J E F F E R S O N M E D I CA L C O L L E G E • T H O M A S J E F F E R S O N U N I V E R S I T Y • W I N T E R 2 014
An interview with President and CEO Stephen K. Klasko, MD, MBA
In Giving, You Receive To learn more about a CGA or other giving options, please contact:
Fritz Ruccius Senior Vice President (215) 955-8733 firstname.lastname@example.org jefferson.plannedgiving.org THOMAS JEFFERSON UNIVERSITY AND HOSPITALS
Did you know you can make a gift to Jefferson and get something back? It’s called a Charitable Gift Annuity: a simple contract between you and Jefferson. In exchange for your gift of cash or stock, Jefferson makes regular fixed payments to you, you and your spouse, or someone you name, for life. You get a charitable deduction, above-CD yields, and favorable tax treatment of your annuity payments. The remaining principal goes to Jefferson when the contract ends. It’s a win-win gift! Let us show you why Charitable Gift Annuities are our most popular life-income gift!
6 Looking Ahead: What the Future May Be 10 From White Coat to Hospital Gown: When the Doctor Needs a Doctor 15 E-cigarettes: What Advice Should You Give Your Patients?
DEPARTMENTS 2 DEAN’S COLUMN 4 FINDINGS Researchers Hone New Approach to Rabies Vaccine
18 FACULTY PROFILE
Rajnish Mago, MD: Building a Better Toolkit to Manage Mood Disorders
20 SPOTLIGHT 22 ALUMNUS PROFILE
10 Questions with . . . Anthony Calabrese, MD ’72
24 CLASS NOTES 25 ALUMNI ASSOCIATION PRESIDENT’S MESSAGE 26 IN MEMORIAM 29 BY THE NUMBERS
Jefferson Alumni Bulletin Winter 2014 Volume 63, Number 1 Senior Vice President, Jefferson Foundation: Frederick Ruccius Vice President for Development and COO, Jefferson Foundation: Stephen T. Smith Editor: Gail Luciani Associate Editor: Karen L. Brooks Design: JeffGraphics Bulletin Committee William V. Harrer, MD ’62 Chair James Harrop, MD ’95 Cynthia Hill, MD ’87 Larry Kim, MD ’91 Phillip J. Marone, MD ’57, MS ’07 Joseph Sokolowski, MD ’62
Quarterly magazine published continuously since 1922. Address correspondence to: Editor, Alumni Bulletin Jefferson Medical College of Thomas Jefferson University 125 S. 9th Street, Suite 700 Philadelphia, PA 19107-4216 215-955-7920 Fax: 215-503-5084 connect.jefferson.edu Alumni Relations: 215-955-7751 The Jefferson community and supporters are welcome to receive the Alumni Bulletin on a regular basis; please contact the address above. Postmaster: send address changes to the address above. ISSN-0021-5821 Copyright© Thomas Jefferson University. All Rights Reserved. JG 14-0902
THOMAS JEFFERSON UNIVERSITY
On the Cover: Stephen K. Klasko, MD, MBA, president and CEO, Thomas Jefferson University and TJUH System.
2 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
The Dean’s Column At Jefferson Medical College, we think of ‘alumni’ in an encompassing way. Former residents, fellows and graduate students are all in our embrace, as are so many other trainees and guest faculty and scientists who have walked our halls and drawn from our hospitals, clinics and research laboratories. This rich alumni web extends to the far reaches of the globe and constitutes a constellation of loyal and avid Jefferson champions. They were enriched by Jefferson, and enrich us in return. Our Jefferson ambassadors in China came into vivid focus for me this past November. My trip to China, several years in the making, was orchestrated by Dr. Xin Ma, one of our professors in the Department of Emergency Medicine and a well-funded principal investigator who is elucidating critical molecular mechanisms of cardiovascular complications associated with metabolic disorders such as diabetes. Dr. Ma has long-standing and deep ties to several Chinese academic medical centers, and over the years, his NIH-funded laboratory has hosted and trained many a faculty and fellow from these institutions. In eight days, we sprinted through major academic medical centers in three
Chinese cities — Beijing, Chengdu, Xi’an — renewing existing Jefferson relationships and planting seeds for new ones. There were signing ceremonies, facility tours, morning rounds, formal leadership meetings with presidents, deans and key departmental leaders, not to mention our own lectures. All of this was liberally interspersed with sightseeing in the cities and their neighboring countryside, with every meal a banquet. At my side were Dr. Theodore Christopher, our chair of emergency medicine; Dr. Ji-Bin (‘Jimmy’) Liu, one of Jefferson’s distinguished radiology faculty (who are internationally recognized pioneers of diagnostic and therapeutic ultrasound technologies); and of course, Dr. Ma. The China of now bears little resemblance to the China I first visited some 20 years ago. This is a China on steroids — building everywhere, on a bewildering scale. Piercing through the chaotic city traffic and smog, there was the remarkable graciousness and warmth of our Chinese hosts. Their respect and profound gratitude to those from Jefferson who have made a difference in their professional careers was palpable. The thanks were tangible as well. Ted and
I went to China with one suitcase apiece. We each left with two, the second full of tokens of appreciation — and the second suitcase itself was a gift. And then there was the true highlight of the trip — a memorable dinner event in Xi’an, two evenings before our departure. Dr. Ma had purposefully underplayed it beforehand. I knew it was to include some former Jefferson trainees, but I was in for a surprise as to just how many. Entering the venue, I was enveloped by a sea of Jefferson T-shirts and beaming faces — 23 in all. The dean of Jefferson had arrived. Not just another foreign guest — it was their dean, accompanied by their scientific mentor and their department chair. During the opening toasts, we circled around the tables as each Jefferson T-shirt-clad attendee proudly touted his or her personal Jefferson connection. Twelve months at Jefferson here, three years at Jefferson there. This panoply of smiling, youthful faces belied a remarkable fact — nearly three-quarters of them now serve in significant leadership roles at Xi’an’s major academic medical center and one of China’s top-ranked health science universities. For them, Jefferson was the enabler, Jefferson is the Mecca,
WINTER 2014 3
Jefferson is what their junior faculty and trainees aspire to. For me, the evening and the setting were so moving. Xi’an is home to one of the world’s heritage sites — the magnificent army of terracotta warriors buried alongside the first Chinese emperor — but far more important to me that evening in Xi’an was the living Jefferson heritage surrounding me. Amidst the hubbub of all that occupies us these days in medical schools — healthcare delivery morphing, NIH funds tanking, education paradigms shifting — we run the risk of forgetting about all that remains constant and good. We are changing the lives of trainees, and through them, the lives of countless others. Those shining faces were a mirror for all that is good about Jefferson. And reflecting upon that evening, what also struck me was ‘the power of one’ — a single Jefferson faculty member, Dr. Ma — one of our accomplished but low-key ‘faculty citizens’ who demands little and gives a lot — has been able to singlehandedly make such a difference in a country of 1.3 billion people. We sometimes forget what we have, what we mean. This kind of vignette helps reset the narrative, recalibrates our perspectives and
is a poignant reminder of why we do what we do here and the difference we can make in the world, even as individuals. I would add one additional thing that impressed me — a willingness of our Chinese hosts to articulate their needs and face up to their deficiencies. In talking to their leaders, I would look to create some reciprocity — pointing out some of the things that we in America could also learn from them — but time and again they would push back. There was little interest in cake walking around the realities as they see them — this is what you have and we don’t. This is where we fall short, and this is what we want to learn from you. As I see it, this attitude is their most powerful trait. I have often said that the single best predictor of academic success for a faculty recruit is openness to learning from others, a willingness to assimilate the input of mentors and peers. I have seen this over and over again. The Chinese leaders I met have assimilated this concept abundantly. As it turns out, Jefferson’s ties to China are far more extensive and go well beyond the network of relationships developed by Drs. Ma and Liu. Just at the chair level the ties that have been cultivated over years are striking — Drs. Adam Dicker (radiation
oncology), John Melvin (rehabilitation medicine), Stephen Peiper (pathology, anatomy and cell biology), Vijay Rao (radiology), Jouni Uitto (dermatology), Charles Yeo (surgery), to name a few. Looking forward, we will look to leverage these existing connections to create additional people-to-people bridges to the East. Many American universities and medical schools are rushing to embrace academic partners in Asia. It’s in vogue. However, the reality is really meaningful relationships only build over time. Our connections to two of the top five ranked academic medical centers in China reflect years of incremental steps and confidence building. I was particularly struck by the comment of one of the leaders at Chengdu’s medical school, who in our diplomatic round-circle leaned over to me and said simply, “I trust Xin Ma.” That said it all. This needs to be the cornerstone of our international alliances — trust, built over time, based on tangible deliverables and patent good will.
Mark L. Tykocinski, MD Anthony F. and Gertrude M. DePalma Dean Jefferson Medical College
4 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Researchers Hone New Approach to Rabies Vaccine
Researchers at the Jefferson Vaccine Center recently reported significant progress in the “holy grail” of rabies research — the development of a single-dose vaccine. This advance is significant because currently, following exposure to a potentially infected animal, a time-consuming and expensive course of preventive antibody followed by four to five doses of immune-boosting vaccines is required. The experimental vaccine has been found to induce an immune response that had not been known to play a role in rabies immunity. Produced in the laboratory of James McGettigan, PhD, the vaccine harnesses the first line of defense against a wide range of viruses and is the first to take advantage of the power of this protective defense against rabies virus. McGettigan says a new approach to rabies treatment in sorely needed. “Two-thirds of the world’s population lives in regions where rabies is endemic. A
Immune cells are activated by a vaccine because it contains part of a germ called an antigen, which stimulates the body’s immune response. B cells can respond directly to the antigen, whereas CD4+ T cells respond to the antigen after it is processed by antigen-presenting cells (APC).
person — usually a child — dies of rabies every 20 minutes. More than 15 million people worldwide receive multi-dose postexposure vaccines, costing about $1 billion annually to prevent rabies infections in humans,” he says. “Rabies is considered a neglected global zoonotic infectious disease. Therefore, efforts to develop a single-dose human vaccine for use in both developing and industrialized countries are critically needed.” McGettigan and his colleagues sought to understand how they could induce a rapid induction of specific cells in the immune system known as B cells, which is required for successful treatment, especially in cases when treatment is delayed after exposure. They developed a vaccine based on a replication-deficient rabies virus that lacks a key gene called the matrix (M) gene, which induced rabies immunity rapidly. “Typically, B cells require ‘help’ from another cell type of the immune system,
Antigen from vaccine
called CD4+ T cells. T cells promote effective B cell responses to secrete antibodies against rabies virus, therefore preventing rabies from causing damage,” McGettigan says. “However, the process by which CD4+ T cells help B cells to make antibodies takes time, which may limit its effectiveness to treat rabies after infection, especially in cases when treatment is delayed.” McGettigan showed that the matrix genedeleted rabies virus-based vaccine bypasses the need for T cells for the development of effective B cells. He says the vaccine induces an antibody subtype, called IgM, which was not known to play a role in rabies immunity. “The speed by which IgM is induced may help reduce the need for multi-dose vaccine strategies,” he says. “More importantly, vaccine-induced IgM may help to reduce the need for the initial dose of protective antibodies — rabies immune globulin — which is expensive and in short supply in developing countries.”
Once the T cell recognizes the antigen from the APC, it becomes active and sends chemical messages to the B cell and other immune cells. Once the messages are sent, the B cell and T cell either divide into memory cells, which the body keeps for future use, or the B cell transforms into a plasma cell, which will create antibodies to attack the virus.
B cell Plasma cell Helper T cell
Antigen-presenting cells digest an antigen, then place a small piece of this antigen on their surface so that a T cell can recognize it.
Memory B cell
Memory helper T cell
WINTER 2014 5
The new vaccine without a key gene called the matrix (M) gene was shown to induce protective immunity against rabies virus more rapidly by bypassing the need for T cell interaction. Here, the B cell recognizes the antigen and, like before, transforms into a plasma cell. The plasma cell, in this case, creates an antibody subtype called an IgM antibody. B cell
Antibody: Antibodies are substances made by the bodyâ€™s immune system in response to viruses. Antibodies attach to the virus so the immune system can destroy them. The body has different types of antibodies that play various roles in the immune system. IgM: IgM antibodies are the largest antibody. They are found in blood and lymph fluid and are the first type of antibody made in response to an infection. They also cause other immune system cells to destroy foreign substances. IgM antibodies were not known to have any impact on the rabies virus until now.
6 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
What The Future May Be
WINTER 2014 7
Three Things Stephen Klasko, MD, MBA, Wants You to Know About the Future of Jefferson
1 2 3
The future is now. How we deliver health care in five years will look nothing like it does today. We will be concentrated on quality and cost. We will be selecting and educating doctors and nurses in a fundamentally different way. And there will be healthcare professions in decision support, cyber-security and healthcare coaching that don’t even exist today. We will lead those transformations.
Jefferson will champion the entrepreneurial academic model. I believe in investing in innovation to create an environment in which faculty and staff know they can take chances. I want scientists from other universities to come to Jefferson to be a part of our spirit of innovation. I don’t want people to be afraid to fail. By taking Jefferson’s history of excellence in academics and adding an entrepreneurial spirit we will build an institution like no other in the country.
The clock is ticking on technology and health care. I love looking at the really leading-edge things out there. Anytime something new is released, whether it’s an app or a new operating system, we need to think about how that technology might improve health care at Jefferson. For example, patients who go through their procedures using ‘Second Life’ before their actual ones have an opportunity to ask questions and ultimately reduce their stress levels. That’s using technology and making a difference in the quality of care. Health care has already missed a step in the high-tech revolution. Why can I schedule a flight on my iPhone, but not a doctor’s appointment? To learn more about Second Life and virtual learning, please visit: connect.jefferson.edu/virtuallearning
8 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
In a decade, Thomas Jefferson University will celebrate its 200th anniversary ... and one of President and CEO Stephen Klasko’s goals is for Jefferson to become the coolest health sciences university anywhere. The staff of the Bulletin interviewed Klasko about his thoughts on what’s needed now to create a unique footprint for Jefferson as a health sciences leader. What do you see as the biggest changes ahead for Jefferson?
faculty appointments will foster a positive atmosphere for interprofessional collaboration between schools.
How will researchers be affected by this model of collaboration and academic innovation?
he first, and one of the most challenging, is to unify Jefferson so we think and act like one institution. We have a tremendous opportunity to offer a robust health sciences education that transcends what’s out there today and start to think like a “single college of health.” We need to explore our options and challenge ourselves to think outside traditional models and as one integrated organization. The second is to be a national leader in simulation as a means to assess technical and teamwork proficiency. With the Dr. Robert and Dorothy Rector Clinical Skills Center, we have a “virtual space” for teams of students and physicians to simulate clinical experiences, but in the future doctors and nurses will need to have their technical and teamwork skills assessed. We can be that future. The third is increasing our partnerships with local communities and aiding the most vulnerable in need of our help. My biggest eye-opening moment that affects how I lead today happened when I was getting my MBA from Wharton. Everything we did there was done as a team. Physicians tend to be autonomous, competitive and hierarchical. I learned how to add creativity, self-awareness and flexibility. The most important part of leadership is being able to identify your strengths and weaknesses. I learned you should always have five people around you who think they can do a better job than you — and three who are right! So I encourage, develop and hire people who have skill sets that complement mine. When you create that kind of team, the energy and enthusiasm are intoxicating, and you’re in a much better position to do fantastic things.
What is your vision for taking Jefferson to the next level of both interprofessional collaboration and academic innovation?
efferson excels at ensuring the best medical team is providing the best patient care, thanks to our commitment to interprofessional collaboration. When it comes to education, my goal is to push the boundaries even more and have every student take courses in other colleges. For example, our medical students taking at least one nursing course, one public health course and one pharmacy course. Doing so will give them a better appreciation for the many facets of care the patient receives. I also want our deans to attend each other’s newstudent orientations so all students recognize that everyone, in every school and college, is vested in their success. Also, dual
ith the creation of longitudinal institutes — Clinical and Research Integrated Strategic Programs, or CRISPS — Jefferson researchers can easily cross-pollinate ideas and deliver some of the best science and discoveries out there. Science no longer happens just within a department. One of the ways I have done that is through what I call “synergy social hours” to break down silos between researchers working in different groups. Using a speed-dating model, I get them to talk to each other and discuss topics across disciplines like health disparities, sports medicine, Alzheimer’s and biomedical engineering. We then provide seed funding for researchers who have never worked together. That approach helps them find commonality among their peers and exchange ideas with colleagues whom they may not have met otherwise.
How does diversity in the workplace play a role in this transformation, especially when such a high percentage of incoming Jefferson students are now of different cultural backgrounds?
iversity contributes to a more emotionally intelligent workplace, often making it easier to accomplish interprofessional initiatives. A goal of mine is to seek and celebrate our cultural diversity. I want to have patients, students, faculty and staff of all cultures and backgrounds, women and men feeling comfortable and celebrated in our workforce experience. Our faculty, our students and our employees must reflect the attributes of the world we live in today. My goal is to develop customized leadership institutes to kick-start our diversity initiatives and a celebration of our diverse cultures. One of our messages will be that “everyone matters.”
What keeps you up at night?
he Eagles and the Phillies. Honestly, I guess what worried me most when I first joined Jefferson was that staff wouldn’t recognize the need for a fast pace of change in an environment where urban academic institutions are under enormous pressure. The competitive landscape we are in requires that we apply some creative thinking to what we’re doing. I don’t think we can look at any opportunity and not say let’s at least explore it.
WINTER 2014 9
Some really smart people believe there will eventually be only a few major medical centers in the state and significant consolidation nationally. They may not be that far off so we can’t debate where property lines fall when the levee breaks and the tsunami is coming. I want to lead that transformation so when the smoke clears, Jefferson is one of those leading-edge centers. We need to change where we invest our dollars and how we look at traditional academic enterprises and NIH funding. Publishing an article in Science and Nature should be our academic goal, but imagine the buzz around publishing an article in Wired magazine or getting a grant from the Gates Foundation for something totally unexpected from Jefferson. Embracing the tried and true is great, but we also need to create some flexibility to push the boundaries and do some things no one would have thought of a few years ago. I also believe physicians are looking for different work models. They now have a choice to be employed by a hospital or university or stay in private practice. That’s not a perfect choice because many of them don’t want to go from having total autonomy and total risk to having little autonomy or little risk. I am working to create several choices for physicians who join Jefferson. If they want to join as employees, as private doctors, or a hybrid — where there are different levels of autonomy and risk — we’re going to present them with options. They will choose us because we offer something different for the future, add value and present so many opportunities. I sleep very well knowing that the hard work and intelligence of our faculty and staff and my team will prepare us now to become one of the leading integrated healthcare delivery systems in the country with exceptional research centers and one of the best health sciences universities in the country.
Is the future now?
rom the start, I knew we couldn’t wait to make changes. We need to do something about the changing landscape of health care. I want to be the place where people are saying, why are they doing that now? Why are they creating a school for computational biology in 2014? Why is pharmacogenomics a part of the curriculum? By 2020, molecular genomics may be a $100 billion industry and the ability to provide efficient, effective care will require decision support. The answer to your question is found in a favorite quote of mine from Buckminster Fuller: “If you want to create the future, don’t change the existing reality. Make a new model that makes the old way obsolete.”
How can our alumni stay connected to what’s happening at Jefferson?
e’re taking advantage of more social media opportunities so alumni can keep up with the cool stuff that’s going on at Jefferson. I am hoping to build a strong loyalty among Jefferson alumni around the world. I want them to know we can help them in the changing healthcare environment and can
continue to be a great resource to them throughout their careers in the health professions. And finally, I want them to know that when they come back to an alumni event at Jefferson, it’s going to be a whole lot of fun. We work hard but also have fun. Learn more about Klasko by visiting us online at: connect.jefferson.edu/klasko Follow Klasko on twitter: @sklasko Follow Klasko’s blog at: leadership.jefferson.edu
10 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
WINTER 2014 11
From White Coat to Hospital Gown:
When the Doctor Needs a Doctor By Karen L. Brooks
STORY SUMMARY High levels of stress and responsibility threaten physicians’ mental and physical health, but medical professionals often delay or refuse care. Reasons for avoiding care include inflexible schedules, concerns about confidentiality and the belief that self-treatment is sufficient. Experiencing illness and hospitalization helps physicians understand the patient perspective and can affect the way they deliver care.
In the 1991 film “The Doctor,” an aloof surgeon notorious for his poor bedside manner is leveled by his own cancer diagnosis. Thrust into the patient experience, he considers for the first time the fear and frustration that come with navigating hospitals, interpreting medical jargon and facing gruff clinicians. After treatment, he returns to practice transformed, his approach re-shaped by a new understanding of the patient perspective. The plot is loosely based on the autobiography of rheumatologist Edward Rosenbaum, MD, who in the 1980s experienced a similar awakening after surviving cancer. And Rosenbaum’s epiphany was hardly unique. When confronting their own health issues, physicians have a reputation for delaying care until absolutely necessary — but once they do assume the role of patient, many report gaining profound self-awareness that forever changes the way they practice medicine.
‘Better Givers than Takers’ Long hours, sleep deprivation, mountains of paperwork, malpractice lawsuits, struggles balancing work and family, university debt: the life of a physician is inherently stressful. This stress can color personalities and spark problems such as anxiety, alcohol and substance abuse and job burnout —
issues that occur more frequently among physicians than most other people. “Physicians are better givers than takers,” says Todd Albert, MD, the Richard H. Rothman Professor and Chairman of the Department of Orthopaedic Surgery at JMC. “As a resident, you’re trained, in a way, to never say no. It is extremely hard for a young physician to find balance, and that ‘neversay-no’ training stays with you.” A major barrier between physicians and health care, particularly for psychological issues and drug abuse, is a reluctance to voice concerns about colleagues. And physicians often fail to seek help independently because they are worried about losing their peers’ respect and jeopardizing medical licensure if their mental health or addiction problems are discovered. “The issue of reporting to the state is something we haven’t gotten a great handle on. If I see a physician who is really impaired, I want to get them the treatment they need without putting their licenses at risk. I’ve had several experiences in which physicians have been reluctant to seek care because of that fear,” says Kenneth Certa, MD ’79, associate professor of psychiatry and human behavior at Jefferson with a clinical interest in the mental health of physicians and residents.
12 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
The Joint Commission, which oversees hospital accreditation, has begun advising that hospitals and licensing boards develop programs to identify physicians’ mental health and substance abuse problems that are separate from physician disciplinary programs.
Self-Diagnosing, SelfPrescribing, Self-Referring All physicians recommend healthy lifestyle strategies for their patients — diet, exercise, work-life balance and an annual checkup. But many do not take their own advice, working through illness, diagnosing and treating themselves and skipping routine screening tests. In 2000, one in three U.S. physicians reported not having a regular general practitioner. “I’ve gone to my GP once in the past 12 years. Surgeons in particular do not go to the doctor — we are trained to wait for a crisis and then respond to it,” says Jim Harrop, MD ’95, professor of neurosurgery. “I haven’t missed a day of work since I got my license. In order to take time off, you have to acknowledge that you’re human. We see the sickest of the sick, the worst of the worst, and we don’t want to acknowledge that those bad things could ever happen to us.” Physicians’ stress levels make them susceptible to illness, but a large majority of residents report that they would continue working if they were vomiting or saw blood in their urine. Those trends typically continue for the duration of a career. “I once had a kidney stone. The pain was indescribable, but I worked in the clinic all day and waited until evening to be operated on. I didn’t want to cancel on my patients,” Albert says. Many physicians consider it unnecessary to consult someone else for an illness they feel competent to manage — but self-treatment removes the objectivity
RIGHT: Craig Richman, MD ’88 (top), and Thomas Willcox, MD, associate professor of otolaryngology at Jefferson (bottom, on left), have both played the role of patient in recent years.
essential to a physician-patient relationship. Physicians who do have personal practitioners often register informally with a friend or colleague, which might result in insufficient “drive-by” consults and examinations squeezed in haphazardly between meetings and appointments. Certa says time pressures prevent physicians from obtaining care: “Medicine is not forgiving about taking time off, especially for house staff or students. A lot of people depend on them, and it’s hard to get them to find the time to see me or anyone else.” When serious illness forces physicians to seek care, transitioning into the patient role can prove difficult. Physicians are used to being in control, and illness
involves loss of control. They may feel uncomfortable showing weakness to colleagues or patients and worry about privacy if seeking help in their own professional communities. The tendency of physicians to give other physicians “VIP treatment” can cause additional problems. Thomas Willcox, MD, associate professor of otolaryngology as well as a patient at Jefferson — he was treated for non-Hodgkin’s lymphoma last year — knew he could use his rank as a faculty member to expedite appointments or deviate from treatment protocol but refused to take advantage of those opportunities. “I didn’t meddle because I have experienced it myself when caring for other doctors — they sometimes want to
WINTER 2014 13
Evan O’Neill Kane, MD 1884, operates on himself for a inguinal hernia at Kane Summit Hospital in Kane, Pa., on Jan. 7, 1932. The operation was considered more delicate than that of February 1921, when Kane astounded the medical world by removing his own appendix. Image courtesy of Thomas Jefferson University Archives & Special Collections.
Self-Surgery: The Ultimate Self-Treatment? Sir William Osler, regarded as the “father of modern medicine,” famously wrote, “A physician who treats himself has a fool for a patient.” But all physicians are guilty of treating themselves to some degree. One legendary JMC alumnus took self-treatment further than most, performing surgery on himself on three separate occasions. In 1921, Evan O’Neill Kane, MD 1884, chief surgeon at Kane Summit Hospital, wanted to test his belief that ether was being used too liberally during operations when less dangerous local anesthetics could be used. He did so by using mirrors to guide himself in removing his own appendix. The procedure was a success, and Kane returned to work 36 hours later. This was neither Kane’s first self-surgery nor his last. In 1919, he had amputated his own finger after it became infected. Then in 1932, at age 70, he operated on himself to correct an inguinal hernia that had bothered him since he was injured while horseback-riding six years earlier. Of Kane’s hernia surgery, Time magazine reported, “To the operating room in Kane Summit Hospital he summoned a reporter and a news photographer. While they recorded details he propped himself on an operating table, cleaned the left groin where he was to cut, gave himself a local anesthetic, proceeded to operate. He chatted and joked with the nurses as he cut, sponged and sutured for one hour, 45 minutes.” Again, Kane was back at work less than two days later.
14 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
“In order to take time off, you have to acknowledge that you’re human. We see the sickest of the sick, the worst of the worst, and we don’t want to acknowledge that those bad things could ever happen to us.” — Jim Harrop, MD ’95 dictate what I should do or cut corners to treatment plans, and that can have adverse outcomes. If you don’t apply the same algorithms to all patients, bad things might happen. Changing medicines or dosages to control side effects, discharging someone early or being talked into doing a different procedure than your instincts tell you to are dangerous shortcuts,” Willcox says. Harrop says he struggles to convince his physician-patients to follow his advice. “I treat doctors all the time, and they don’t listen to a word I’m saying. I tell someone not to go back to work for six weeks, and they go back in two.”
An Exercise in Empathy Among the few bright sides of physician illness is the one discovered by William Hurt’s character in “The Doctor” — a new compassion for patients. Ill physicians learn how exasperating things like long waiting times or noisy hospital roommates really are. The experience is often powerful enough to change the way they deliver care. “All the years I practiced, I never knew how much pain my patients were in when they had ruptured discs,” says William Buchheit, MD, Jefferson’s former chair of neurosurgery, who had a cervical discectomy shortly after his retirement. “My experience in the hospital made me completely rethink how I had approached things. Simply getting pain medicine was a problem; the nurses didn’t want to give me more than I was written for, and it was not enough. I was in agony, so I picked up the phone and called the resident myself. But the average guy can’t do that.”
Craig Richman, MD ’88, medical director at Meadows Psychiatric Center near State College, Pa., had a pituitary tumor removed in 2010 and was surprised how infrequently medical staff identified themselves when they entered his hospital room throughout his six-day stay. “Only students introduced themselves; otherwise, I had to ask for everyone’s name and role. I have always introduced myself to patients, but now I am extraaware of that in my own practice. A patient should never have to read a name badge to figure out who someone is,” says Richman, who also gained a new appreciation for the efforts patients put into managing their prescriptions. “As a doctor, even I have difficulty making sure I take my nine medications and don’t run out of refills,” he says. “This has made me more sensitive when my patients struggle with their medication regimens.” Willcox’s experience with cancer even changed the way he interacts with patients physically. “One thing I do intentionally now is to touch people more. The nurses in the Infusion Center, when they touched me, it would break down a barrier. I gave one of my patients a hug today. Almost without exception now, when I go by a bedside, I put my hand on my patient’s hand,” he says. “One of my mentors, Dr. Louis Dinon, used to glibly remark that every doctor should get sick every year, and some more than once a year, because they’ve lost their humanity. I couldn’t help but think about that once I started getting this whole new perspective during my treatment. Now I’m on the patient side for life.”
Physician-Patients Are Simply Patients The easy answer to all of the issues posed when physicians face illness is the same: physician-patients are just patients. They must adjust to their new role and use the healthcare system like all other patients, choosing their clinicians based on who will provide the best and most thorough — rather than the most convenient — care. Certa says the best way to maintain health is through communication with a close confidant. “Everyone, including physicians, should develop a relationship with someone who will nag you to stay healthy — in a loving way, of course,” he says. “For physical health, they can remind you to schedule that colonoscopy or take your medication every morning. For mental health, having someone to talk to keeps you sane. There is a hierarchy of defense mechanisms that people use to deal with all the slings and arrows of daily life, and the healthiest defenses are the ones that involve other people.” Physicians treating other physicians should reassure their patients about confidentiality and use the same protocols they would in any similar case, avoiding “corridor consults” and explaining diagnoses and treatments comprehensively without assuming the patient has background knowledge to fill in any blanks. By helping ill physicians focus on healing and not being responsible for care, those providing advice or treatment enable them to return to health as quickly and effectively as possible.
WINTER 2014 15
WHAT ADVICE SHOULD YOU GIVE YOUR PATIENTS? By Gail Luciani
Every year, millions of smokers make New Yearâ€™s resolutions to kick the habit. But like exercising more or eating better, these good intentions often fail within weeks for a variety of reasons, including the level of difficulty involved in modifying behavior.
16 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Anatomy of an Electronic Cigarette
STORY SUMMARY Electronic cigarettes have altered the landscape for smokers.
AIR FLOW SENSOR
Reaction is mixed in the healthcare community. Smoking cessation remains the healthiest option for smokers.
or smokers, the electronic cigarette, also known as an e-cigarette, e-cig or personal vaporizer, is a game changer. These battery-powered nicotinedelivery systems are little more than a cartridge with a reservoir and a mouthpiece. An atomizer helps vaporize a heated liquid solution, which is usually nicotine based. Some even have LED lights at the tip that resemble the glow from a conventional cigarette. While they don’t produce smoke, they do emit a mist that quickly disappears. Aggressively marketed by the tobacco industry, e-cigarettes are promoted as a healthier and cleaner alternative to traditional smoking. The Food and Drug Administration, which has oversight over the cigarette market, is expected to weigh in on the issue soon.
Popular Aid for Quitting The Centers for Disease Control and Prevention estimate that smoking leads to more than 440,000 deaths each year. The life expectancy of smokers is eight to 10 years less than that of non-smokers, so the incentive to quit is high. Even though “vaping” has not been determined to be safer than smoking, the CDC reports that in 2011, approximately 21 percent of adults who smoke traditional cigarettes had used e-cigarettes, up from about 10 percent the previous year. And the numbers are expected to climb. Supporters argue that e-cigarettes are less harmful than conventional cigarettes, can help smokers cut down or eliminate the habit completely and don’t produce secondhand smoke. Because e-cigarettes contain no tobacco, nothing is burned, so there is no tar and carbon dioxide. E-cigarettes give smokers the same “throat hit” they get with conventional cigarettes, and they satisfy the same oral fixation.
REPLACEABLE NICOTINE CARTRIDGE
“E-cigs are a reasonable alternative because they aren’t like a real cigarette,” says Sandra Weibel, MD, assistant professor of medicine in the Division of Pulmonary and Critical Care. “They can help patients because for the most part, they are less toxic than traditional cigarettes, which kill their users.” Approximately 20 percent of pulmonary patients at Jefferson are smokers. “It is a critical point for pulmonary disease,” she adds. “Sometimes they have lung conditions where smoking cessation is the treatment. Some people need more time to quit, so we bring them back separately just for smoking cessation.”
JeffQuit For smokers concerned about their health, quitting is still the primary goal. “Quitting smoking is the cheapest way of saving a huge amount of money for health care,” says Anna Tobia, PhD, a clinical psychologist who is the director of the JeffQuit program at the Jefferson-Myrna Brind Center of Integrative Medicine. “If you don’t do it right, it’s hard. If you do it right, it can be easy and you can be successful. For less than the average cost of a month of cigarettes, smokers can increase their life expectancy and have a better quality of life.” Darlene Richardson, a billing coordinator in the Department of Family and Community Medicine, completed the program three years ago. “I tried other products and programs, but this worked for me,” she says. “By the second week, I could only smoke half a cigarette, and by the third week, I was through.” The program has been successful due to its approach; by encouraging smokers to switch from their regular brand to ones that deliver less nicotine, smoking becomes
less satisfying. “It breaks the connection of the look and feel of smoking, and that’s where e-cigs fit in,” says Tobia. “While we don’t use e-cigs in our program, they work in a similar way to gradually diminish nicotine. But it’s important to note that we also deal with the emotional component of smoking, which needs to be part of an integrated quitting protocol.” Weibel agrees. “Some people benefit from switching to e-cigs, but the biggest aspect of successful smoking cessation is behavior modification,” she says. “The cost of cigarettes is also a major issue for many smokers, so they are often willing to try the e-cig, which is cheaper. Or patients who are not quite ready to quit can make small changes, and at least start cutting down by using e-cigs.”
Indoor Use While many proponents of vaping cite the lack of second-hand smoke as a rationale for indoor use, the impact of vapors on nearby non-smokers is still unknown. “Currently, we don’t know about the risk of second-hand vapors,” says Weibel. “But if using e-cigs helps the patient quit smoking without significant harm to others, it seems like a reasonable alternative.” At Jefferson, a new campus-wide non-smoking policy went into effect in January. “E-cigarettes are prohibited under our policy,” says Pam Teufel, senior vice president and chief human resources officer. “We believe that as leaders in health care, we need to lead the charge with respect to public health. At least for now, we are siding with those in public health who believe the jury is still out on e-cigarettes and second-hand vapors, and consequently indoor smoking bans should apply to their use. We are also monitoring
WINTER 2014 17
LEFT: Cigarette advertisement from 1946.
smoking monkey as its mascot. E-cigarette flavors include chocolate, gummy bears and, as a seasonal special last fall, V2 Cigs offered a pumpkin spice e-cigarette. Vype e-cigarettes were advertised — inadvertently, according to its parent company — in a children’s iPad game last fall.
More Research Needed
a bill pending in the Pennsylvania House of Representatives that would ban e-cigarette use in all Pennsylvania workplaces.”
Teen Usage and Target Marketing For the tobacco industry, declining cigarette sales may be offset with a projected increase in the sale of e-cigarettes. Critics fear that these high-tech gadgets will make smoking popular again, especially among teenagers. “This is just the beginning,” says Tobia. “E-cigs are the first change in cigarettes since they added the filter, and they will only improve as time goes forward.” Teenage smoking has been declining in the last 10 years, she says. But according to the CDC, the percentage of U.S. middle- and high-school students who use e-cigarettes more than doubled from 2011 to 2012. In addition, data from the National Youth Tobacco Survey says that the percentage of high-school students who
reported using an e-cigarette rose from 4.7 percent in 2011 to 10 percent in 2012 and that almost two million middle- and high-school students nationwide had tried e-cigarettes in the same year. Nicotine remains an addictive drug. Teens who try e-cigarettes may become hooked and eventually turn to conventional cigarettes. Research shows that more than 75 percent of middle- and high-school students who used e-cigarettes also smoked conventional cigarettes in the same 30-day period. Only one in five middle-school students who reported using e-cigarettes say they have never tried conventional cigarettes, which raises a red flag for a possible connection between the use of the two types of cigarettes Critics also note that e-cigarette companies are marketing their products with cartoon mascots and flavors that could draw young users. Reminiscent of Joe Camel, eJuiceMonkeys has a smiling,
Some tobacco researchers are pressing for restrictions on e-cigarettes, hoping to prevent a new generation from getting addicted to nicotine. Some have found harmful ingredients in certain e-cigarettes, such as ethylene glycol, a primary ingredient in brake fluid and antifreeze. And some say that there is little evidence e-cigarettes actually can help smokers quit. Although e-cigarettes appear to have few of the toxins found in traditional cigarettes, researchers agree that the effect of e-cigarettes on long-term health must be studied. In addition, research should assess the impact of e-cigarette marketing on smoking initiation, particularly among teenagers. Many healthcare professionals agree that the best option for smokers is to quit both traditional cigarettes and e-cigarettes by taking advantage of successful cessation programs. “I would recommend JeffQuit to anyone,” says Richardson. “Though I will say, to be successful, you have to want to quit.” Dr. Tobia is available to answer questions about the JeffQuit program or help physicians provide support for their patients who are trying to quit. She can be reached at 215-955-3402 or email@example.com. JeffQuit groups start the second Tuesday of every month, run for three sessions over four weeks and are often covered by insurance. For more information, please visit jeffersonhospital.org/jeffquit.
18 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Jefferson Faculty Rajnish Mago, MD
Building a Better Toolkit to Manage Mood Disorders Some trainees in Jefferson’s Department of Psychiatry and Human Behavior call them “Magoisms” — the tenets around which associate professor Rajnish Mago, MD, encourages them to shape their practice. “Always aim for your patient to get 100 percent better,” one he echoes often, stands out as particularly ambitious. “We should not be satisfied with a patient’s improvement as being ‘good enough,’” says Mago, director of the Mood Disorders Program, which covers both depressive and bipolar disorders. “We must use a broad range of interventions, not just a prescription, and always try to have patients improve 100 percent, even though we know this is not always possible.” While people with mood disorders often receive medication and psychotherapy from separate clinicians, Mago prides himself on his expertise in both areas. He is as much a researcher as a clinician and has conducted important studies into the adverse effects of antidepressants, previously neglected territory. “A typical recommended minimum duration for an antidepressant is eight to 12 months, but within three months more than half of patients quit, mostly because of side effects. We must find ways to manage these. It’s like with cancer and chemotherapy — the medication can be life-changing, and you can’t stop it just because of side effects.” With a grant from a private, donor-funded foundation, Mago completed the first-ever study of antidepressant use and excessive sweating, a problem experienced by up to 14 percent of people taking antidepressants. He demonstrated an effective treatment for the sweating, enabling patients to continue treatment without the distressing side effect. The same foundation awarded him a second grant with which he developed computer software to systematically assess medications’ side effects. Patients answer questions before and after starting a medication, and the software uses an algorithm to determine whether various symptoms may be related to treatment. Mago recently shared his views on his work and the practice of psychiatry.
What are some of the major issues in your field today?
Two problems are occurring simultaneously: underdiagnosis and overdiagnosis. More than two-thirds of people with bipolar disorder are initially misdiagnosed, which is a big problem because they get don’t get the right treatment.
But then anyone who is sad is said to have ‘depression’ — not to be depressed, but to have depression, as if a virus got into them. We need to distinguish between being depressed about a specific situation and having a clinical depressive disorder, because overdiagnosis leads to inappropriate prescription of medication. These days, you can’t throw a stone without hitting someone who’s on antidepressants, and a lot of the prescribing is unscientific. Feeling sad doesn’t necessarily mean you have a chemical imbalance.
What are you currently studying?
I am always working with the pharmaceutical industry to develop new medications, and I am currently examining whether a new antidepressant reduces sexual dysfunction, one of the most problematic reactions to antidepressants. I am also looking at the relationship between genetics and side effects. A battery of genetic tests has become readily available in recent years, and I got a grant from one of the test manufacturers to study people who have unusually frequent side effects to see if genetic differences can explain that.
What is your teaching philosophy?
I break down the widely accepted dichotomy of clinician versus researcher. Many researchers don’t see patients in the clinic, and many clinicians don’t do research, don’t read research and cannot interpret research. Students shouldn’t think they have to be one or the other. I have a passion for teaching evidence-based medicine, for showing students how to interpret scientific literature so that they can apply research to their clinical work.
What advice would you give students pursuing psychiatry today?
I’d tell them to be prepared for good and bad. This is an exciting time for psychiatry because we’re seeing a lot of progress in basic neuroscience and hoping that new treatments will come out of it; we are poised for a growth spurt. On the other hand, most students are interested in clinical work, and this is a challenging time for clinical psychiatrists. Payments have decreased, and many doctors have to see more patients in less time than ever before. Students must be aware of the challenges they will face.
WINTER WINTER2014 2014 19
Photo by Sabina Pierce
What do you consider your greatest contributions to your field?
I am proud of my research because it has directly helped many patients. For example, since my study on antidepressants and excessive sweating, many doctors have told me they are identifying and treating this problem, which they never did before. I am also proud of my mission to raise awareness of adult attention deficit hyperactivity disorder. I have seen a lot of so-called treatment-resistant patients, and over time I realized many of them weren’t getting better because the underlying problem was actually ADHD, and their depression was a consequence of struggling in life due to that. Since I’ve shared this discovery with my colleagues, many of them have identified patients with ADHD and treated them successfully.
Where do you see your field heading in the future?
New medications are constantly being developed, so I see progress toward better treatments. We also need to focus on technology. Medical science has been slow to take up the Internet. Health information is one of the most important things people seek online, yet physicians don’t tell their patients what websites to use, which is dangerous because the Internet is full of misinformation. I’d like to see an increase in the use of new technologies to disseminate accurate information and counter the fiction that is out there. I also hope to see clinicians finding ways to spend more time with their patients, which our healthcare system currently discourages. Some psychiatrists only spend 15 minutes with each patient — they can’t even remember their patients’ names. But there is no shortcut to good psychiatry. The clinical history that a physician takes is the gold standard for accurate diagnosis. — Karen L. Brooks
20 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Spotlight FACULTY HIGHLIGHTS Mitchell Inducted to National Black College Alumni Hall of Fame
Edith P. Mitchell, MD, was one of 16 professionals inducted into the National Black College Alumni Hall of Fame in Atlanta in September 2013. The
ceremony honored graduates of historically black colleges and universities for their service to their country and alma mater and for excelling in their fields. Mitchell is a clinical professor of medicine and medical oncology and program leader for gastrointestinal oncology at Jefferson as well as associate director for diversity programs and director of the Center to Eliminate Cancer Disparities for the Kimmel Cancer Center at Jefferson. She was
recognized for her work to help individuals in medically underserved areas realize that simple lifestyle changes can have a dramatic impact on cancer care. She has demonstrated the importance of community service and outreach especially to those who may not have the means to seek out more conventional medical advice. Mitchell’s research in breast, colorectal and pancreatic cancers and other GI malignancies involves new
Dale D. Berg, MD, and Michael P. Savage, MD ’80, Recognized with New Professorships Dale D. Berg, MD, was invested as the first G. Fritz Blechschmidt, MD, Professor of Clinical Skills on Sept. 24, 2013.
Michael J. Vergare, MD, senior vice president, academic affairs; Stephen K. Klasko, MD, MBA; Berg; and Mark L. Tykocinski, MD, Anthony F. and Gertrude M. DePalma Dean, JMC.
Berg joined Jefferson in 2001 and with his wife, Katherine Berg, MD, helped establish the Dr. and Mrs. Robert D. Rector Clinical Skills Center as one of the premier centers of its kind in the world. Blechschmidt, a 1958 JMC graduate, died in San Diego on June 29, 2011. In addition to bequeathing the professorship to JMC, he endowed a scholarship in his estate for a student with financial need. Michael P. Savage, MD ‘80, was invested as the first Ralph J. Roberts Professor of Cardiology on Dec. 19, 2013. Savage, director of interventional cardiology and the cardiac catheterization laboratory at Jefferson, has been a JMC faculty member for 25 years.
Brian L. Roberts, chairman and CEO, Comcast Corp.; Klasko; David Binswanger, former chair, Thomas Jefferson University Board of Trustees; Ralph J. Roberts (seated); Savage; and Tykocinski.
This professorship was established in honor of Ralph J. Roberts, founder of Comcast Corp., by his colleagues Lawrence Smith and John Alchin and their partners, Christine Smith and C. Halford Marryatt, in gratitude for his mentorship and friendship.
WINTER 2014 21
drug evaluation and chemotherapy, development of new therapeutic regimens, chemoradiation strategies for combined modality therapy, patient selection criteria and supportive care for patients with gastrointestinal cancer.
Brent Receives John Scott Award
Robert L. Brent, MD, PhD, the Distinguished Louis and Bess Stein Professor of Pediatrics, Radiology and Pathology and head of the Clinical and Environmental Teratology Laboratory at the Alfred I. duPont Hospital for Children (a major Jefferson partner), received the 2013 John Scott Award for his work on “environmental causes of birth defects including environmental exposure to drugs, chemicals, ionizing radiation, microwaves and ultrasound.” The John Scott Award is given to men and women whose inventions have contributed in some outstanding way to the “comfort, welfare and happiness” of mankind. Scott, an Edinburgh druggist, set up a fund in the early 1800s calling upon the “Corporation of Philadelphia entrusted with the management of Dr. [Benjamin] Franklin’s legacy” to support “ingenious men or women who make useful inventions.” The first John Scott Awards were made in 1834 for the inventions of the knitting machine and a door lock, and through the years, the awards have been given internationally for inventions in industry, agriculture, manufacturing, science and medicine. Candidates are nominated by a committee of Philadelphians and vetted through the Board of Directors of City Trusts of the City of Philadelphia.
11th Annual Jefferson Awards Gala Honors Local Luminaries Jane and Leonard Korman were recognized for their outstanding leadership and philanthropy at Jefferson’s annual gala in October 2013. They received the Jefferson Award of Merit, which is presented each year to accomplished Philadelphians who have enhanced the medical experience through leadership, contribution and innovation. Together, Jane and Leonard have been dedicated to creating and supporting numerous initiatives and programs in the cultural and healthcare fields. A recent gift established the Jefferson – Jane and Leonard Korman Lung Center. The partnership, supported by the Jane and Leonard Korman Family Foundation, will allow Jefferson to better understand lung disease through innovative research and expanded clinical programs. Roger B. Daniels, MD, received the Achievement Award in Medicine. This award honors individuals who have achieved and maintained excellence in their profession and who have actively contributed to the growth and development of their field. Daniels routinely is listed in the Best Doctors in America and is a fellow in the American College of Physicians. In 2008, the organization honored him with the Pennsylvania Clinical Practice Award. In 2011, a group of his Jefferson colleagues and patients established an associate deanship in professionalism in his name. The 2013 gala raised more than $925,000 to support two organizations selected by the awardees. Gifts honoring Dr. Daniels will benefit the Daniels Fund for Excellence in Primary Care, and gifts honoring Jane and Leonard Korman will benefit the Jefferson – Jane and Leonard Korman Lung Center.
Leonard and Jane Korman; Stephen Klasko, MD, MBA, and his wife, Colleen Wyse; and Susan and Roger Daniels, MD, at the 11th Annual Jefferson Awards Gala.
22 JEFFERSON JEFFERSONMEDICAL MEDICALCOLLEGE COLLEGEALUMNI ALUMNIBULLETIN BULLETIN
Photo by David Rehor
WINTER 2014 23
10 Questions with . . .
Anthony Calabrese, MD ’72 Anthony Calabrese, MD ’72, has hit many high notes since he graduated from JMC. Professionally, Calabrese served the country on active duty as chief of gastroenterology at Andrews Air Force Base in Maryland. He served as president of the medical staff at Anne Arundel Medical Center in Annapolis, Md., and is a member of the Maryland State Colorectal Cancer Advisory Committee. He has been consistently voted a “Top Doc” and continues to care for patients as a founding member of Anne Arundel Gastroenterology Associates. Personally, he married Nancy (nee) Meier in 1970. She later became a Jefferson alumna herself, graduating with the first BSN class at Jefferson in 1974, and is now a nurse practitioner at St. John’s College in Annapolis. They have two sons. In his spare time, Calabrese hits high and low notes as the lead tenor saxophonist for the Bayside Big Band, a 17-piece orchestra. Nearly every week the band performs jazz and swing music at concert halls, clubs, weddings and other venues in the Washington-Baltimore area. Calabrese joined the band 15 years ago, but his love of music began early in life growing up in Elizabeth, N.J. “I started to get interested in music at about age 9,” he says. “My dad was a truck driver but played piano professionally on weekends as a second job. I took lessons from one of his colleagues and later played first chair clarinet with my highschool band.” Music remained in the background for years, but after his time in medical staff leadership, Calabrese picked up his saxophone and clarinet again. “When my tenure as medical staff president was completed, I decided I would make more time for me and get back to playing more seriously,” he said. “After a long period of only rarely bringing out my instruments to play, I started back playing regularly with the local community college band and then was recruited to join Bayside Big Band.” The rest, as they say, is history.
hen you were 5, what did you want to be when you grew up? W The first thing I can remember is thinking I’d work in a pharmacy like one of my dad’s musician friends. I always liked the idea of helping people, but I saw limited options since neither of my parents had finished high school. Later, when I did well academically, I thought I might consider dentistry. I began college as a pre-dental student, but with the encouragement of my dad, I soon switched to aspiring to becoming a physician.
What drew you to your specialty (gastroenterology)? There are four main reasons: a) the breadth of GI encompasses all of internal medicine; b) the “art” of taking a history and listening how patients describe their symptoms to come to an accurate diagnosis; c) the impact of Jefferson professors (most notably Drs. Gonzalo Aponte
and O. Dhodanand Kowlessar); and d) the ability to be both a cognitive and procedural specialist.
What was the most fun you ever had in your career? When serving on active duty in the Air Force, I was asked to be the attending physician for members of the U.S. Congress on a “junket” through the Caribbean. I got to spend two weeks with the congressmen, their spouses and staffs. The trip included touring several countries, off-shore fishing and fighting a blue marlin and several days in Cuba. We had personal meetings with several political leaders, including Fidel Castro.
What was your first job? My first real job was the summer after high school when I worked on a “track gang” repairing railroad tracks with hand tools for the Pennsylvania RR. Of note, that summer job earned enough for me to pay for my first year’s college tuition (I was a commuter and lived at home).
What is your biggest pet peeve? What I see as an America that has historically afforded tremendous opportunities through both personal and family effort and sacrifice becoming a society where excellence and honest achievement are not goals held deserving of reward. Entitlement and mediocrity are not what made America great.
What is the biggest challenge in your field? The marked rise of educational costs and longer training programs required for certifications, coupled with the anticipated decreased compensation for physicians across the board, make planning for economic realities for physicians alarming going forward. The days of private practice may be gone.
What was your most memorable moment at Jefferson? Graduation day, when my Italian immigrant grandparents and my parents were so proud to see me graduate as a physician cum laude.
8 9 10
What is the proudest moment in your career? Being consistently named by my peers as a “Top Doc.” What is your highest priority for the coming years? Phasing out of practice and into retirement gracefully. What is the best decision you ever made? Inviting myself to join my current GI practice in Annapolis.
— Stacey Miller
24 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Gerald Marks is sad to report that his wife of more than 62 years, Barbara, died Aug. 19, 2013, after a seven-month struggle with a frontal lobe glioblastoma. Barbara, a 1947 graduate of the Jefferson School of Nursing, was the grandniece of J. Parsons Schaeffer, MD, PhD, the famous editor of Morris’ Human Anatomy. She was the mother of Richard M. Marks, MD ’88 and John H. Marks, MD ’89. She served as a suture nurse and ultimately became a supervisor in the operating room. Barbara became well known to the Jefferson students of the 1960s because she graciously hosted the barbeques that followed Friday evening faculty-student softball games. She was active on Jefferson’s Women’s Board, along with her great-aunt Mary Schaeffer, and was a founding member of the Faculty Wives Club. Marks continues to work part time in colorectal surgical practice at Lankenau Hospital, where he is also engaged in clinical research. He directs the Marks Colorectal Surgical Foundation and serves on the executive boards of the International Federation of Societies of Endoscopic Surgeons and the Multidisciplinary International Rectal Cancer Society. Marks lives in Penn Valley, Pa.
Samuel Krain is a retired radiologist and enjoys spending time with his grandchildren. He lives in Philadelphia.
Elliott J. Rayfield received the 2014 Sidney H. Ingbar Distinguished Service Award from the Endocrine Society, or
ENDO. The award recognizes distinguished service in the field of endocrinology. During the past decade, Rayfield has been a driving force in the establishment of the Clark T. Sawin Memorial Library and Resource Center, which preserves historical endocrine literature. He was also instrumental in instituting the Fisher Fellowship Program and Lectureship at ENDO. He is a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.
Cora Christian received the 2013 American Academy of Family Physicians Humanitarian Award on Sept. 25, 2013, for her work to provide preventive health services to vulnerable populations. In addition to practicing family medicine and serving as the medical director for HOVENSA, an oil company, Christian is the medical director of the Virgin Islands Medical Institute Inc., which she founded in 1977 to provide advocacy and technical assistance and to help Medicare beneficiaries receive quality care. She lives in the U.S. Virgin Islands.
James W. Redka says he is enjoying his full-time family medicine practice while grappling with the changes required by the Affordable Care Act, accountable care organizations and patientcentered medical homes. He lives in Williamsport, Pa.
Joseph J. Korey Jr. is in his 35th year of practicing obstetrics and gynecology and says he will “continue to work as long as my hands and eyes permit.” He says
his wife, Linda, and his children and grandchildren are all well. Korey lives in Reading, Pa.
Thomas Carnevale is in his 23rd year of general ob/gyn practice at Clearfield Hospital in Clearfield, Pa. Donald Zeller proudly celebrated his 30th wedding anniversary with his wife, Diane, in November 2013. He works as lead physician at University of Pennsylvania’s family medicine practice in Phoenixville, Pa.
Sharon B. Mass is chair of the New Jersey section of the American College of Obstetricians and Gynecologists and of the New Jersey Women’s Health Coalition. She lives in Randolph, N.J.
Andrew E. Denker is proud to announce the birth of his daughter, Natalia, in January 2013. She joins two older sisters. Denker lives in Rumson, N.J. Amanda Grant Smith is an associate professor of psychiatry and behavioral neurosciences at the University of South Florida
in Tampa, Fla., and is medical director of the USF Health Byrd Alzheimer’s Institute. She lives in Lutz, Fla., with her husband, Sam, and two daughters. (She also reports that she regularly plays “Words with Friends” with Jefferson’s president, Stephen Klasko, and occasionally lets him win.)
Andrew S. Bilinski continues to serve in the U.S. Army Medical Corps, taking care of soldiers.
Jeannette R. Jakus has been awarded the American Academy of Dermatology’s Translational Biotechnology Fellowship, a partnership of t he American Academy of Dermatology and Galderma Research & Development, SNC. As part of the fellowship, Jakus will work in drug development and translational medical research at Galderma’s R&D facility located in Sophia Antipolis, France, where she will learn about the specific requirements of drug development and be given opportunities for creative exploration within the pharmaceutical industry environment.
What’s New? Send us your personal and professional updates for the Bulletin’s Class Notes! Contact the Foundation at 215-955-7751 or firstname.lastname@example.org. Mail to: The Jefferson Foundation 125 S. 9th Street, Suite 700, Philadelphia, PA 19107
WINTER 2014 25
Alumni Association President’s Message
The Spirit of Jefferson “Oh when the saints, go marchin’ in”… Growing up, we always looked forward to Halloween, but for Catholic-school kids, the added bonus was having off the following day to remember All Saints’ Day. This year, some of Jefferson’s medical students marked Nov. 1 with their own saintly celebration. As a show of love and support for a fellow student, they organized a fundraiser that would make Jefferson history. For 75 years, the Black and Blue Ball was an annual gala sponsored by Kappa Beta Phi (backwards for Phi Beta Kappa). It was a night when all four classes and faculty came together to dance around the school colors and celebrate the fellowship that is Jefferson. Some years ago, the Ball slipped off the calendar. In July 2013, one of our senior students, Greg Snyder, sustained an injury that rendered him paraplegic. My colleague Joe Majdan, MD, approached me as the president of the JMC Alumni Association with a request to organize a fundraiser for this young man. When I asked Dean Tykocinski if we could revive the Ball with a new purpose, he gave his permission without hesitation. Dr. Majdan accepted the role of chairman with its many responsibilities. Student Council President Nicole Sgromolo sprang into action. She and a committee of seven students raised more than $35,000 for Greg. While juggling the usual demands of clinical rotations and mid-terms, they found time to send
invitations, recruit a DJ, solicit auction items and order food. On the budget of a senior prom in the gym, the Hamilton Building lobby was transformed into an elegant ballroom. A great banner reading “Black and Blue Ball” welcomed guests as they entered, while black and blue balloons filled the room. The center of the dance floor was lit with the Black and Blue logo and the mood was set by soft blue lighting. When the guest of honor appeared, he was warmly embraced by his classmates and his Alpha Kappa Kappa brothers. Looking elegant in his tuxedo, Greg was accompanied by his parents and his girlfriend, Christina Constantino, another senior medical student. Midway through the event, Dr. Majdan expressed his thanks to the committee for their great work and to the students for attending. No one says it better than Saint Joe Majdan, who is the quintessential role model for students and fellow physicians alike. He truly exemplifies the compassionate physician. Then it was Greg’s turn to speak. Just a few months after experiencing a life-changing trauma, he found the courage to return in a wheelchair and rejoin his fellow students. While facing an audience of more than 350 peers, he said he was overwhelmed as he thanked his parents, his girlfriend and his Jefferson family. It was hard to hold back our tears as he shared his heartfelt emotions. The applause was deafening. At that moment, the sum of the emotions in the room was definitely greater than its parts. And have no worries about today’s youth. These members of Generation Y definitely ‘get it.’ The evening ended with a thunderous rendition of “Sweet Caroline,” with circles of students dancing around Greg and Christina. One student
remarked, “This night reminded me why I came to Jefferson to study and become a doctor.” A special thank you to Greg for his inspiration as a man of honor with a firm resolve to earn his Jefferson diploma. And “when the saints go marchin’ in,” I surely want to be in that number. Because this was a night of extraordinary memories. This was a night that defined the spirit that is Jefferson!
Marianne T. Ritchie, MD ’80 President, JMC Alumni Association
Christina Constantino with Greg Snyder at the Black and Blue Ball.
26 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Wallace B. Hussong, 93, of Merchantville, N.J., died Feb. 19, 2013. Following an internship at Cooper Hospital and a psychiatric residency at Pennsylvania Hospital, he served as a physician in the U.S. Navy at Oakland and Long Beach Hospitals in California and at Parris Island, S.C. He was in private practice in the Camden and Cherry Hill area for 50 years, and he was an active member of his community. He is survived by his wife of 70 years, Catherine, three children and three grandchildren.
William Larch Fidler III, 88, died July 30, 2013, in Daleville, Va. Larch interned at Cooper Hospital in Camden, N.J., and worked in a family medical practice in Stratford, N.J., before resuming his pediatric studies at Jefferson. He was recalled by the Navy in 1950, then finished his pediatric training at Children’s Hospital in Detroit in 1953. He established a private practice in Cranford, N.J., and worked there for 35 years before retiring in 1988. In retirement, he enjoyed spending time with his family, gardening, playing the flute and mentoring. He is survived by his wife of 65 years, Beryl; three children; and five grandchildren. George F. Tibbens, 91, of Washington, Pa., died Sept. 16, 2013. After a residency at Jefferson, he joined the U.S. Air Force during the Korean War. He was stationed in Japan for a year and then spent a year at Clark Air Force Base Hospital in the Philippines. In 1953, Tibbens was discharged as a captain. He joined his father in ophthalmology practice in 1954 in Washington, Pa., and continued practicing until 1991. He was a member of the staff of Washington
Hospital, the American Medical Association and the Washington County Medical Society. He retired at age 70 and pursued passions including hunting, fishing, gardening, farming and woodworking. Tibbens is survived by four children, Pamela, William, Susan and Martha; seven grandchildren, Amanda, Andrew, Abigail, Hilary, Emily, Lee and Marla; a niece; two nephews; and a greatgrandson. He was preceded in death by his wife, Nancy, and a sister, Martha.
Walter E. Boyer, 87, of Oil City, Pa., died April 27, 2013. Boyer served in the U.S. Navy and was awarded a Korean Service Medal. Upon honorable discharge, he moved home to Oil City in 1952 and began a career in family practice, from which he retired in 1994. Boyer was past president of the Oil City Hospital medical staff and the Venango County Medical Society. He became a fellow of the American Academy of Family Physicians in 1977 and was a member of the Board of Governors of the Oil City Area Health Center from 1983 to 1991. Boyer served on the University of Pittsburgh Medical School faculty from 1975 to 1980 and volunteered as the physician for the athletic department at Venango Christian High School for more than 20 years. Boyer is survived by his wife, Deborah; their two kittens, Tess and Princess; two sons, Walter and Jeffrey; three daughters, Susan, Debra (MD ’83) and Patricia; eight grandchildren, Donald, Dianna, Emily, Elisabeth, Matthew, Christopher, Jason and Patrick, five great grandchildren; and many nieces and nephews. Mortimer Terrence Nelson, 91, of Long Beach Island, N.J., and Boca Raton, Fla., died Nov. 14, 2013,
after a long battle with Parkinson’s disease. Mortimer served in the U.S. Army during World War II and completed his internship at Queens General Hospital and his residency at Beth El Hospital in Brooklyn, N.Y. An obstetrician and gynecologist, he delivered more than 20,000 babies and took care of thousands of women during his career. In August 1963 alone, he delivered 99 babies. He was one of the founding members of Lower Bucks Hospital, where he ultimately served as president of the medical staff and held many other leadership positions. He was an avid fisherman, pilot and sports enthusiast and a member of many philanthropic organizations, holding positions on the boards of the United Way, Combined Jewish Appeal and the Exchange Club. Mortimer is survived by his wife of 64 years, Marcia; four children, Mimi, David, Janie and Judy; and eight grandchildren, Kyle, Todd, Andy, Danielle, Ryan, Jenna, Ian and Connor.
Jerome J. Lebovitz, of Pittsburgh, died Sept. 5, 2013. Lebovitz practiced internal medicine for 51 years and is survived by his wife, Joanne.
Franz Goldstein, 91, of Bryn Mawr, Pa., died Nov. 19, 2013. After emigrating to the U.S. from Germany in 1947, he worked as a research technician in John H. Gibbon’s surgical research lab at Jefferson. He graduated first in his JMC class. He was an intern and resident at Graduate Hospital before returning to Jefferson to practice gastroenterology. Early in his career, he became involved in the study and treatment of inflammatory bowel disease. He was recognized by the American College of
Gastroenterology for his work with Crohn’s disease, and he became active in its leadership. He went to Lankenau Hospital in 1979 and served as chief of gastroenterology before returning to Jefferson in 1996. He received many awards, including the American College of Gastroenterology (ACG) Rorer Award in 1974, 1975 and 1981. He was the ACG Samuel Weiss Award winner for lifelong service in 1992. He is survived by his wife, Beatrice; his son, Richard; his daughters, Jean and Nancy; and five grandchildren, Caroline, Albert, Phillip, James and Jon.
Robert David Bloemendaal, 80, of Rapid City, S.D., died at home Aug. 26, 2013. Bloemendaal served residencies at Minneapolis General Hospital and Charles T. Miller Hospital in St. Paul, Minn. Board certified in clinical and anatomical pathology, he practiced in Sioux Falls, S.D.; Cody, Wyo.; and Rapid City, where he was a partner in the Clinical Laboratory of the Black Hills. He served on the South Dakota Blue Shield Board of Directors for 12 years and was chief of the medical staff at the time of the groundbreaking for Rapid City Regional Hospital. He loved fishing from his boat and hunting game birds. More than anything, he loved being a dad and grandfather. Bloemendaal is survived by his wife of 57 years, Shirley; son, Stephen; daughter, Sarah; four grandchildren; brother, Bill; sister, Nancy; and many cousins, nieces and nephews.
John P. Capelli, 77, of Haddonfield, N.J., died at home June 29, 2013. Capelli served his internship at Michael Reese
WINTER 2014 27
Hospital in Chicago and then returned to Jefferson for a residency in internal medicine. He completed his post-doctoral fellowship in nephrology at the National Institutes of Health in 1967, his board certification in internal medicine in 1969 and his board certification in nephrology in 1972. During this time, he also served in the U.S. Air Force Reserves as a flight surgeon with the New Jersey Air National Guard. In 1969, Capelli founded and served as the first director of the Dialysis and Transplant Center at Our Lady of Lourdes Medical Center in New Jersey, holding that position until his retirement in 2010. In 1974, he established South Jersey’s first kidney transplantation program at the hospital, where he was chief of nephrology from 1975 until 2001. In 1987, Capelli was appointed vice president of medical affairs, a position he also held until his retirement. After retiring, he continued to practice internal medicine and nephrology until illness interfered. In addition to his achievements in medicine, Capelli was given the papal appointment of a Knight of St. Gregory in 1995. Capelli is survived by his wife, Patricia; three children, John, Elizabeth and David; and four grandchildren, James, Justin, Isabella and John.
Charles H. Klieman, 72, of Newport Beach, Calif., died suddenly Sept. 25, 2013. For nearly 40 years, Klieman was on the medical staff at St. Francis Medical Center in Lynwood, Calif., where he was a highly regarded cardiovascular and thoracic surgeon. During his career, he held key elective positions at St. Francis including chief of surgery and chief of staff and was an integral part of the emergency and trauma services team. Klieman invented and patented several medical devices and instruments, including an embolectomy catheter and a clip applier to quickly close wounds. He was selected as the recipient of the 2013 Vincentian Spirit Award, the highest honor from St. Francis Medical Center. The award was accepted by his wife and son in November 2013 at the Center’s annual Charity Ball. Several years ago, Klieman spent three weeks as a volunteer performing vascular surgeries at Landstuhl Regional Medical Center, a U.S. Army Medical Command post in Germany used as the first stop for injured American soldiers leaving Iraq and Afghanistan. He was a photographer and artist, donating many of his photo paintings to St. Francis. He is survived by his wife, Candace; son, Michael; daughter, Valerie;
stepdaughter, Megan; two granddaughters, Dagny and Jacqueline; three sisters, Judith, Susan and Carol; two nephews, Eric and Robert; and two nieces, Laura and Jessica.
Jay Nogi, 66, of Richmond, Va., died March 21, 2013. Nogi was a veteran of the U.S. Army Medical Corps and served a residency at the University of Virginia and a pediatric orthopedic fellowship at A.I duPont in Wilmington, Del. He was the Beverley B. Clary Professor of Pediatric Orthopedic Surgery at the Medical College of Virginia and surgeon-in-chief and director of pediatric orthopedic services at Children’s Hospital Inc., who brought him on in 1979 as its first full-time pediatric orthopedic surgeon. He was president of the Virginia Orthopedic Society and a member of the Pediatric Orthopedic Society of North America, the American Academy of Orthopedic Surgeons, the American Academy of Cerebral Palsy and Developmental Medicine, the Virginia Orthopedic Society, The Richmond Academy of Medicine, the Scoliosis Society and the Medical Society of Virginia. He was an avid reader and supporter of the arts and enjoyed golfing and traveling. Nogi is survived by his wife of 45 years, Sandra; his daughter,
Jill; his son, Scott; two grandsons, Jacob and Evan; his sister, Janet; and several nieces and nephews.
John Richard Sosnowski, 92, of Wadmalaw Island, S.C., died Sept. 12, 2013. Sosnowski served two years in the U.S. Army Medical Corps after graduating from the Medical University of South Carolina in 1945. He was a partner in the Charleston, S.C., ob-gyn practice of Rivers, Wilson and Sosnowski and was instrumental in bringing Swiss physician Paul Tournier’s “The Meaning of Persons” movement to the United States and his local medical community. The philosophy encourages healthcare providers to minister to the whole patient, both body and soul. He was named to the Board of Commissioners of Roper Hospital in 1961 and was appointed medical education director for Roper and St. Francis Xavier hospitals in 1974. He also worked as a professor of obstetrics and gynecology at MUSC and was assistant dean of the College of Medicine. He was a member of the Carolina Yacht Club and St. Michael’s Church. Sosnowski is survived by his wife, Elizabeth; a daughter, Elizabeth; two sons, John and Chris; four grandchildren, Liza, Trish, Cory and Anna; and a brother, Frederick. CORRECTION
Antoinette “Toni” Agnes, 56, of Philadelphia, died Jan. 8, 2014. Toni worked for Jefferson for 11 years as an administrative assistant, primarily in alumni relations in the Jefferson Foundation. She is survived by her daughter, Celeste L. Agnes, and numerous family members and friends. Toni was an animal lover, and she and her daughter rescued a dog named Vada from a Philadelphia animal shelter in 2013.
In the fall 2013 Bulletin, the obituary for Robert H. Holland, MD ’44S, misspelled his name and listed an incorrect date of death. Holland died on May 26, 2013. The Bulletin regrets the error.
28 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Design for Living Housed in the Scott Library, the University Archives and Special Collections contains artifacts that range from early photographs to this 19th century doctorâ€™s portable toolkit. How will doctors communicate with and treat patients at a distance in the future? Haptics, robotics and advances in telemedicine spring to mind. Jefferson archivist Michael Angelo and design scientist Peter Lloyd Jones, PhD, are examining these questions collaboratively, as Jefferson builds on the past to lead the healthcare transformations of the future. What do you think the next-generation physicianâ€™s toolkit will contain?
WINTER 2014 29
By Numbers Health in the White House Monday, Feb. 17, marks this year’s celebration of Presidents’ Day. From George Washington’s toothlessness (he had no teeth left by middle age) to George W. Bush’s colon polyps, the leaders of the free world have suffered from many diseases and ailments. Here are some facts about the health issues that have affected U.S. presidents.
Presidents who died in office:
Number of real teeth in George Washington’s mouth when he was elected:
(William Henry Harrison, Zachary Taylor, Abraham Lincoln, James Garfield, William McKinley, Warren G. Harding, Franklin D. Roosevelt and John F. Kennedy)
Days William Henry Harrison spent in office before dying of pneumonia:
(During his inauguration, he wore dentures made from carved hippopotamus ivory and gold.)
Health crises experienced by Dwight D. Eisenhower during his two terms in office:
Visits Warren G. Harding paid to the J. P. Kellogg sanitarium in Battle Creek, Mich., “to recover from fatigue, overstrain and nervous illnesses” between 1889 and 1901:
Age at which Franklin D. Roosevelt experienced a severe attack of polio that resulted in total paralysis of both legs:
(heart attack, stroke and Crohn’s disease)
Age of the oldest president, Ronald Reagan, when he assumed office plagued with chronic conditions including urinary tract infections, prostate stones, TMJ and arthritis:
Number of medications JFK was known to use simultaneously during his presidency to fight the pain and anxiety caused by his many health conditions, which included colitis, prostatitis, Addison’s disease, allergies and osteoporosis of the lower back:
Weight of William H. Taft, the heaviest president in U.S. history:
Non-Profit Org. US Postage PAID Permit #276 Philadelphia, PA
925 Chestnut Street, Suite 110 Philadelphia, PA 19107-4216 Change Service Requested
Now it’s easier than ever to stay connected! FOLLOW THESE E ASY STEPS T O G E T S TA R T E D . 1. Visit connect.jefferson.edu and select the MEDICAL COLLEGE community in the top bar. 2. Click “register now” in the upper right-hand corner. 3. Fill in your name to search for your record. 4. Enter your constituent ID. Not sure what it is? It’s right above your name in the mailing label on this page.
******3-DIGIT 19107 500374190 Mr. and Mrs. Thomas Jefferson PO Box 123 Philadelphia, PA 19107-0123
5. Take a few minutes to set up your profile. 6. Simply click “login” every time you visit in the future.
FOLLOW US AND WE’LL FOLLOW YOU!
Keep up-to-date with JMC and the Jefferson community. Follow us @JeffersonAlumni