said Dr. Andrew Saykin.
Cell Repository for Alzheimer’s Disease, the nation’s largest clearinghouse of blood, tissue, spinal fluid and other samples collected from people across the country with Alzheimer’s disease. Researchers from dozens of institutions mine the samples to compare the genes of patients with Alzheimer’s disease to those without. “We are the national center for banking specimens related to neurodegenerative disorders,” said Dr. Jay Hess, dean of the IU School of Medicine. “Many of our insights into diseases like this come from having very well characterized tissue for genetic analysis, and we’re supporting the entire country.”
Not too long ago, researchers could only study the biology of Alzheimer’s disease in patients after they died through an autopsy. But Saykin, a professor of radiology and imaging sciences, is part of a new class of researchers who are changing that. With the aid of high-tech MRIs, PET scans and other technology, he can peek inside the brains of patients with Alzheimer’s disease. The pictures he produces look nothing like standard x-rays; they measure brain activity, blood flow, abnormal proteins, and even how fast the brain burns glucose to power itself. The scans are crucial for
Lamb describes that prospect as “huge.” The body is built to protect against foreign substances getting into the brain. Normally, that’s good. But in the case of Alzheimer’s disease, it makes drug development especially tricky. Targeting cells outside the brain could circumvent that challenge. “This is an area that is really important to understand,” said Lamb, who is expected to be named the first holder of the Roberts Family Chair in Alzheimer’s Disease Research when he arrives at IU in January.
several reasons. First, they can identify patients with evidence of Alzheimer’s, but who haven’t yet started showing symptoms. Studies are underway that begin treatment during this window. Imaging also helps assess whether potential drugs work by measuring if they clear plaques and tangles, abnormal proteins in the brain that are hallmarks of the disease. Finally, marrying imaging with genetic analysis provides a powerful one-two punch. By pairing what he sees with patients’ genetic profiles, Saykin sheds light on how specific genetic glitches affect the brain. For example, a multi-institutional team led by Saykin and other IU scientists recently discovered that a specific variant in an immune system gene is associated with higher rates of amyloid plaque buildup— and a higher risk for Alzheimer’s disease. Drugs that target the downstream effects of the gene are already used to treat rheumatologic and inflammatory conditions, and an antibody is being tested for some types of leukemia. Those therapies can now be evaluated as possible therapies for Alzheimer’s disease.
IU neurologist Dr. Martin Farlow is internationally recognized for his work in clinical research and has been involved with nearly every major trial to test Alzheimer’s drugs. Drug trials take years to complete, and they can easily be derailed. An otherwise effective drug may seem like a failure and Andrew Saykin, Psy.D. be abandoned if the dosing is wrong, or if it’s not reaching the central nervous system as intended. So in addition to being involved with the trials themselves, he’s looking for ways to catch those kinds of IMMUNE INFLUENCE issues early on. Research involving patients is absolutely Farlow is among a group of experts essential, but it has limitations. Dr. Bruce building an NIH program to improve Lamb, a neuroscientist recruited from the testing of drugs in the earliest stages of Cleveland Clinic to be director of the Stark development. Here’s how it will work: A Neurosciences Research Institute, brings small catheter will be inserted through a a strong basic science background to the needle into the space just below a patient’s program. His studies use mice modified spinal cord, allowing with human genes researchers to test spinal known to be linked to MAKE A GIFT TO fluid over 24 or 36 Alzheimer’s. ALZHEIMER’S RESEARCH hours. Then the patient One focus of his will be given a dose of To learn how you can support laboratory involves a drug. Alzheimer’s disease research at the understanding the role “We’ll be able to IU School of Medicine, contact: of the immune system measure levels of that Lee Vriesman in Alzheimer’s disease. drug to know if it gets He and his team have 317-278-4142 into the central nervous identified an immune firstname.lastname@example.org system and how it’s cell that typically processed,” Farlow circulates throughout said. “We’ll also be able the body, but in to look and see if it’s some cases migrates doing what we think it is in terms of target to the brain. When it does, it seems to engagement with tau, amyloid beta or with increase the risk of Alzheimer’s disease various other proteins that are involved in laboratory models. “If this is true, can with Alzheimer’s disease. This is a very we detect these cells outside the brain and exciting program that’s just now getting target them there?” he asks. geared up.”
A MAN AND HIS LAB Hal Broxmeyer, Ph.D., spent the better part of two decades overseeing research at the schoolâ€™s Walther Oncology Center and as chair of the Department of Microbiology and Immunology. Over the past five years, heâ€™s stepped away from administrative duties to run a lab at the IU School of Medicine that focuses on hematopoietic stem cells.
LIFE IN THE BLOOD DR. HAL BROXMEYER PIONEERED THE USE OF UMBILICAL CORD BLOOD TO TREAT CANCER AND IMMUNE DISORDERS. THE PROCEDURE HAS BEEN PERFORMED 35,000 TIMES. YET RESEARCHERS STILL HAVE QUESTIONS. THE VETERAN SCIENTIST AND HIS LAB ARE RELENTLESSLY SEEKING ANSWERS.
By MATTHEW HARRIS n a slow afternoon in early July, Hal Broxmeyer was counting. The longtime professor of microbiology and immunology hunched over an Olympus CKP-TR microscope. Peering down its binocular tube into a well, his 70-year-old eyes scanned small clusters of cells before he lifted his head to scrawl digits in a column on a sheet of paper. Scoring cell colonies is as rudimentary as bench research gets. It’s also a task veteran researchers tend to cede to newbies in their lab’s employ. Few would dispute Broxmeyer’s right to hand this task off. Over a 32-year career at the Indiana University School of Medicine, the native New Yorker conceived, developed and proved the utility of using once-discarded blood from umbilical cords to treat blood and bone cancers. Over the last three decades, physicians have collected blood from cast-off cords, frozen it, thawed it, and infused it into patients more than 35,000 times. Call up Broxmeyer’s name in a database that sifts through research journals, and it pops up more than 1,100 times. Scan faces of past presidents of the American Society of Hematology, and there’s Broxmeyer—the only non-physician to ever lead the group. So why does Broxmeyer engage in counting cells, the most elementary of tasks? “It kind of relaxes me,” he said. And the trusty, if battered, Olympus remains his instrument of choice. Forty years ago, a mentor gifted it to Broxmeyer. Now, its gray paint is nicked, and a crack splits the glass plate on its stage. Nostalgia as much as utility keeps him from ditching one of the few items he packed up before decamping from Memorial Sloan Kettering Cancer Center in 1983. “It’s a pretty crummy one,” Broxmeyer said. “But it’s all I need.” And it sates a ravenous curiosity. Age has not weathered Broxmeyer’s tenacity. Nor have two fights with thyroid cancer deterred him from seeking to answer a single question: Can we make cord-blood transplants better? With Broxmeyer focused on the matter, the answer is yes. This June, he and the seven investigators working in his lab unveiled a major finding in Cell, one of the world’s most prominent scientific journals. So why stop? Broxmeyer and his microscope have revelations to share.
IRST YOU NEED a history lesson about the genesis of cordblood transplants. To help, Broxmeyer stores an artifact in a cubicle across the hall from his office. Big Boy, he calls it. And the moniker is apt for a dry-shipper—a cross between a propane tank and Igloo water cooler—meant to shutters, churning out red and white blood cells, platelets keep its contents locked in a deep freeze. and more stem cells. Broxmeyer and fellow collaborators In September 1988, Scott Cooper, the laboratory’s proved through laboratory studies that cord blood was a de facto manager and Big Boy’s roommate, belted the tank viable source of hematopoietic stem cells, and that the liquid into a seat on a Trans-Atlantic flight to Paris. Inside, liquid harbored enough cells to equal what could be culled from nitrogen cooled the air to minus 283° Fahrenheit to ferry bone marrow. 5 ounces of blood more than 4,000 miles. In an isolation Still, most of Broxmeyer’s peers dismissed the notion ward at Hospital Saint-Louis, a 5-year-old boy named that cord blood could be used in place of traditional bone Matthew Farrow waited for it to flow into his marrow transplants. Assuaging skeptics veins. meant proving cord blood’s utility in PLUGGING AWAY Inelegantly put, the child was a beta test. patients. Since proving the utility of And Broxmeyer has held on to the relic “We had to pick a disease there was some cord blood as a source of that made it possible. “He’s hoping the good hope for,” Broxmeyer said. Their transplantable stem cells, Smithsonian will want it someday,” Cooper choice: Fanconi’s Anemia. Broxmeyer and those in his said. The rest of the story unfolds perfectly. lab—seen above in 1993—have Since age 2, Farrow had suffered from The Farrows’ unborn daughter lacked the tackled nagging questions about Fanconi’s Anemia, a disorder that left his genotype for Fanconi’s. Her tissue was how to extract more cells and bone marrow unable to generate blood cells a near identical match to Matthew’s. In help them better take root in a to ward off infections, ferry oxygen or clot February 1988, Dorothy Farrow, whose patient’s bone marrow. wounds. Matthew’s prognosis had been grim. name meant “gift from God,” was born. An older sister failed as a potential match to Blood was drawn from her umbilical cord provide bone marrow, and his parents weren’t and shipped to Broxmeyer’s lab at IU. optimistic the National Donor Marrow Several months later, the Farrows jetted Program registry would better their son’s to Paris, where European protocols allowed odds. the procedure to take place. Ultimately, In 1987, the Farrows conceived a third it fell to Cooper to deliver the blood to child and hoped the baby’s marrow could the physician who agreed to perform the one day match with Matthew’s. But a scientist transplant. Broxmeyer followed behind a from the Indiana University School of week later. Medicine would offer an unconventional On October 6, 1988, the blood from solution. Dorothy Farrow’s umbilical cord flowed Imagine hematopoietic stem cells as from an IV into her brother. Broxmeyer miniature blood factories operating deep flew back to the States for a nerve-wracking in our big bones. The assembly line never three weeks waiting to see if the procedure
Photos: Tyagan Miller (left); IUPUI University Library Special Collections and Archives (above left and right)
worked. “It was very scary because it took Matthew a long time,” he said. On Day 22, his blood count came back normal. Two months after the transplant, Farrow had received his final blood cell transfusion, and his B-positive blood had changed to O-positive—the same as his sister’s.
HREE DECADES LATER, the procedure is reliable. Often, administering cord-derived stem cells to rebuild a patient’s obliterated immune system takes less than 15 minutes. Blood can be stored for up to 25 years, giving rise to a blood-banking industry that one estimate predicts will generate $15 billion in revenue by 2019. And success rates using cord
blood mirror those of bone marrow. But questions still nag Broxmeyer and other researchers. The procedure is most common, and successful, in children. How can we ensure there are enough cells to treat adults? Can you boost the number of cells available? What would help those stem cells home in on marrow and engraft? And how can the financial burden—it can cost upwards of $40,000 for a single unit of cord blood—be slashed to remove another hurdle for patients?
Roughly five years ago, Charlie Mantel, then a longtime member of the lab, had a hunch. He wondered: How does a stem cell behave in normal air? Typically, the oxygen level in bone marrow ranges between 1 and 4 percent. This is five times less than the air we breathe. Exposure to normal air, Mantel thought, might tax the cell. To cope, a stem cell evolves, becoming a progenitor cell in a process the lab dubbed EPHOSS—Extra Physiologic Oxygen Shock Stress. This differentiation matters. Hematopoietic stem cells are like a Kinko’s that never closes, capable of copying themselves infinitely. A progenitor, though, can only replicate a limited number of times. By collecting cord blood in normal air, perhaps physicians were losing stem cells needed for a transplant by unwittingly causing them to become progenitor cells. So Mantel pitched Broxmeyer an idea: Gather the stem cells in low oxygen. “Let’s go for it,” Broxmeyer replied. “Let’s test it.”
ARLY IN HIS CAREER, Broxmeyer didn’t decompress. After long days at Sloan Kettering, he’d descend into the underbelly and commute along the rumbling innards of New York’s subway. The jostling car was a mobile office, one where he meticulously plotted out experiments. During the next day’s trek, he’d digest data and start composing abstracts in his head. “I was driven because I loved what I did,” Broxmeyer said. “When things work out, you want to work more.” When he first arrived at IU, the marching orders were clearly defined: If there was open space at the bench, a researcher should be sitting there. “He was just tenacious,” said Cooper, one of Broxmeyer’s first hires upon arriving in Indiana. “He could probably see before all of us where this was going to open up a new field.” Broxmeyer frames his ascent up the ranks as a product of skill and timing. In the late 1980s, Dr. Joseph Walther, himself a professor of medicine at the school, had money from the sale of Winona Memorial Hospital and used some to set up the Walther Oncology Center. He asked Broxmeyer to head up its research arm—a job he held until 2009. Over the same span, he led the Department of Microbiology and Immunology. Prolific is the attribute most often pinned to him. In his tenure at the School of Medicine, it has been his routine to publish 25 papers a year. Quantity doesn’t rob those investigations of quality, either. His work has graced the high-impact pages of Science, Nature Medicine, Blood and the New England Journal of Medicine. This corpus is as influential as it is ample. Peers have cited its contents more than 27,000 times. “Hal is a force of nature,” said Dr. Patrick Loehrer, who is director of the Indiana University Melvin and Bren Simon Cancer Center and who joined the medical school faculty in 1983 with Broxmeyer. “He works with one speed—fifth gear. He’s never off.” It’s a quality evident outside the sedate confines of his laboratory, as well. Growing up, Broxmeyer realized he loved weight lifting on its own merits more than he did for its original purpose—cross-training track. No, it’s not a hobby. There’s a full Olympic weight set in his basement. He’s won the USA Weightlifting Federation master’s division—twice. Give Broxmeyer five minutes to dig through his hard drive for a PowerPoint. He’ll
pull up a presentation packed with grainy photos from his youth. There he is with a head of curls and Buddy Holly glasses clad in a singlet. His jaw is clenched, torso angled forward and a strained bar loaded with iron plates hoisted above his head. Learning moderation involved veering into excess. There was the time he tried to run 100 laps on a track—in searing 98-degree heat. Why? Just to see if he could. It took a passerby telling Broxmeyer no one would be around to pick up his body after he collapsed to end the attempt. Or there was his endeavor to complete a 20-kilometer race around Central Park. His training regimen? Clipping off a brisk two miles a day for two weeks. “I almost died,” he said. “They had to hospitalize me.” He paused a beat. “But I finished.”
REPLY TO Heather O’Leary’s e-mail hit her inbox faster than she expected. It was 2011, and O’Leary was wrapping up a doctorate at West Virginia University and casting about for a post-doctoral fellowship. She’d studied how leukemia behaves in bone marrow, but wanted to learn more about normal blood cell development, a process called hematopoiesis. She’d dashed off a message to Broxmeyer, hearing his lab might mesh with her interests. “I am going to call you in 20 minutes,” Broxmeyer wrote. At the time, Mantel and the lab had only done very preliminary experiments investigating how EPHOSS affected stem cells in cord blood. Once O’Leary joined the team, she and Mantel would collect cells from the femurs of mice, process them, and then plate them in a setting with only 3 percent oxygen. Their early data was promising. It showed that low-oxygen conditions could net larger colonies of cells. But their findings were also hit or miss. The problem was they did their work in the mechanical equivalent of a plastic bag. To mimic the low-oxygen environment, like the one in bone marrow, scientists use a hypoxic chamber. It’s a sealed plastic box where you can regulate how much oxygen is present in air. And the lab didn’t own one. So Mantel, a longtime protein chemist, improvised using materials like PVC pipe and plastic lining. He cut armholes in the front,
Broxmeyer’s laboratory showed brief exposure to normal air curbs the number of stem cells in cord blood.
along with an air lock. A hose ran across the lab from a large tank to pump in nitrogen. “It was really like somebody tinkering in their garage,” Cooper said. “There was nothing pretty about it.” To work, a researcher would slide his arms into dishwashing gloves and be duct-taped into the apparatus. And even then, the oxygen level would fluctuate, sometimes to twice the ideal level. A year later, an alumnus of the lab based in South Korea agreed to buy the group a proper chamber. With the right apparatus and the same procedure, the impact of EPHOSS was clear. “Collecting cells in ambient air, you actually get less stem cells than there should have been,” Broxmeyer said. The finding was interesting, but not enough to pique the interest of editors at a journal like Cell. They had to show it held true in humans. A routine took hold. When a mother who agreed to donate her child’s umbilical cord underwent a Cesarean section, a pager would buzz. O’Leary and Cooper would trek to Eskenazi Hospital to collect the cord and transport it back to the lab, extracting the blood using the same process they had with bone marrow from mice. The outcome followed the same line: You could triple the number of stem cells if they weren’t exposed to normal air. “We look at that not as an end, but as a beginning of how cells are really functioning in the body,” Broxmeyer said. “The key is, ‘Can we take this work to the next step? Can we make cord blood transplantation better? Can we make other stem cell things better?’”
HE FIRST SIGN that something was wrong was mostly innocuous: A slow tightening at the base of his neck. Then there was the routine checkup, followed by a scan, then the biopsy. In late 2013, the diagnosis was handed down. It was thyroid cancer. Yet Broxmeyer fretted more about outsiders’ perceptions of his condition than his own health. He worried long-standing grants—some stretching back to the mid-1980s—wouldn’t be renewed. There were papers in press that he didn’t want languishing on an editor’s desk. “He was
Photo: Memorial Sloan-Kettering Cancer Center
LEADING THE WAY Broxmeyer fended off thyroid cancer twice in the last two years, with the second battle robbing him of his vocal cords. Yet it hasn’t kept him from remaining a leading figure in his field and sharing insights.
worried his value might decrease,” Cooper said. So he only told five people outside the lab. While he recuperated after surgery in January 2014, he didn’t want his name on the door. He only missed a week of work. “Everything was hunky-dory,” Broxmeyer said, “except they missed some in my voice box.” Late last year, a thyroglobulin test came back high. The cancer had invaded his vocal cords. Endocrinologists told him another surgery would require sacrificing his voice. A vocal prosthesis could be installed. Speech therapy would be necessary. A quarter-sized hole near his throat is a scar he accepts matter-of-factly. “No sense worrying about it now,” he said. “If something tries to kick him, you can bet he’s going to kick back,” said Dr. Randy Brutkiewicz, who was recruited by Broxmeyer as an assistant professor in 1997 and rose to his current role as the School of Medicine’s
RESEARCH If you would like to make a gift to support Dr. Hal Broxmeyer’s research at the IU School of Medicine, please contact: Jill Kooiman 317-278-2113 email@example.com
associate dean for graduate studies. Ceding his administrative roles and tussling with cancer helped crystallize Broxmeyer’s focus now as he oversees his laboratory. “He’s psyched,” Brutkiewicz said. “It’s just that simple. He’s having fun.” The ramifications of EPHOSS still have to be worked out, but Broxmeyer is clear in framing how wideranging they might be, spreading beyond the mere application to cord blood. If personalized medicine is to move forward, creating a world where therapies are tailored for each patient, it involves removing cells from the body to look at what genes they express. “What if the cell is different, even a little bit, from how it is in the body?” he asks. “You’re not really learning what’s going to happen when you try modulating it with therapy.” A lone circumstance will impede him from keeping up his work. “Only death,” he says with a grin, “is going to stop me.”
Photo: Samaritan’s Purse
20 IUMEDICINE WINTER 2016
ENTERING SUFFERING BY KAREN SPATARO IU School of Medicine alumnus Kent Brantly survived a near-death battle with the Ebola virus. But that hasn’t scared him away from the prospect of returning to life as a medical missionary.
T THE LONG WALK
Kent Brantly, M.D., worked on the front lines of the Ebola outbreak as part of a team of physicians affiliated with Samaritan’s Purse, which staffed ELWA Hospital in Monrovia, Liberia.
his past June, Dr. Kent Brantly lay in the same bed, in the same house, where Ebola almost took his life just 11 months before. The Indiana University School of Medicine alumnus had returned to Liberia for the first time since he was evacuated to America under the glare of the international media in August 2014. During the visit, Brantly and his wife, Amber, stayed with their two young children in a house on the Atlantic Ocean that they had called home after moving to the West African country as aid workers. It was also the same house that later became his isolation unit as he fought Ebola. As he lay there, emotion overcame him. “I rolled over to Amber and said, ‘The last time I was here I didn’t know if I would ever see you again,’” Brantly recalled recently. “I just wept for, I don’t know, a long time. “ Given his near-death experience and the anguish his family endured, it would be easy to understand if Brantly chose
a safer and more predictable path forward. But that is not his way. While he and Amber, a nurse, don’t know exactly where their future will take them, they remain committed to a life of service and are pledging not to shy away from countries in need because of the threat of Ebola and other potential dangers. “To be a person of faith does not mean to be safe,” said Brantly, who speaks frequently about how he is called by his faith to serve the poor and underprivileged. “To be a person of faith means to take action.” For now, action means using his newfound fame to advocate for the people of Liberia and West Africa. Since recovering, he has sat down with President Barack Obama, testified before Congress, and was a fixture in the 24/7 news cycle. Most recently, he and Amber released a book, “Called for Life— How Loving Our Neighbor Led Us into the Heart of the Ebola Epidemic,” and they embarked on a book tour this summer that included a stop in Indianapolis hosted by the IU School of Medicine. “This is not something we sought out,” he said of all the attention. “It’s not really something we enjoy.” But, he added, “We feel the responsibility to be good stewards of all we have been given. Right now that means being a voice for the people who don’t have a voice in West Africa.” That should come as no surprise to those who know Kent Brantly or who have followed his story.
“These people taught me how to be a doctor, but so many of them also taught me how to be a good doctor,” Dr. Kent Brantly said. “They never discouraged me from the calling that took me to medical school.”
SERVICE THROUGH MEDICINE
Brantly grew up in Indianapolis and attended Heritage Christian School. Though his father is a physician, he didn’t always see himself following in those footsteps. When he enrolled at Abilene Christian University in Texas, he had not decided on a major. He toyed with the idea of being a high school math teacher and coach, but that didn’t stick. Eventually, he settled on studying Biblical texts, though he wasn’t quite sure what career that would lead to. Medicine didn’t enter his mind until the summer between his junior and senior years, when he traveled to East Africa as part of an internship. He
CLEAR FOCUS A medical mission trip during college set Brantly on his career course. Arriving at the School of Medicine in 2005, faculty sensed his passion, and noted how humbly he went about his work.
began seriously considering a life of service through medicine. He stayed on at Abilene Christian University for a fifth year to take the science classes needed to get into medical school. The effort paid off: He was offered admission to the Indiana University School of Medicine. When a 24-year-old Kent Brantly set foot on campus in Indianapolis in August 2005, he had a clear focus. He wasn’t just training to be a doctor, but for a career serving in long-term medical missions. And he took that responsibility seriously. “He had already done some volunteer work in more countries than I had visited,” said Dr. Javier F. Sevilla-Mártir, now the assistant dean for diversity affairs and an associate professor of clinical family medicine. “Nevertheless, his humbleness and desire to learn were obvious, as he often sought advice about caring for the underserved locally and globally and in the selection of the medical field he should pursue to better serve communities.” Dr. Richard Gunderman, a Chancellor’s Professor, recalls that the aspiring physician enrolled in a Spanish-language version of an introduction to medicine course and served on a number of medical mission trips during his time as a medical student.
Photos: Samaritan’s Purse (Above); IU School of Medicine (left)
TELLING THEIR TALE Brantly contracted Ebola in July 2014 and was evacuated to Emory University Hospital in Atlanta. A month later, he was discharged (left). Since then, Brantly and his wife, Amber, have used their story to underscore the importance of serving the less fortunate.
He also served as president of the Christian Medical and Dental Association and was elected to the Gold Humanism Honor Society, which recognizes those who are exemplary in humanistic patient care. “He was not as concerned about grades and test scores as other students, and treated his entire education as preparation for his calling,” Gunderman said. For Brantly, IU was a place to learn, to soak up the knowledge and skills he would need to serve those most in need. He credits SevillaMártir and Gunderman, as well as other faculty physicians, as being important influences in his life. He’s also quick to note that many important lessons came from basic science faculty members who taught him during the earliest stages of his medical school career. “These people taught me how to be a doctor, but so many of them also taught me how to be a good doctor,” he said of his IU mentors and professors. “They taught me that there is more to medicine than simply diagnosing and treating pathology. And they never discouraged me from the calling that took me to medical school in the first place.” After graduating in 2009, Brantly pursued a residency in family medicine and other advanced training at John Peter Smith Hospital in Fort Worth, Texas, a large, publicly funded hospital that serves a substantial poor population. In October 2013, just months out of residency, he and Amber moved to Liberia with their then 4-year-old daughter, Ruby, and son Stephen, who was not yet 3. They had signed up for a two-year stint with the international aid organization Samaritan’s Purse.
LIFE IN LIBERIA
Brantly was assigned to work at ELWA Hospital, a facility with about 50 beds on the south side of the capital city of Monrovia. Liberia is a poor country that was devastated by civil wars and relies heavily on foreign assistance. Medical resources common in America are scant there. ELWA Hospital didn’t have even some of the most basic equipment, and there were only four working sinks. Of the many dangers the Brantlys might have worried about,
Ebola was not one of them. There had never been a documented case of Ebola in West Africa. “When we moved there it was not on the radar,” Brantly said. “It was not even on the list of scary things you might worry about. Shark attacks were on the list.” Right from the beginning, he worked long days at the hospital, seeing children and adults with a variety of medical needs, caring for pregnant women, and serving as the physician liaison for the hospital’s HIV treatment program. While that time was trying, it turned out to be the calm before the storm. Ebola first started appearing in West Africa in March of that year, but it had not yet crossed into Liberia. Nonetheless, Brantly and his colleagues began preparing. They converted the hospital’s chapel into an isolation unit to treat those infected. They developed protocols and learned all they could. They received their first Ebola patient by ambulance on June 11, 2014. She would not survive. Over the next several weeks, dozens of infected patients arrived at the hospital. They would writhe in pain, suffer through horrendous diarrhea and vomiting, spike dangerous fevers, and struggle to breathe. Brantly has called it a humiliating disease that leaves its victims utterly helpless. Dressed in layers of protective gear, he held patients’ hands, sang songs to them, and tried to help them maintain a sense of dignity. In the end, all but one patient he cared for died. The lone Ebola survivor was a 14-year-old boy named Gebah.
‘IT’S POSITIVE FOR EBOLA’
The story of Brantly’s personal battle with Ebola is now well known. He awoke on the morning of July 23, 2014, and he just didn’t feel right. Amber and the kids had flown out a few days earlier in advance of a brother’s wedding in Texas, so he was alone. He decided to stay home from the hospital until he could shake whatever was ailing him. He didn’t think it was Ebola, but hospital staff came to his house anyway, dressed themselves in protective gear, and drew blood. As he awaited the results, his home became his personal isolation unit. Convinced he had malaria, he performed three rapid tests on himself that first day. All came back negative. Meanwhile, his health continued to decline. The official diagnosis came July 26. Brantly’s friend and colleague, Dr. Lance Plyler, stood outside the small house, unable
to enter without full protection. His other friend and caregiver, Dr. John Fankhauser, stood at his bedside in protective gear. Speaking through an open bedroom window, Plyler delivered the news to the feverish and dazed patient: “Kent, bud, we got your test result. I’m really sorry to tell you it’s positive for Ebola.” Within days, Brantly was clinging to life. Thousands of miles away, Amber hunkered down out of the public view, prayed and waited for updates. When he was well enough to FaceTime, she’d take a screenshot, not knowing if that would be the last time she’d see her husband alive, she recalled in their book. “He can’t die,” she wrote in her journal one night. “I can’t raise these kids on my own. They need their daddy. I need their daddy.” At one point, as his fever hovered around 105, his heart raced, and he labored with every breath, colleagues decided to administer a dose of the experimental drug ZMapp. Though it had been tested in animals, no human had ever been treated with it. Shortly after, Brantly was evacuated on a private air ambulance to the United States for treatment at Emory University Hospital, becoming the first person with Ebola to set foot on American soil. In a moment that was captured by hovering news helicopters and watched live around the world, Brantly mustered the strength to climb out of an ambulance and walk into the hospital in his white hazardous materials suit. At that point, it was uncertain whether he would ever walk out. Improbably, he did. On what he called a “miraculous day,” Brantly was discharged from Emory on August 21, just shy of a month after his ordeal began.
THE SUFFERING OF ANOTHER
In May, Brantly returned to his medical alma mater to deliver the commencement address to the 404 physicians, scientists and researchers who graduated from the IU School of Medicine. In his speech, he asked graduates to take the time to dig through their computer files and find their medical school application essay. The vast majority of the newly minted
VITAL ADVICE In May, Brantly told new School of Medicine graduates not to lose sight of the compassion that led them to become physicians.
“Compassion means to be moved in your inward parts,” Dr. Kent Brantly said, “to relinquish your own right to comfort and safety, and to step into the suffering of another.”
PRESERVING DIGNITY For over a month before he became infected with Ebola, Brantly donned a protective suit to treat patients in Liberia. Only one survived. To give them comfort and dignity, he would sing to them or hold their hands.
physicians, he guessed, had written about how they were driven to medicine by a sense of compassion, by a desire to help others. He implored them not to lose sight of that. “Compassion is a visceral image,” he said. “It doesn’t mean to feel sorry for somebody, or to have pity, or to give charity to. Compassion means to be moved in your inward parts, to relinquish your own right to comfort and safety, and to step into the suffering of another. And isn’t that exactly what physicians do? We give up the comfort of a 9-5, Monday-to-Friday job in order to enter into the suffering of others. We give up our nights and weekends to be on call for other people’s emergencies. We take care of people with deadly disease despite the risk to our own health. When everyone else is running away in fear, we stay to help, to offer healing and hope.” It is through that lens, he said, that he considers his time spent treating Ebola patients a success, even though so many lives were lost. “Losing so many patients certainly was difficult, but it didn’t make me feel like a failure as a physician, because I had learned that there’s a lot more to being a physician than curing illness,” he said. “In fact, that isn’t even the most important thing we do. The most important thing we do is to enter into the suffering of others, and in the midst of what was becoming the worst Ebola epidemic in history, we were showing compassion to people during the most desperate and trying times in their lives.”
Photos: Samaritan’s Purse (Left); IU School of Medicine (above)
A RETURN HOME Kent Brantly, his wife, Amber, and Dean Jay Hess at a book signing and speaking session hosted by the IU School of Medicine in July.
Scholarship was ‘priceless’ in Brantly’s mission to serve
ucille and Jay Kahn played a big role in getting Dr. Kent Brantly where he is today. But it just so happens that he never met them. Years before Dr. Brantly was admitted to medical school, Mrs. Kahn set up a bequest to establish the endowed Jay C. and Lucile L. Kahn Scholarship at the Indiana University School of Medicine. Her reason was simple: She and her late husband cared deeply about their community and promoting health care. Mrs. Kahn passed away in 2002, and Brantly became one of the very first recipients of the scholarship that bears the Kahns’ names. “It was incredible, as a recently admitted student, to get that affirmation of a scholarship,” Brantly said. “It helped me start
school off with some confidence: I made it here, and someone else thought I deserved to be here.” More than providing an emotional boost, it provided invaluable financial assistance. Brantly received $8,000 a year for all four years of medical school. Medical school debt is a serious concern for all students. Almost 85 percent of IU School of Medicine graduates will leave with loan obligations, which for the most recent class averaged $184,000. But it was particularly a worry for Brantly, who knew his income would be limited as a medical missionary. Having $32,000 less in medical school loans “was priceless,” he said. Dr. Jay Hess, dean of the IU School of Medicine, noted that donors who support scholarships
SUPPORT SCHOLARSHIPS To make a gift to support scholarships for medical students at the IU School of Medicine, contact: Jill Kooiman 317-278-2113 firstname.lastname@example.org
simply cannot begin to imagine the impact they may have on a medical student, and what that student may go on to accomplish through his or her career. “A scholarship didn’t make Kent Brantly a selfless physician,” Hess said. “He came to IU already destined to serve the world’s neediest and most vulnerable people. But a scholarship can make it easier for students to follow the path they choose.” For his part, Brantly wants donors to know their generosity makes a very real difference—not only in students’ lives, but in the lives of the patients they go on to care for. “You may not get a return on investment in your bank account,” he said, “but you are giving a return to society.”
Jane Ransel is like many pancreatic cancer patients. An innocuous ache turned out to be the only clue about a disease that can evade detection and slough off conventional therapies. The IU Simon Cancer Center has a team of scientists working to improve detection, screening and treatment.
CATCHING THE ENEMY BY MATTHEW HARRIS
IN IT TO WIN In October 2014, Jane Ransel was diagnosed with Stage IV pancreatic cancer. Originally given less than a year to live, she’s still fighting. As a volunteer with the 24 Hours of Booty bike ride, which raises money for the IU Simon Cancer Center, she knows the importance of supporting research.
The creeping ache nagged at Jane Ransel. As she watched movers load up boxes headed to her new home in Westfield, Indiana, Ransel told her husband it was probably just a mild strain from packing. “It was just like this finger was pressing against my stomach,” she said. Still, the discomfort lingered. So Jane scheduled a rare trip to her family physician. A couple of days later, she was taken aback when he unveiled the results of an ultrasound: A mass resting in her pancreas and liver. “You can never prepare for that,” she said. Pancreatic cancer is as cunning as it is cruel. The disease kills upwards of 40,000 people annually, and is often only detected after silently metastasizing for up to two decades. By the time physicians unmask it, the cancer has usually spread, leaving a prognosis of just a few months. After five years, only 2.3 percent of patients with Stage IV disease are still alive. For decades, researchers studying pancreatic cancer have faced a frustrating task. Its symptoms—abdominal pain, bloating, and jaundice—are easily ignored. Usually, the disease is so advanced when found that surgery is off the table, meaning physicians can only try to attack it with chemotherapy or sear it with radiation. Even then, the tumor may be so fibrotic and dense that it’s hard for these weapons to reach nests of cancer cells. Worse, the tumor uses natural selection as a weapon, choosing the most aggressive and hardiest cells to reproduce. At the Indiana University Melvin and Bren Simon Cancer Center, a group of 50 researchers from multiple disciplines are melding their expertise to combat the disease. They seek to improve detection, develop new therapies, and build a clinical trials program to help drugs reach patients. The infrastructure is in place for success. The IU School of Medicine, in partnership with the IU Health hospital system, is a national powerhouse in the treatment of pancreatic cancer. It is among the top programs in the country in terms of volume, completing more than 3,000 pancreatic procedures a year. These doctors collaborate closely with laboratory scientists, ensuring all research is designed to benefit patients as quickly as possible. These physicians and scientists are working at a feverish pace, knowing that patients like Ransel are relying on them to make much-needed breakthroughs. “We’re getting to a point where almost as many people die from pancreatic cancer as breast cancer,” said Dr. Bert O’Neil, the Joseph W. and Jackie J. Cusick Professor of Oncology who oversees early stage clinical trials at the IU Simon Cancer Center. “That’s got to change at some point.”
FINDING CANCER in its infancy would mean
BEFORE PANCREATIC CANCER emerges, a
forerunner may already take root in the organ: cysts. These fluid-filled, abnormal growths, which appear in 3 percent of adults, form tower-like structures in the lining of the pancreas and can evolve into cancer. But not all cysts become malignant. The challenge is figuring out which ones will, and which ones are harmless. With no good way to know, most patients currently have some or all of their pancreas removed, a risky and potentially life-threatening procedure. Dr. C. Max Schmidt runs the Pancreatic Cyst and Cancer Early Detection Center.
Murray Korc, M.D., leads a team of 50 researchers tackling pancreatic cancer at the IU Simon Cancer Center.
“We’re getting to a point where almost as many people die from pancreatic cancer as breast cancer,” Dr. Bert O’Neil said. “That’s got to change at some point.” He wants to determine in advance which patients with cysts are at risk. Recently, his lab identified a critical clue: The presence of growth factor above a specific concentration means that a cyst will remain benign. And, just as important, the lab developed a test for the growth factor— one that is 99 percent accurate. The research, which is supported by philanthropy, could help physicians identify patients who require close monitoring and treatment. And it could allow others to avoid dangerous and unnecessary surgeries, and buy them peace of mind. “For me to protect you from a treatment worse than
your disease,” he said, “we need a test to assure you that it’s benign.” What comes next? “It needs to be in clinics,” Dr. Schmidt said. That’s no easy feat. Start-up costs for labs to run the test aren’t cheap. The volume of tests would be low in the beginning. The logic, though, is that enough data would be generated, analyzed and published to establish the test’s credibility and expand its demand.
OVER THE PAST YEAR, Ransel has fought her
cancer to a draw. From the earliest days, Dr. Safi Shahda, her oncologist, has been pleased with how she’s handled her regimen. In that span, Ransel has carved out a routine. On Tuesdays, her son, Andy, picks her up and takes her to the Simon Cancer Center. They grab lunch from the cafeteria, shop on Amazon.com or watch episodes of House of Cards on her iPad. “I can’t wait for chemo day, because I get to see Andy,” Ransel said. But for most patients, chemo is only a temporary option. Pancreatic cancer is devilishly smart. Over time, tumor cells find ways to overcome traditional chemotherapy, meaning treatments that work in the beginning eventually fail. That leaves researchers searching for ways to “resensitize” the disease to chemotherapy. After nearly two decades of work, Dr.
Photos: IU School of Medicine (above left); courtesy the Bigelow family (above right)
patients like Ransel would have the opportunity to undergo surgery to remove diseased parts of the organ, an option ruled out in 85 percent of cases. Too often, the tumor has grown around major arteries and veins, or is too dispersed to adequately treat. Catching the disease early requires identifying a biomarker—a signature of the disease that physicians can be on the lookout for. Think of high cholesterol and high blood pressure as biomarkers for cardiovascular disease. A warning sign for pancreatic cancer has been elusive. But the wait may be coming to an end. Dr. Murray Korc has shown that a specific type of microRNA—tiny molecules that help regulate protein expression in the body—is elevated in patients with aggressive pancreatic cancer. “Even though it’s a very small thing, it’s able to orchestrate a response that’s very harmful to patients,” said Korc, who leads pancreatic cancer research at IU. Just as important, this microRNA drifts along in our circulatory system, meaning it could be detected with a simple blood draw. Korc and his colleague at IUPUI, Dr. Rajesh Sardar, are engineering a test for that purpose that involves using an ultrasensitive sensor. Another two years may be needed to further refine the test, but Korc insists its ramifications are substantial. “The same thing could be used for any cancer,” said Korc, who holds the Myles Brand Chair in Cancer Research and receives philanthropic support from an endowed fund established to honor the late president of both IU and the NCAA. “This particular assay has ramifications for all human disease.”
Mark R. Kelley may have found another tool in the arsenal against pancreatic cancer. His research focuses on an enzyme called Ref1. The enzyme plays a role in helping cancer cells survive and grow. Dr. Kelley, who is the Betty and Earl Herr Professor of Pediatric Oncology Research, has shown that a compound—APX3330—prevents the enzyme from initiating a sequence of events and disrupts its work. The drug appears to work alone and could potentially be used in combination with chemotherapy drugs. There’s also another added benefit: APX3330 appears to have low toxic side effects, according to early studies. The results of laboratory research have been positive enough that, in partnership with a startup biotech company founded by Kelley, plans are moving forward for a Phase I clinical trial to test the safety of the treatment in patients.
RANSEL’S LIFE IS PLOTTED OUT on a legal-sized piece of
paper she keeps folded and creased in her purse. The calendar is filled with color-coded blocks that show a life still in motion. This fall, she trekked to North Carolina and a cabin nestled in the Smoky Mountains for a retreat with other cancer survivors. Ransel also jetted to the West Coast and Newport Beach, California, to visit her son, Scott, who will get married this coming May. She hasn’t relinquished her career in the process, either. Ransel still works as a marketing specialist at Spohn Associates. Her bosses allow her to work a rotating schedule: One week receiving chemotherapy, SUPPORT THIS and then another week back RESEARCH at the office. To learn how you can Over the past four years, support pancreatic she’s also volunteered cancer research at at 24 Hours of Booty, the IU Simon Cancer a round-the-clock bike Center, contact: ride in which cyclists Mary Maxwell tick off laps on a 3.5317-278-2130 mile loop to raise money email@example.com for cancer survivorship. Since the event started in Indianapolis, Ransel has volunteered at the Booty Store, greeting riders with warm smiles and chatting about how they overcame their illness, the struggle of their loved ones still grappling with cancer, or how they ride in memory of those lost. Now, Ransel is a beneficiary of the ride’s efforts, with a portion of proceeds going to support the IU Simon Cancer Center. “It’s just funny how life’s path takes you,” she said. Ransel admits she never has been a worrier. And even after being told the grim statistics associated with pancreatic cancer, she felt events would ultimately turn out fine. “I never even cried,” she said. And it’s why she tells her son, Scott, he can expect to see her as he strides down the aisle in a few months. “I keep telling him I’m not just in this for quality of life,” she said. “I’m in this fight to beat it.”
WHY THEY GIVE | THE BIGELOWS
‘Often when they diagnose you, it’s too late’
ike Bigelow figured he tweaked a muscle during a pick-up basketball game. The pain in his midsection had to be that, right? It wasn’t until the assistant general counsel at drug maker Eli Lilly had a physical in February 2008 that he learned something may be amiss: His liver enzyme levels were high. What came next was a two-month search for a diagnosis. There was a CT scan, an MRI and other tests. Clarity didn’t arrive until early April, when a surgeon at the IU Simon Cancer Center emerged early from a procedure to remove part of Bigelow’s pancreas: A mass found earlier turned out to be cancer. It had also spread to Bigelow’s liver. Over the next 13 months, Bigelow endured chemotherapy, which beat back the disease for a time. Yet in March 2009, Bigelow died after the family returned home early from its annual spring break trip to Florida. He was only 41, an age when only three in 100,000 men his age are diagnosed with the disease. Bigelow’s family and friends banded together to ensure other families don’t endure the same plight. Since 2009, they’ve hosted the Bigelow Open golf C. Max Schmidt, tournament each July, an event that so far has raised M.D., Ph.D. more than $400,000 to support pancreatic cancer research at the IU School of Medicine. Their generosity is essential to bolstering an area of research with limited funding. The past five years have been a period of belt-tightening for federal agencies such as the National Institutes of Health. And even when the NIH earmarks money for research, pancreatic cancer tends to receive only a fraction of the support. Since 2011, the disease has received only 20 percent of the amount allocated for breast cancer research. Money raised from the Bigelow Open has been pivotal in sustaining the work of Dr. C. Max Schmidt, a surgeon and researcher at the medical school who studies pancreatic cysts, which can be precursors to cancer. “If you can promote the early detection side of it, that would go a long way,” said Mike Bigelow’s wife, Kris. “Too often when they diagnose you, it’s too late.”
A BETTER KIND OF TREATMENT
Photo: IU School of Medicine
Mary Beth Gadus has fought metastatic breast cancer into remission three times. Early on, treatments were akin to waging ‘chemical warfare’ on the disease compared to the personally tailored therapies available today.
For over 27 years, MARY BETH GADUS has waged a fight against breast cancer. In that span, she’s seen radical advances in treatment—some of which started as mere hunches by researchers. Today, she and other passionate supporters are banding together to help fund scientists as they coax brilliant ideas into new ways to help patients.
Voicing a tenor of
By BRIAN HARTZ
ary Beth Gadus has been battling metastatic breast cancer for 27 years. Think about that for a few seconds. Allow it to sink in. Now imagine that during that time, she’s launched one of the most collaborative fundraising initiatives at the Indiana University Melvin and Bren Simon Cancer Center: 100 Voices of Hope. The campaign hit the cumulative $1 million mark in December—the ultimate way to pay it forward for everyone affected by this devastating disease. First diagnosed in 1988, at age 36, Gadus has been in remission three times. Her method of treatment has evolved from one option that everyone diagnosed with breast cancer in the 1980s received—“chemical warfare,” in her words—to increasingly targeted therapy. As research advanced and the way we thought about cancer changed, so did Gadus’ treatment each time she faced a recurrence. She attributes her survival to new options made available due to years of hard work by cancer researchers. Gadus has been fighting for her life for so long that today she finds herself in a brave new world of precision genomics, a treatment method rooted in the Human Genome Project that uses a cancer patient’s genetic profile to fight the specific mutations that drive a tumor. “I believe there is a solution out there. Precision genomics is incredible, and it will be the way all are treated in the future, but it is also the area of cancer research with the biggest need for funding,” Gadus said. Grants are available but the bulk of them come from large federal organizations like the National Institutes of Health and the National Cancer Institute, which won’t dole out money to unproven ideas, no matter how much promise they might show. And flat budgets, coupled with increases in the cost of research, have further shrunk the pool of money for cancer research. Gadus’ will to live—and to see other women stricken with breast cancer live—prompted her to monitor the efforts of cancer researchers such as Harvard scientist Judah Folkman, whose pioneering work in the area of inhibiting tumor angiogenesis led to the development of drugs that help cut off the blood supply to tumors. Gadus recalls going to hear the now-deceased Folkman speak and being inspired by the incredible story of how his idea was rejected 25 times—“he used the rejection letters as wallpaper,” she said—before the New England Journal of Medicine finally published his findings in 1971. “They scoffed at his idea but it turned out to be the basis for many drugs that stop tumors from growing,” she said. “How many people could have been saved if someone had believed in his idea? Cancer researchers are having ideas, but they can’t get funding. So these ideas just sit there.” The concept of “sitting there” does not seem to have a place in Gadus’ worldview. So in 2008, she founded 100 Voices of Hope, a program at the IU Simon Cancer Center that funds, via grassroots philanthropy,
“There is a solution out there,” Mary Beth Gadus said. “Precision genomics is incredible, and it will be the way all are treated in the future, but it is also the area of cancer research with the biggest need for funding.”
research ideas that would otherwise languish. Initially, she asked friends, family and fellow cancer survivors to help meet her fundraising goal of $100,000 to aid the development of what she calls “hunches”—out-ofthe-box ideas, like Folkman’s decades earlier—that could very well yield incredible results if only given the chance. Not even a decade later, 100 Voices of Hope has raised $1 million, helping IU Simon Cancer Center researchers make incredible progress on several fronts. During her initial campaign, she sought $1,000 each from 100 people—thus the name of the organization. However, there are many donors who contribute lesser donations, known as “Whispers,” and greater ones, known as “Shouts.” But what’s truly unique about 100 Voices of Hope is the level of engagement and access donors enjoy. In contrast with most traditional philanthropy, people who donate to 100 Voices of Hope can experience
VITAL SUPPORT Mary Beth Gadus and the board of directors for 100 Voices of Hope, left, have marshaled support to raise $1 million for breast cancer research. Those funds go to help scientists such as Hari Nakshatri, Ph.D., above, who is co-director of the breast cancer research program at the IU Simon Cancer.
exactly how each and every dollar they contribute gets allocated and applied. “It’s like American Idol,” Gadus said of the process by which hunch proposals are selected. Cancer researchers present three ideas to donors at an annual meeting, and the winning hunch receives $100,000 in funding. Once a hunch is selected for funding, donors connect directly with the research team via meetings and progress reports throughout the year. “The Voices have unprecedented access to the research and researchers,” Gadus said. “If you give to out-of-state organizations, you often don’t know what’s happening with your money.” One of the most successful hunches to date came from Dr. Hari Nakshatri, co-director of the cancer center’s breast cancer program and the Marian J. Morrison Professor of Breast Cancer Research at the IU School of Medicine. Dr. Nakshatri and his co-director, Dr. Kathy Miller, serve as 100 Voices of Hope’s research leaders. Their roles
MAKE A GIFT To make a gift to support 100 Voices of Hope, contact: Susanna F. Scott 317-278-2120 firstname.lastname@example.org
include screening all hunches before being presented to donors to ensure scientific validity. Nakshatri was able to identify a potential biomarker—or red flag— for recurrent breast cancer in circulating blood. His discovery led to a $400,000 grant from the National Cancer Institute and a $1.2 million Department of Defense grant, which in turn allowed him to patent his biomarker. Nakshatri’s success brings up another key component of the 100 Voices of Hope model: how it serves as a springboard for additional funding. The funded “hunches” have led to an additional $4.5 million in grants. What’s more, nine grants are in various stages of submission, five papers have been published, and a clinical trial is on the horizon thanks to the grassroots generosity of donors. Last year, the organization received a record number of hunches from researchers. The winning hunch for 2015 is a collaboration with Purdue University that blends the biological expertise from IU and the mechanical expertise from Purdue. Researchers are trying to develop a cell shredder that circulates in the blood stream and destroys migrating cancer cells that lead to metastasis. Gadus speaks with great excitement and enthusiasm about the big ideas her efforts are enabling—“philanthropy will one day cause breakthroughs,” she avows—but when you’ve battled cancer on and off for nearly three decades, it’s the smaller, fleeting, more personal moments that tend to leave the most enduring impressions. “My mother-in-law died from breast cancer before we were married; I only knew her for a few months,” Gadus recalled. “At our wedding, the loss of her two years earlier brought tears to everyone’s eyes.” “When I got breast cancer, I said I will do whatever it takes to be at my sons’ weddings, Gadus said. (She and her husband have two sons: Michael, 30, and Matthew, 28.) “They have always known a life with a mother who has breast cancer. They’ve lived with it their entire lives. I’ve had the gift of seeing them grow into two kind and successful men. And I’ve enjoyed two college graduations, a beautiful wedding, and we just celebrated the birth of our first grandson.” When it comes to hope, Gadus’ continues to grow. “Never, ever, did I ever think I’d live to see all of this. It’s pretty special.”
INTERVIEW Dr. Jerome Adams ’02
‘Right into the fire’
Indiana’s health commissioner confronts an HIV crisis and high infant mortality rates → Interviewed by MATTHEW HARRIS
DR. JEROME ADAMS HAD LITTLE TIME to settle in after Gov. Mike Pence appointed him commissioner of the Indiana Department of Health in October 2014. Within six months, an outbreak of HIV, tied to needle-sharing among users of prescription pain killers, broke out in Scott County. Meanwhile, data from the Centers for Disease Control showed Indiana had the seventh-highest infant-mortality rate in the country, featuring a wide gap between white mothers and those who were black and Latino. “I stepped right into the fire,” said Adams, a 2002 graduate of the Indiana University School of Medicine. Ever since he was a medical student, Adams has been a proponent of applying policy and programs to impact the health of the population. During a fellowship abroad in Africa, he saw first-hand how futile it can be to treat patients long after they become ill. “If you waited, you were less successful than if you worked to keep people healthy in the first place.” While he enjoys his role as an anesthesiologist, he realized that for every patient he helped, there were a dozen more he couldn’t treat. “It was absolutely necessary to do more than keep plugging holes in a dike,” he said. What facets of medicine drew you in? What was the hook?
My parents were teachers, and I always wanted a career where I interacted with people. I majored in biochemistry and planned to complete my doctorate. But I worked in a lab with a gentleman who also did rounds. When you’re meeting with a patient, you’re educating them about their disease and improving their chances of overcoming the malady they’re facing at the moment. You’re from Maryland and were recruited by a slew of topflight medical schools out of college. What separated IU from those institutions?
IU did a great job putting together a competitive financial aid package. That’s important. Medical students accrue large debt. It doesn’t drive choice as the sole factor, but it’s there. IU also had deep ties to Eli Lilly and Company and other stakeholders. IU isn’t just an academic center. It values community and industry input.
Now as I travel, I see how deeply respected IU is for its clinical programs. At IU, you get so much diversity in settings and patients at the VA, Eskenazi Hospital, Riley Children’s Hospital and University Hospital. You’re an anesthesiologist. Where do those roles intersect?
You convene people: Doctors, nurses, scrub techs, patients and their families. You bring them together to improve the health of the person having surgery. It’s the same in public health. You bring together diverse groups and convince them to be on the same team to improve health. There’s diversity, too. I may start the day with an 8-month-old patient and end with an 89-year-old patient. You’ve got to know a little bit of everything. You split time between the operating room and keeping a state agency on track. Is there any crossover?
Working as a physician lends me credibility. I’m not ignorant to the reality of what’s going on in the real world and in our state. It’s hard for someone to question your advice on trauma care after you spent the night before on call taking care of someone in the operating room who has been shot multiple times. As far as public health, I’m not hesitant anymore to bring up smoking or healthy eating with a patient. My job is to be an advocate and direct them to resources.
Gov. Mike Pence has his priorities. So does the state Legislature. And there are initiatives you feel are important. What’s an example of where those interests align?
Lowering the infant mortality rate is one. We’re at 7.1 percent, one of the nation’s worst rates. We told the governor, his wife and House Speaker Brian Bosma about the obstacles we face. Karen Pence helped unveil the Labor of Love campaign, and Speaker Bosma sponsored legislation to fund pilot projects aimed at lowering that number. Starting a syringe-exchange program in Southern Indiana is another example. Indiana law doesn’t allow those. I explained to Gov. Pence they’re effective at halting the spread of infectious disease. We reached a consensus, and he signed an executive order for an exchange program to halt the HIV epidemic in that part of the state. I was proud he took that stance and that we could find space in the middle. The state put forward $11 million to fund those infant-mortality programs. What objectives or projects is the department targeting?
We’ve looked at data from around the state to identify ZIP codes that are our largest contributors to infant mortality. We’re targeting hospitals and community groups in those areas most affected. Those projects could address prenatal care, which is a major risk factor. There are also projects for safe sleep, which is one of the best ways to prevent infant mortality in our state.
“Working as a physician lends me credibility,” Dr. Jerome Adams said. “I’m not ignorant as to the reality of what’s going on in the real world and in our state.”
NAME: Jerome M. Adams, M.D., M.P.H. POSITION: Indiana State Health Commissioner EDUCATION: B.S. in biochemistry and B.A. in biopsychology, University of Maryland-Baltimore County; M.D., Indiana University School of Medicine; M.P.H., University of California-Berkeley. NOTED: Adams is an assistant professor of clinical anesthesia at the IU School of Medicine and a staff anesthesiologist at Eskenazi Health. He has served in leadership positions for the American Medical Association, Indiana State Medical Association and the Indiana Society of Anesthesiologists. Adams chairs the Professional Diversity Committee of the American Society of Anesthesiologists. He is married and is the father of three children. His family lives in Fishers, Indiana.
The state health commissioner is appointed by Indiana’s governor, and oversees nine divisions that promote essential public health services such as vaccinations, maternal and child welfare, tobacco cessation and vital health records.
The number of new HIV cases in Southern Indiana has leveled off. Systems are in place for testing, dispensing medication, treatment and exchanging needles. What lessons did you take away?
We all need to be more aware of what goes on around us. Physicians need to grasp there’s an opioid epidemic. It’s national. And it starts with over-prescribing. It’s not just doctors, but we all need to be aware we contributed to this breakout. Eighty-percent of heroin users say their abuse started with prescription medications. We know the use of intravenous drugs is going up because hepatitis C rates are climbing. Indiana’s numbers have risen dramatically in the past decade. We’ve also got to partner. We can’t do it alone. It includes working with church-based groups, community groups and law enforcement. As physicians, we usually don’t interact with those groups, but they were critical in Scott County. The IU School of Medicine seems uniquely positioned to help. What role can it play moving forward?
Answers have been edited for length and clarity.
We would not have been able to get this outbreak under control without the IU School of Medicine. It doesn’t just train physicians, and it doesn’t just play a role in the immediate area of its campuses. In Scott County, the sheriff told me, “I want IU down here.” It’s a respected institution in the eyes of citizens. It establishes credibility and helps get over trust issues. They can see, “This is Indiana University. They’re going to do the right thing. I can trust what they’re telling me.”
The number of employees working at the State Department of Health around the state of Indiana.
Millions making up its operating budget this year. Almost two-thirds of those funds are from federal grants.
Source: Indiana State Department of Health
TWO CENTS Tim W. Ueber
Annuity Advantage Flexibility makes this planned gift appealing, and there’s a unique opportunity to double the impact of your gift to the School of Medicine.
hen I’m meeting with donors and their personal advisors, I find that many are already familiar with how a charitable gift annuity works. But there are some creative ways to structure gift annuities that may not be so obvious. Before I dive into that, let’s review the basics about gift annuities. You make an irrevocable gift to a charity (in our case the Indiana University Foundation). The gift usually consists of cash or appreciated stock. In exchange for the gift, the charity promises to pay an annuity to you for life. Upon your death, whatever is left in the fund goes to support the organization. Your annuity rate is based on your age, so the older you are, the larger the payments. In addition to ongoing income, you receive an immediate charitable income tax deduction. But that’s only one way to take advantage of a gift annuity. Let’s say you’re providing financial support to a family member. A gift annuity is a creative way to continue that support beyond your death. I recently worked with a couple, let’s call them Marcia and Bill. Marcia’s 65-year-old brother isn’t as financially secure as she and Bill are, and they want to make sure he’s taken care of. The couple established a $500,000 gift annuity and named the brother as the beneficiary. First, it brought them peace of mind. The brother will receive $25,000 a year for the rest of his life, even if Marcia and Bill die first. On top of that, Marcia and Bill will receive an immediate charitable tax deduction of about $140,000. Finally, they’re able to support research and education at the IU School of Medicine, and even chose the specific department they want to benefit. Using some basic assumptions about the brother’s life expectancy and growth in value of the underlying assets, the department stands to receive about $900,000 to support its mission. Here’s another example. A few years ago, I worked with an executor who was settling her brother’s estate. The brother had specified that $100,000 was to be given to the IU School of Medicine to establish a gift annuity, with his 26-year-old nephew named as the beneficiary. Not only did the brother’s estate receive an estate tax charitable deduction, but the nephew has
A gift annuity can provide benefits to you and the School of Medicine. And if used creatively, it can also benefit a family member.
commented that each time he receives a payment he pauses to think about his generous uncle. Over the nephew’s lifetime, the assets in the gift annuity will most likely grow in value to well over $2 million—up from the initial $100,000. That’s money the School of Medicine will use to educate students and reduce patient suffering in Indiana and beyond. As you can see, a gift annuity can provide benefits to both you and the IU School of Medicine. And if used creatively, it can also benefit a beloved family member. You can establish a charitable gift annuity to support the School of Medicine with a minimum gift of $10,000. One last note: There’s a unique opportunity available right now that can double the financial support some gift annuities provide to the School of Medicine. Indiana University will celebrate its 200th anniversary in the year 2020. In anticipation of this milestone, IU has launched a special fundraising campaign and will match income generated from newly established endowments. For instance, a $100,000 endowed scholarship will result in $9,000 per year for a student, rather than the typical $4,500. A gift annuity can be used to fund one of these endowments, and here’s the interesting part: The university will start paying those matching funds as soon as your gift is received. Normally, the school doesn’t benefit from a gift annuity until the donor has passed. But in this case, we receive the university’s match right away, and you get a chance to see your generosity at work. Of course, there’s some fine print, but that’s the big picture. If you wish to explore a gift annuity, including a possible match, please do not hesitate to contact me. I’d be happy to meet with you and your legal and tax advisors. Tim W. Ueber is the director of planned giving at the Indiana University School of Medicine. He has nearly 20 years of experience helping individuals and families with their estate and charitable planning needs. He may be reached at 317-274-0187 or email@example.com.
IUSMNEWS Making Rounds
LAMB SELECTED TO HEAD NEUROSCIENCES CENTER Bruce T. Lamb, Ph.D., a neuroscientist at Cleveland Clinic’s Lerner Research Institute, has been named director of the Stark Neurosciences Research Institute at the Indiana University School of Medicine. Lamb’s research has focused on the basic disease mechanisms of Alzheimer’s disease, including the genetic factors involved in the metabolism and buildup of the protein that makes up the plaque deposits associated Bruce Lamb, Ph.D. with the disease. His work has shed light on how complex mechanisms associated with Alzheimer’s have hampered efforts to find effective treatments in clinical trials. His lab also has studied the relationship between traumatic brain injury and Alzheimer’s disease. When he joins the Stark Institute on January 18, Lamb is expected to be named the first holder of the Roberts Family Chair in Alzheimer’s Disease Research. David and Susan Roberts established the chair to honor David’s father, Wayne, who died from Alzheimer’s disease. They were motivated to help eradicate the disease through medical research. David Roberts is the chairman, president and CEO of Carlisle Companies Incorporated, a global manufacturing company. The Stark Institute was created in 2003 as a multidisciplinary research institute in the neurosciences with the assistance of
Anantha Shekhar, M.D., Ph.D.
a $15 million gift from Paul and Carole Stark. Paul Stark, M.D., served as a faculty member in the Division of Clinical Pharmacology at the IU School of Medicine, was a research leader at Eli Lilly and Co. and founder of the International Clinical Research Corp. Approximately 50 IU scientists are primary investigators and members of the Stark Institute, conducting research in such areas as pain, spinal cord and brain injury, addiction, movement and neurodegenerative disorders. Lamb, who received his Ph.D. in molecular biology at the University of Pennsylvania in 1991, joined the faculty of the Department of Genetics at Case Western Reserve University in Cleveland in 1996. In 2005 he relocated his lab to Cleveland Clinic’s Lerner Research Institute, where he served as a full staff member, equivalent to
the position of professor. He succeeds Gerry Oxford, Ph.D., founding director of the Stark center, who is retiring. SHEKHAR NOW LEADS IUSM’S RESEARCH ARM Anantha Shekhar, M.D., Ph.D., a nationally recognized researcher at the IU School of Medicine and director of Indiana’s largest statewide research organization, has been selected to lead the school’s $300 million research enterprise. Shekhar, who currently holds several leadership posts at IU and Indiana University Health, became executive associate dean for research affairs effective August 1, overseeing all research-related activities at the IU School of Medicine. He is one of six executive associate deans who make up the school’s executive leadership team with Dean Jay L. Hess, M.D., Ph.D.,
M.H.S.A. “Anantha has been a tremendous asset not only to the school and IU Health, but to the state through his leadership of the Indiana Clinical and Translational Sciences Institute,” Hess said. “The depth of expertise that Anantha brings to the role in both clinical and scientific research will further enhance our academic mission and commitment to improving health and patient care.” Shekhar, the August M. Watanabe Professor of Medical Research, succeeds David S. Wilkes, M.D., who was named dean of the University of Virginia School of Medicine. He has served as the founding director of the Indiana CTSI since 2008, helping create one of the most dynamic and innovative such organizations in the country. The Indiana CTSI, a statewide collaboration that includes Purdue University, the University of Notre Dame and numerous life sciences businesses and community organizations, works to speed the transformation of scientific discoveries in the laboratory into new therapies for patients and new businesses for Indiana. Shekhar continues to direct the operations of the Indiana CTSI. He also serves as associate vice president for university clinical affairs for Indiana University and executive vice president of academic affairs for clinical research at Indiana University Health. DEPARTMENT OF MEDICINE GETS NEW CHAIR Mark W. Geraci, M.D., a pulmonologist and lung cancer researcher who led the Division of Pulmonary Sciences and Critical Care Medicine at the
University of Colorado Anschutz Medical Campus, has been named the new chair of the Department of Medicine at the Indiana University School of Medicine. His appointment was effective August 24. “As chair of our largest department, Dr. Geraci will play a pivotal role in setting our future direction at the School of Medicine,” said Dean Jay Hess. “Dr. Geraci led the nation’s top program in pulmonary medicine. He is widely recognized for his commitment to teaching and mentoring, the developMark Geraci, M.D. ment of physician-scientists and for his leadership of a broad range of initiatives including genomics and translational medicine.” Geraci heads a department with more than 450 physicians and researchers working in a dozen subspecialties involving heart disease, cancer, lung disorders, kidney and liver disease, infectious disease and others as well as general internal medicine and geriatrics. Having been funded by the National Institutes of Health for the past 20 years, Geraci’s research has focused on the biology of lung cancer and pulmonary vascular disease, and he has conducted promising tests in humans of compounds to prevent the development of lung cancer in current and former smokers. Geraci succeeds David W. Crabb, M.D., who stepped down as chair after serving 14 years in the position. SHAH NAMED PERMANENT CHAIR OF RADIOLOGY Himanshu Shah, M.D., interim chair of the Department of Radiology and Imaging Sciences, has been named the perma-
nent chair of the department effective December 1. Shah had been serving as interim chair since June 1, 2014, following the departure of Valerie Jackson for the American Board of Radiology. An associate professor of clinical radiology and imagHimanshu Shah, M.D. ing sciences, Shah is chief of radiology at Eskenazi Health, but plans to step down from that position. The recipient of numerous teaching awards within IU School of Medicine, Shah has served as a fellow with both the Society of Interventional Radiology and the American College of Radiology. He currently chairs the American College of Radiology CME and SAMS Committee. He has been named a “Top Doc” by Indianapolis Monthly annually since 2012. IUSM-SOUTH BEND HAS A NEW LEADER Mark Fox, M.D., Ph.D., became associate dean and director for the IU School of Medicine-South Bend effective August 1. Fox is an expert in community health and providing health care to disadvantaged populations. He Mark Fox, M.D., Ph.D. served as associate dean for community health and research development at the University of Oklahoma School of Community Medicine in Tulsa since 2008. He also was medical director of the OU Wayman Tisdale Specialty Health Clinic and associ-
ate director of the Oklahoma Bioethics Center in Tulsa. Fox received his medical degree as well as a doctorate in religion, ethics and society at Vanderbilt University, and a master of public health degree from the University of Rochester School of Medicine and Dentistry, where he completed residency training in internal medicine/pediatrics. IU School of Medicine-South Bend is one of nine campuses of the IU School of Medicine across the state. YAMAMOTO SELECTED AS CHAIR OF PHARMACOLOGY Bryan Yamamoto, Ph.D., an internationally recognized authority on the impact of drugs of abuse on the brain, has been named chair of the Department of Pharmacology and Toxicology at the IU School of Medicine. He also holds the title of Robert B. Forney Professor of Toxicology. Yamamoto, whose appointment was effective July 1, came to IU Bryan Yamamoto, Ph.D. from the University of Toledo College of Medicine and Life Sciences, where he served as chair of the Department of Neurosciences since 2008. Yamamoto’s research has focused on how drugs of abuse affect the neurochemistry of the brain and contribute to brain injury. He has been at the leading edge of research into the neurotoxic impacts of amphetamines, and how their interactions with stress alter brain function and produce toxicity in regions of the brain that are critically involved in controlling movement and cognitive processes. He has been continuously
funded by National Institutes of Health research grants since 1986. Yamamoto received his Ph.D. in neurobiology at Syracuse University and completed a postdoctoral fellowship in clinical pharmacology at the University of Colorado Health Sciences Center. He served in research and academic leadership positions at Northeastern Ohio Universities College of Medicine, Case Western Reserve University School of Medicine and Boston University School of Medicine before joining the University of Toledo. LONGTIME IU RESEARCHER PICKED TO LEAD GENETICS Tatiana Foroud, Ph.D., a highly regarded genetics researcher who holds several leadership positions at the IU School of Medicine, has been selected to be chair of the school’s Department of Medical and Molecular Genetics. Foroud, who joined the IU School of Medicine faculty in 1994, was named the P. Michael Conneally Professor of Medical and Molecular Genetics in 2005. She is director of the department’s Hereditary Genomics Division and is scientific director of Tatiana Foroud, Ph.D. the Indiana Biobank, a primary biospecimen resource at Indiana University. She also leads the Genetics, Biomarker and Bioinformatics core, a recent addition to the NIH-funded Indiana Alzheimer Disease Center. Along with departmental colleague Gail Vance, M.D., Foroud had been serving as interim chair of the department since former chair Kenneth Cornetta, M.D., stepped down to begin a fellowship in palliative care. Foroud’s research focuses
on the identification of genes contributing to disease, including neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, intracranial aneurysms, alcohol dependence and cancer. TRAVIS HEADS PROGRAM IN CANCER SURVIVORSHIP A widely recognized expert on cancer survivorship has been recruited to lead the development of a new research program at the Indiana University Melvin and Bren Simon Cancer Center. Lois B. Travis, M.D., Lois Travis, M.D., Sc.D. Sc.D., has been named the Lawrence H. Einhorn Professor of Cancer Research at the IU School of Medicine and director of the Cancer Survivorship Research Program at the IU Simon Cancer Center. The new survivorship program will include research to
predict who is susceptible to toxicities in cancer treatment and then alter the treatment or develop preventive measures to protect the patient from longterm adverse side effects. Lawrence H. Einhorn, M.D., an IU Distinguished Professor and Livestrong Foundation Professor of Oncology, revolutionized cancer treatment more than 40 years ago when he combined the platinum-based cisplatin with two additional drugs. The combination became the cure for testicular cancer. The survivorship program will not only benefit testis cancer patients, but it has the potential to impact the nearly six million people worldwide eligible for treatment with a platinum-based agent each year for 12 other types of cancer. Previously, Travis was the director of the Rubin Center for Cancer Survivorship and chief of the Division of Cancer Survivorship at the University of Rochester Medical Center. She also was a senior principal investigator and lead research investigator at the National Cancer Institute, where for nearly 20 years she conducted interna-
tional studies of late treatment effects in cancer survivors, with an emphasis on second malignant neoplasms. Philanthropy played a critical role in bringing Travis to the IU Simon Cancer Center. The Einhorn Chair, income from which will support her research, was funded with a $2 million gift from Farhad Moshiri of Monaco. PILI NAMED MILLER PROFESSOR OF ONCOLOGY Roberto Pili, M.D., a national expert in prostate, renal and bladder cancers, has joined the IU Simon Cancer Center. Most recently, Pili was professor of oncology, chief of the genitourinary section, and leader of the genitourinary program Roberto Pili, M.D. at Roswell Park Cancer Institute in Buffalo, N.Y. In his new position, he directs
the genitourinary research program at the cancer center. In addition, he serves as the medical director of the genitourinary clinical program at the IU Health Simon Cancer Center. The genitourinary program supports treatment for prostate, bladder, kidney, testicular and penile cancers. Pili said that the genitourinary research program’s scientists will collaborate with researchers at the Purdue University Center for Cancer Research. The developing program will be co-led by Dr. Timothy Ratliff, the Robert Wallace Miller Director of the Purdue cancer center. On the clinical side, Pili said his goal is to focus on drug resistance in those genitourinary cancers, providing new options for those patients. Pili is the Robert Wallace Miller Professor of Oncology. V. Richard and Jane Miller established the “Robbie Chair” in memory of their 11-year-old son who was stricken with undiagnosed rhabdomyosarcoma and died after a game of baseball. His only symptom was a runny nose. Robbie is also survived by his siblings, Rick Miller and Pam Dilley and their families.
Don’t miss your class reunion! IU School of Medicine Alumni Association Medical Alumni Weekend May 20-21, 2016 Celebrating the classes of 1956, 1961, 1966, 1971, 1976, 1981, 1986, 1991
For more information on Medical Alumni Weekend visit www.go.iu.edu/TXy
1110 W. Michigan Street, LO 506 Indianapolis, Indiana 46202â€“5100
Published on Jan 13, 2016
IU Medicine is produced by the Indiana University School of Medicine Office of Gift Development to keep alumni and donors informed about the...