Biological Sciences Division
A Medical First, Years Later
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Medicine Midway U niv ersit y of Chicago
Oceanic Mystery by Suzanne Wilder Timothy Wootton, PhD, professor of ecology and evolution, spends his summers on the West Coast. Half a mile away from the mainland of Washington state on Tatoosh Island, Wootton and a team of researchers are looking at the dynamics of ecosystems. What they found is that the level of acid in the ocean changes far more frequently and rapidly than was widely thought in the scientific world. Ten years ago, Wootton and his team—including his wife and fellow researcher Cathy Pfister, PhD, associate professor of ecology and evolution— decided to measure ocean conditions and the effects on the ecosystem around Tatoosh Island. The biologically rich island is “one of the most intensively studied pieces of real estate,” Wootton said. The site has been used in the past for weather observation and military use, and scientists have studied the island for about 40 years. The surrounding rocky waters prevent people from visiting too often, which means the research equipment there is undisturbed. Wootton and Pfister’s earlier research on the island showed what species were present from one year to the next, how different species interacted, which plants and animals were thriving, and how they responded to changes in their environment. In recent years, researchers set a pH meter into the Pacific Ocean. They measured substantial variations in the ocean’s level of acidity in small amounts of time. “The rate of change in pH is a lot faster than people have predicted,” Wootton said.
The ocean water is growing more acidic at a rate 10 times faster than expected, which could have far-reaching effects on oceanic ecosystems and the plants and animals within them. “Now we’re trying to increase our understanding of why the pH is going down and what the implications of that might be,” Wootton said. He and his team will be seeking answers about the causes and effects of the acid levels. Species with shells, such as mussels, snails and clams, fare poorly as acid levels increase. Algae and kelp do well in the same circumstances. The species seen at Tatoosh may evolve over time as the acid levels in the water change.
Photos by Timothy Wootton, PhD
features Recognition for Rowley Janet Rowley, MD, the Blum-Riese Distinguished Service Professor of Hematology and Oncology, received the Presidential Medal of Freedom from President Barack Obama. by Robert Mitchum_ __________________________________________
A Medical First, 20 Years Later Before she was a year old, Alyssa Smith was among 700 infants waiting for a liver transplant. But in November 1989, in a procedure performed by Medical Center doctors, she underwent the first living donor liver transplant in the United States. by Katie Scarlett Brandt________________________________________
Options for Treating an Aggressive Disease While the prognosis for pancreatic cancer is still grim, Medical Center doctors are exploring leading-edge treatments. by Cheryl L. Reed_____________________________________________
After Flames Manoj Rana suffered burns on 95 percent of his body surface when his apartment building was set on fire by an arsonist. Determination by Medical Center doctors, nurses and social workers saved him. by Susan Chandler and Philippe Tapon____________________________
JBK at 100 Joseph B. Kirsner, MD, PhD, who spent the past seven decades building the Section of Gastroenterology, Hepatology and Nutrition at the Medical Center, turns 100 years old. by Susan Chandler____________________________________________
Challenges to a Pioneer: James Bowman, MD Professor Emeritus in the Departments of Pathology and Medicine, Bowman spent most of his life proving himself and his theories to skeptics. by Katie Scarlett Brandt________________________________________
departments Midway News Catch up on the latest research and news in medicine and biological sciences.________________________________________
Medicine off the Midway
Before entering the Pritzker School of Medicine, student Dan Krebs had an unusual background, one that included travel to Africa and Russia. by Katie Scarlett Brandt________________________________________
Alumni News/Class Notes Read about alumni of the Pritzker School of Medicine and the Division of Biological Sciences._ ________________________________
Perspective Stacy Tessler Lindau, MD, assistant professor in the Department of Obstetrics and Gynecology, writes about why some doctors are reluctant to discuss sexual problems with female cancer patients.______________
James L. Madara, MD, CEO, stepped down October 1
Roy E. Weiss, MD, PhD is serving as interim Chair of the Department of Medicine
Everett E. Vokes, MD is serving as interim CEO
Madara Steps Down, Vokes Named Interim CEO James L. Madara, MD, stepped down from his position as chief executive officer of the Medical Center and dean of the Biological Sciences Division and the Pritzker School of Medicine on October 1. Everett Vokes, MD, chair of the Department of Medicine and professor in the Departments of Medicine and Radiation and Cellular Oncology, is serving as interim chief executive officer. Roy E. Weiss, MD, PhD, is serving as interim chair of the Department of Medicine. Madara, 59, the Sara & Harold Lincoln Thompson Distinguished Service Professor at the University of Chicago, will remain on the faculty. Madara came to the University in July 2002 as dean of the Division of the Biological Sciences and the Pritzker School of Medicine and university vice president for Medical Affairs. In 2006, he became the first chief executive officer of the Medical Center, bringing together the University’s biomedical research, teaching and clinical activities. “I am grateful for Jim’s vision and leadership over the past seven years, during
which the science, education, clinical and community outreach programs for which he is responsible marked a number of extraordinary achievements, and the Medical Center has defined and pursued a strategy that positions it for success far into the future,” said Robert J. Zimmer, president of the University of Chicago. During Madara’s tenure, he oversaw a significant expansion of the biomedical campus, including the Comer Children’s Hospital, the Gordon Center for Integrative Science, the Knapp Center for Biomedical Discovery and, most recently, the New Hospital Pavilion, a $700 million, 10-story, 1.2 million-square-foot facility, which is scheduled to open in 2013. He recruited many world-renowned physicians and scientists and dramatically increased medical student selectivity as well as student financial support. Madara also helped design and launch the Urban Health Initiative, a collaborative effort that brings together the Medical Center and South Side doctors, nurses, health centers and community hospitals to improve the long-term health of area residents.
The interim dean and chief executive officer, cancer-specialist Everett Vokes, 54, is an international authority on the treatment of head and neck cancer, lung cancer and drug development. He is a pioneer in organ-sparing therapies, which combine intensive radiation and chemotherapy to bring locally advanced head and neck cancers under control, often without the need for major surgery. He is a prolific researcher and has been principal investigator of the University of Chicago’s National Cancer Institute Phase II program, which performs clinical trials of novel anti-cancer agents. Weiss, an expert on the mechanisms of thyroid hormone action at the molecular, physiological, and psychological levels and on diseases of the thyroid and pituitary, has described several genetic endocrine diseases. He and his colleagues have one of the largest referral centers for genetic thyroid disease in the world.
Surgeon Saves Remaining Leg for Amputee When Bob Mitchell began to experience extreme pain in his right foot in 1998, he knew that it was due to the same disease that resulted in the amputation of his left leg. The pain was so extreme that Mitchell actually wanted another amputation. “Mr. Mitchell had a longstanding history of lower extremity peripheral arterial occlusive disease, which is caused by the obstruction of large arteries in the legs,” said Hisham Bassiouny, MD, professor and chief of Vascular Surgery and Endovascular therapy at the Medical Center. “When he came to our clinic, the circulation of blood in his leg was around 15 to 20 percent of normal.” Mitchell reluctantly agreed to let Bassiouny try to alleviate his pain while
sparing his leg. In a highly complex surgery, Bassiouny performed a lower extremity arterial reconstruction to redirect blood flow and correct the insufficiency in his circulation. After selecting and removing the most suitable vein for Mitchell’s bypass graft, Bassiouny attached the vein to the artery above and below the area of arterial blockage. Currently, Mitchell’s graft is functioning well and circulation to that leg has significantly improved. “I am so grateful to Dr. Bassiouny,” Mitchell said. “If it wasn’t for him, I would be a double-amputee. Instead, I still have my leg, I can walk, I can drive and I feel good.” Hisham Bassiouny, MD (left), performing surgery.
2 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
Morgan Wirthlin, an undergraduate in the Biological Sciences Division, recording dolphin sounds at the Brookfield Zoo. Below is a mother dolphin, Tapeko. Photos provided by Morgan Wirthlin.
Noteworthy Mindy Statter, MD, associate professor of surgery and pediatrics, will hold a clinic for pediatric patients every Friday in the Evanston Professional Building, at 1000 Central Street in Evanston. The Gwen and Jules Knapp Center for Biomedical Discovery was completed in June, and a video chronicling its construction is available on the Medical Center newsroom Web site (www.uchospitals.edu/news)
Translating Dolphin Speech Decoding the language of dolphins isn’t easy. First, an observer must identify the “unique signature whistle” of each dolphin. Then, the researcher must figure out if other noises are random or meaningful. When it came time to decide on a topic for an honors thesis, Morgan Wirthlin, an undergraduate in the Biological Sciences Division, decided to study dolphin communication. Previously, Wirthlin had met Jason Bruck, a University of Chicago graduate student who was interested in both dolphin social memory and understanding their signals. As part of his dissertation research, Bruck won grants that paid for an aquatic microphone at five zoos around the country, including Brookfield Zoo. During 2007 and 2008, Wirthlin manned the recording device at Brookfield, getting up at 5 a.m. every morning to set up the underwater microphone in the dolphins’ habitat to study their sounds.
Transparent acrylic panels allowed observers to watch the dolphins. Together, Wirthlin and Bruck were able to identify at least three new dolphin whistles. Their most interesting finding was that the whistles “aren’t gibberish,” Wirthlin said. “This is the first time it’s been shown there are complex repeated whistles—besides the signature whistles—in the dolphin’s repertoire. What’s exciting is that the new sounds are being used consistently in particular behavior contexts, such as aggression or play, although there’s still a long way to go before we can decipher their meaning.” Wirthlin was advised on his thesis by Jill Mateo, PhD, assistant professor in the Department of Comparative Human Development; and Stephen Pruett-Jones, PhD, associate professor in the Department of Ecology and Evolution. Bruck acted as Wirthlin’s mentor.
Fruit-fly Study Could Speed Detection of Kidney Cancer Large-scale data mining of gene networks in fruit flies has led researchers to a sensitive and specific diagnostic biomarker for human renal cell carcinoma, the most common type of kidney cancer. In the journal Science, published online January 22, 2009, a team based at the University of Chicago shows that the biomarker known as SPOP is produced by 99 percent of clear cell renal cell carcinomas, but not by normal kidney tissue. Physicians could use SPOP levels to confirm or rule out a diagnosis of renal cell carcinoma (RCC). The levels also could help physicians determine the original source of cancers that spread to other organs from an unknown primary tumor. “This could serve as a diagnostic tool, lead us to new drug targets and potentially help us detect kidney cancers sooner,” said study-director Kevin White, PhD, professor of human genetics, ecology and
evolution, and director of the Institute for Genetics and Systems Biology at the University of Chicago. “It also confirms our strategy of using genomics and systems-level analysis of model organisms such as fruit flies to identify factors that play crucial roles in human disease.” About 75 percent of all renal cell cancers are clear cell RCC. The SPOP test even revealed that a few tumors had originally been misdiagnosed as clear cell RCC. Those tumors turned out to be other types of kidney cancer when examined more closely by pathologists. “These results indicate that SPOP is a highly sensitive and specific diagnostic biomarker for clear cell RCC,” the authors conclude, “and can help distinguish histological subtypes of RCC.” It also could be used to help identify the primary tumor in metastatic cancers – an important factor in treatment decisions.
Medical Center patient success stories are now collected on the Medical Center Web site, at: www.uchospitals.edu/news/patient-stories. The Medical Center publishes updates on new research and health care industry news via the Science Life blog at www.sciencelife.uchospitals.edu or view our new research video at uchospitals.edu. The Pediatric Multispecialty Clinic in Naperville has moved. For more information, contact the clinic at 630-335-4885 or visit them at 1020 E. Ogden Ave, Suite 207 in Naperville.
Briefly Comer’s epilepsy experts add suburban partnership A partnership between Comer Children’s Hospital and Adventist Hinsdale Hospital is making it possible for children and teenagers from the suburbs who have epilepsy to stay close to home and be monitored by top national experts. Patients are monitored at Adventist Hinsdale and their data is transmitted to pediatric epileptologists at Comer Children’s Hospital.
Study offers answers for fish extinction Large size and a fast bite spelled doom for bony fishes during the last mass extinction 65 million years ago, according to a study published March 31, 2009, in the Proceedings of the National Academy of Sciences. Today, those same features characterize large predatory bony fishes, such as tuna and billfishes, that are currently in decline and at risk of extinction themselves, said Matt Friedman, PhD, author of the study and a graduate student in evolutionary biology at the University of Chicago. “The same thing is happening today to ecologically similar fish,” he said. “The hardest hit species are consistently big predators.” The study is the first to test this theory with hard data and to quantify the relationship between body size, jaw function and vulnerability of fish during the Cretaceous extinction, according to Friedman. “Any way you sliced it, the data showed that if you were a big fish with a fast bite you were toast,” he said.
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Bringing World-Renowned Transplant Care to NorthShore The University of Chicago Medical Center has opened a transplant evalu ation clinic at NorthShore University HealthSystem’s Specialty Suites, 1000 Central Street in Evanston, adjacent to NorthShore’s main campus. Opened in July, the clinic provides pre-and posttransplant exams for patients who are potential candidates for or recipients of a heart, lung, liver, pancreas and/or kidney transplant, bringing Medical Center services closer to patients’ homes. The new clinic is an expansion of the academic affiliation that started between the Medical Center and NorthShore last year. Residents at the Medical Center and students at the Pritzker School of Medicine will receive part of their training at NorthShore, gaining exposure to additional patient populations, a different hospital system and practice tools.
Once a patient is identified as a potential recipient of a transplant, he or she will be officially listed in the national database of the United Network for Organ Sharing. The actual surgery will take place at the Medical Center’s Hyde Park facility when an organ match is made. “The University of Chicago Medical Center has been a leader in transplant care for several decades,” said J. Michael Millis, MD, director of the Transplantation Center at the Medical Center. “NorthShore was a natural fit for the excellence in care we’ve always provided in Hyde Park.” Since the first animal organ transplant was performed at the University of Chicago in 1904, its physicians have become the first in the world to perform a successful living-donor liver transplant, heart-liver-kidney transplant and the first in the United States to perform segmental liver and split-liver transplants.
Photo by Costello Communications
Physicians are First to Use Unique Cardiac Lead Following FDA approval, cardiologists at the University of Chicago Medical Center are the first in the United States to implant the thinnest lead body for left-heart leads into a patient. Approved in April by the FDA, the device makes improved treatment possible for certain patients with heart failure. The lead is used with an implantable cardiac resynchronization therapy (CRT) device and helps physicians deliver CRT by accessing very small cardiac veins. In many cases, those small veins can be the best spots to implant leads to resynchronize cardiac rhythms in patients.
Measuring 1.32 millimeters in diameter (or 4 French, a standard measurement system for cardiac leads), the lead is slightly thinner than other left-heart leads. That miniscule change in size can make a big difference in where the lead can be placed in the heart. “In the world of heart anatomy, a fraction of a millimeter means a lot,” said Medical Center cardiologist Albert Lin, MD, who implanted the lead. “The size of this lead allows it to be placed in incredibly small cardiac veins where some patients need it to receive better CRT.”
The lead is placed in the lateral cardiac vein on the exterior of the left ventricle and is connected to a CRT device, which sends electrical pulses to help keep the left ventricle in unison with the right ventricle. The bipolar lead contains two electrodes that an electrophysiologist (a physician who specializes in heart rhythm problems) can program in order to pace the heart. The first lead was implanted in an 82-year-old patient on April 23, 2009.
Pritzker’s Rapid Rise Among Top Medical Schools The University of Chicago’s Pritzker School of Medicine tied for 13th in the latest U.S.News & World Report ranking of the nation’s best graduate schools, up from 22nd in 2004. Pritzker is the fastest rising medical school in the top 50 during the last five years. As a comparatively small institution, the University of Chicago’s medical school is at a disadvantage in total research funding from the National Institutes of Health, a key component of the medical school survey. Pritzker regained some of that ground, however, by ranking fourth in the country on research funding per faculty member, with average annual NIH grant support per researcher of $292,300.
4 University of Chicago Medicine on the Midway
Pritzker also has dramatically and steadily increased its ability to attract the best medical students. Since 2004, the medical school’s student selectivity has improved from 32nd in the United States to third, behind only Harvard and Washington University. Two bioscience graduate programs— paleontology and ecology/evolutionary biology—are still ranked among the best in the United States. (The bioscience rankings were not updated for this year’s magazine.) Graduate programs in the biological sciences overall tied for 18th in the magazine’s “Best Graduate Schools” issue, which was published April 27, 2009. No other Illinois program scored as well in either medical education or the biological sciences.
Pritzker medical students in class. Photo by Dan Dry
Briefly Evolution of fins, limbs linked with that of gills
Medical Center Contributes to National Health Care Forum Michele Norris (of NPR’s All Things Considered) moderated a panel of nationally known experts at the University of Chicago-curated “Chicago Contributes” health care forum, held September 10 in Washington, DC, the day after President Barack Obama’s speech to Congress. After a keynote address by Secretary of Health and Human Services Kathleen Sebelius (above right) that echoed many of the points the President made himself the night before, the stage was turned over to a national group of university experts. The
panel included (above, left to right) Michele Norris, Eric Whitaker, MD, Executive Vice President of Strategic Affiliations and Associate Dean of Community-Based Research at the University of Chicago Medical Center, and Patrick SoonShiong, MD, Executive Director, UCLA Wireless Health Institute, University of California, Los Angeles. To read more about the discussion go to: http://sciencelife.uchospitals.edu/2009/ 09/11/looking-beyond-health-care-reform/
Artificial Liver Device Tested at Medical Center Researchers at the University of Chicago Medical Center are engaged in a Phase II trial of an external artificial liver device that they believe will provide better outcomes for patients with acute liver failure in the future. The Medical Center was the pilot center for the first trial of the device in 1999. In this phase, the multi-center trial will involve 18 patients around the country with sudden liver failure, including patients from the Medical Center. Helen Te, MD, associate professor of medicine in the Section of Gastroenterology, Hepatology and Nutrition, is overseeing the trial here. She determines whether a patient could benefit from the treatment
with the Extracorporeal Liver Assist Device. Because the artificial liver can’t provide all the functions of a real liver, its benefit over a prolonged period is not known. Patients only can be hooked up to it for 10 days in the new trial. “We use it when we think a patient’s chance of survival is compromised, but we don’t want to use it when there is no hope,” she said. “The study is very complex. It requires intensive monitoring along with rigorous nursing and physician oversight,” Te said. “The trial can’t just be done anywhere. It has to be performed at a transplant center with a committed research team, which is the reason we’re in the study.”
The genetic toolkit that animals use to build fins and limbs is the same toolkit that controls the development of part of the gill skeleton in sharks, according to research published in Proceedings of the National Academy of Sciences by Chicago researcher Andrew Gillis, professor Neil Shubin, PhD, associate dean for Organismal and Evolutionary Biology, and Randall Dahn, PhD, researcher at the Mount Desert Island Biological Laboratory. “In fact, the skeleton of any appendage off the body of an animal is probably patterned by the developmental genetic program that we have traced back to formation of gills in sharks,” said Gillis, lead author of the paper and a graduate student in Organismal Biology & Anatomy. “We have pushed back the evolutionary origin of the developmental genetic program that patterns fins and limbs,” Gillis added. This new finding is consistent with an old theory, often discounted in science textbooks, that fins and, later, limbs evolved from the gills of an extinct vertebrate. “A dearth of fossils prevents us from definitely concluding that fins evolved from gills,” he said. “Nevertheless, this research shows that the genetic architecture of gills, fins and limbs is the same.” The findings build on the breakthrough discovery of the fossil Tiktaalik, a “fish with legs,” which Shubin and his colleagues found in 2006.
Scientists’ Discovery Could Help Crops Stave Off Disease Scientists have discovered a naturally occurring compound that triggers a plant’s immune system, thereby protecting the plant from a secondary bacterial infection. The patent-pending discovery could lead to an effective, inexpensive and environmentally safe way to improve plants’ resistance to disease, according to research published in Science on April 3, 2009. “The potential for crop protection in organic and conventional farming is strong,” said Jean Greenberg, PhD, associate professor of molecular genetics and cell biology at the University of Chicago and corresponding author of the study. “This could lead to better food quality and higher agricultural yields.
“We’re very excited to see something so practical come out of our lab that could have an impact in the real world,” she added. Although it has long been known that plants have immune systems, just how these systems function has been the subject of intense study. Greenberg and colleagues identified new compounds involved in the immune system of Arabidopsis, (pictured right) a plant in the same family as mustard, cabbage, broccoli and cauliflower. Fall 2009 5
Grapefruit Juice Boosts Drug’s Cancer-Fighting Effects In a small, early clinical trial, researchers at the University of Chicago Medical Center have found that combining eight ounces of grapefruit juice with rapamycin can increase drug levels, allowing lower doses of the drug to be given. They also have shown that the combination can be effective in treating various types of cancer. For two decades, pharmacists have pasted “do-not-take-with-grapefruit-juice” stickers on various pill bottles because the juice can interfere with the enzymes that break down and eliminate certain drugs. In data presented at the 100th annual meeting of the American Association for Cancer Research in 2009, the University of Chicago researchers examined ways to exploit this fruit’s medication-altering properties. “Grapefruit juice can increase blood levels of certain drugs by three to five times,” said study director Ezra Cohen,
MD, a cancer specialist at the University of Chicago Medical Center. The study followed 28 patients with advanced solid tumors, for which there is no effective treatment. Twenty-five participants remained in the study long enough to be evaluated. Seven of those 25 (28 percent) had stable disease, with little or no tumor growth. One patient (4 percent)—Albina Duggan—had a partial response, with the tumor shrinking by about 30 percent. Less than 15 percent of rapamycin is absorbed when taken by mouth. This study showed that substances known as furanocoumarins, plentiful in some forms of grapefruit juice, can decrease the breakdown of rapamycin. This makes the drug reach higher levels in the bloodstream, two to four times the levels seen without a juice boost.
Albina and Tim Duggan (center) with their family. Photo by Bart Harris
Could a grapefruit make cancer treatment more effective?
We believe it can. Physician-scientists at the University of Chicago Medical Center found that grapefruit juice could potentially increase the potency of cancer medications by up to five times their normal strength. Does that mean it could change the way cancer is treated? At the University of Chicago Medical Center, we ask questions like this every day. Questions that have the potential to forever change the course of cancer treatment. We do this because we have a passion for saving lives. Our multidisciplinary team of more than 150 oncologists, surgeons and specialists is dedicated to innovation — using what we learn in the lab to transform the care we provide to our patients. We also take a highly collaborative approach to oncology, coming together to debate and discuss each case in real time to develop the best treatment plan possible. Whether we’re working to unlock ways to cure cancer tomorrow through groundbreaking clinical research, or advancing patient care today with pioneering surgical, radiation and chemotherapy treatments and procedures, our commitment remains the same — changing the lives of those touched by cancer. How can we change yours?
discover for yourself. Learn about the discoveries we’re making in oncology and other areas.
discover.uchospitals.edu | 1-888-UCH-0200
Discovering the Practical Science in Breakthrough Medicine In June, the University of Chicago Medical Center launched a new advertising campaign. The theme of the campaign, which will run through November, is “Discover for Yourself.” “Discover for Yourself” is a unique approach to reaching today’s consumers who are inundated with health care advertising despite the current economic downturn. Rather than conforming to the traditional messaging that prevails in health care marketing, the campaign educates consumers on the relevance of the groundbreaking science that takes place at the Medical Center. This underscores the value of the Medical Center’s translational research, the direct application of laboratory studies to understanding and treating human disease.
Family Grateful for Grapefruit Discovery Albina Duggan, a mother of four in Bourbonnais, Ill., has a rare cancer: an epitheliod hemangioendothelioma that originated in the liver and subsequently spread to the lymph nodes and to two vertebrae in the neck. She had surgery and radiation therapy and was evaluated for a liver transplant, but evidence of cancer beyond the liver made her ineligible for a transplant. Duggan investigated other therapies. Physicians at the Medical Center offered three clinical trials. The most appealing to her was the rapamycin plus grapefruit study. She took her first dose March 11, 2008, and is still on the drugjuice combination. Duggan says her tumor is smaller and is no longer growing. Below are excerpts of the letter her husband, Tim, wrote to friends to update them of Albina’s progress: “….Today, Albina officially defied the odds. On July 21, 2004, her doctor sat us down in her office and told us that Albina
has cancer. She said that Albina had three years left, maybe five if we’re lucky. “Five years have come, and five years have gone. I’d like to say they went by quick ly, but quite t he opposite is true. The important part is that they did, indeed come and go. And so today we’re celebrating! “Albina survived four surgeries, rehabilitation, radiation and two clinical drug trials so far. The current trial she is in has already made headlines. Don’t believe it? Google “Albina Duggan Cancer” and take a look at the first 40 entries! “The latest scans from last month now show that the base tumor in her liver has shrunk 49 percent since she started on this rapamycin/grapefruit juice combination. All assumptions are that the other tumors in her body are responding in a similar fashion. Since this has always been a slow-growing cancer, we’re confident that we’re buying lots of time. Now, she plans to outlive us all.”
6 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
The ads are as distinctive as the Medical Center’s agenda-setting science and target the independent quality-seeker among health care consumers. They feature straightforward text highlighting scientific breakthroughs at the Medical Center and graphically appealing images that together bridge the gap for consumers between science and medicine. For example, one of the ads shows the center of a grapefruit with a question: Could a grapefruit make cancer treatment more effective? The accompanying text explains how physicianscientists at the Medical Center found that grapefruit juice could potentially increase the potency of cancer medications by up to five times their normal strength. The ads feature thought-provoking imagery with questions that grab readers’ attention. The ads are featured in local and national publications as well as on the Internet and the radio. Discover for yourself at discover. uchospitals.edu.
recognition for Rowley by Robert Mitchum
You could say that Janet Rowley is having a pretty good year. In March, the Medical Center molecular geneticist stood at President Barack Obama’s right arm as he signed an executive order clearing the way for federal funding of embryonic stem-cell research. Early in July, she was declared the recipient of the 2009 Peter and Patricia Gruber Genetics Prize, which comes with a $500,000 cash award and a gold medal. Then on July 30, another tremendous honor was announced for the still-active 84-year-old: the Presidential Medal of Freedom, the highest award an American civilian can receive from the White House. The Medal recognizes “an especially meritorious contribution to the security or national interests of the United States, world peace, cultural or other significant public or private endeavors.” Among the other 15 recipients are Stephen Hawking, the late Sen. Edward Kennedy and Desmond Tutu; very prestigious company indeed. In addition, among ten previous recipients affiliated with the University of Chicago are scientist James Watson, economists Gary Becker and Milton Friedman, and historians Hanna Gray and John Hope Franklin. In typical fashion, Rowley—the Blum-Riese Distinguished Service Professor of Hematology and Oncology—downplayed being recognized for her important research in the early days of cancer genetics. In her University of Chicago laboratory, Rowley discovered recurring chromosomal abnormalities in leukemias and lymphomas—findings that revolutionized how cancer is understood and treated. “Janet Rowley’s work established that cancer is a genetic disease,” said Mary-Claire King, PhD, a geneticist at the University of Washington. “She demonstrated that mutations in critical genes lead to specific forms of leukemia and lymphoma, and that one can determine the form of cancer present in a patient directly from the cancer’s genes. This changed the way cancer was understood, opened the door to development of drugs directed at the cancer-specific genetic abnormalities and created the paradigm that still drives cancer research.” Rowley’s colleagues applauded her accomplishments and the attention they have garnered her and the university. “By showing that unique genetic abnormalities are the root cause of
Janet Rowley, MD, a pioneer in demonstrating that cancer is a genetic disease, receives the Presidential Medal of Freedom from President Barack Obama at a White House ceremony on August 12.
cancer, Rowley laid the foundation for personalized cancer care and targeted therapy,” said Richard L. Schilsky, MD, professor of medicine at the University of Chicago and past president of the American Society for Clinical Oncology. “Janet was a pioneer in what is now called ‘translational research,’ the direct application of laboratory studies to understanding and treating human disease,” added leukemia specialist Richard Larson, MD, professor of medicine at the University of Chicago. “She opened a window that allowed us to see the genetic basis of the leukemias and other cancers. She also has been a champion of international collaboration for the advancement of science.” “I felt very humbled, but also as though I didn’t deserve it,” Rowley said of her initial reaction to the honor. James L. Madara, MD, chief executive officer at the University of Chicago Medical Center and dean of the Division of Biological Sciences and Pritzker School of Medicine, praised Rowley: “Dr. Rowley has brought and will continue to bring much distinction and honor to our institution, and we are grateful and very proud to call her one of our own.” For much of the past decade, Rowley served on President George W. Bush’s Council on Bioethics, advising the White House on controversial scientific topics such as embryonic stem-cell research. Rowley continues her research at the Medical Center, and is an avid swimmer, sailor, cyclist and gardener. “It’s a great honor,” said Rowley, “to have one’s colleagues still recognize one’s accomplishments.”
To learn more about Janet Rowley’s accomplishments, watch the video interview and read the press release on the Medical Center Web site at www.uchospitals.edu/news/2009/20090730-rowley.html.
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Teri and John with Alyssa days after her surgery.
A Medical First, Years Later
by Katie Scarlett Brandt
In November 1989, Alyssa Smith lay sedated in a tiny bed at the University of Chicago Medical Center. Not yet 2 years old, she had undergone a surgery—the first of its kind—that drew an entire country’s attention.
Alyssa needed a new liver. However, at that time patients who
required liver transplants had no other option but to wait for cadaver donors. This created an especially long waiting list for infants because they could only receive organs from other young donors closer to their size; adult livers were too large to fit their bodies. a When Alyssa went on the transplant list in 1988—at less than a year old—the list had grown to 700 infants in the United States alone. Approximately one-third of all children, including half of all infants, placed on liver transplant waiting lists at the time died while waiting to get a donor organ, according to J. Richard Thistlethwaite, MD, a Medical Center surgeon and professor of transplant. Above from left: Jamie Harrison, RN and Barb Nihill, RN, who cared for Alyssa following the transplant. Right: Alyssa with her mother as a toddler after the surgery; with her brother, Ricky Smith; at high school graduation with her parents; and in her senior photo.
8 University of Chicago Medicine on the Midway
“Once you’ve given someone a big piece of your heart, it’s easy to throw in a little bit of liver.” – Teri Smith
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During 13 and a half hours, surgeons removed Alyssa’s liver in its entirety and replaced it with one-third of her mother’s—specifically the left lobe. By 9 p.m., Alyssa’s new liver was in place—the artery, veins and bile ducts sutured, and the organ functioning.
The surgical team removing Teri’s left lobe for transplantation into her daughter Alyssa that same day. Photo by James L. Ballard
But Christoph Broelsch, MD, then-chief of the Medical Center’s liver surgery service, was working on an idea that might take some pressure off those waiting lists. A few years before Alyssa’s surgery, he became the first surgeon in the United States to transplant a section of a deceased donor’s liver into a child. His next project: to split a cadaver liver in two and transplant the halves into separate children. Again, the operation proved successful. Broelsch was working toward something that, to many people, may have seemed ludicrous. Because the liver can regenerate, he reasoned, why not take part of a healthy, living adult’s liver and transplant it into a child who would otherwise have to wait for a cadaver liver? “Our goal was not only to do the procedure, but to develop a concept on when a living donor liver transplant ought to be done, why it should be done, and what the ethical implications are,” he wrote in a Medical Center report in 1990. In papers, Broelsch described the procedure; he attempted it in animals with positive results. But when surgeons in Brazil and Australia jumped to operate on emergency patients without Broelsch’s oversight, the recipients died. “Broelsch was one of only a few people who were working on this idea at the time. However, he was the only one to thoroughly and systematically evaluate the procedure including proof-ofprinciple experimentation in animals, ethics consultation, and public announcement of the planned procedure with request for comments,” Thistlethwaite said. The university’s transplant team took serious precautions. They spent a year developing the program and set out to approve a small group of patients for the initial trials. “If successful,” the Associated Press reported in newspapers across the country, “the operation at the University of Chicago would provide a solution to a severe shortage of organs for children who need transplants.”
San Antonio to Chicago
Hundreds of miles away, Alyssa’s parents in the San Antonio suburb of Schertz, Texas, were trying desperately to keep their youngest child “as healthy as possible.” At 11 weeks, physicians had diagnosed Alyssa with biliary atresia—the most fatal liver
10 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
disease among children. The bile duct between the liver and small intestine is blocked or absent, pushing bile into the liver and blood stream. “We knew she’d have to be transplanted if she even made it to that point,” Teri Smith said of her daughter Alyssa, who was in and out of the hospital multiple times during those early months of her life. However, Teri and her husband John—both in their twenties—tried to maintain a normal life as they added Alyssa’s name to the organ transplant registry and prepared themselves for a long wait. Alyssa was never in critical condition, but physicians warned Teri and John that the disease could turn for the worse at any moment. The Smiths didn’t let the potential negatives disturb them. “Emotionally we’re a very grounded family,” Teri said. “We say, let’s get the job done. Let’s get (Alyssa) the best treatment.” Aside from her daily medications and medical check-ups, Alyssa was a typical infant. She met verbal and physical development standards and ate normal foods. The Smiths continued to work, and left Alyssa with a babysitter daily. That is, until the day in August that a San Antonio physician presented a different sort of treatment option. He told the Smiths that the University of Chicago had published an article in the New England Journal of Medicine about a new procedure for living donor liver transplants and the ethics involved. The university ethicists decided that the risk for the donor— an otherwise healthy individual—was the procedure’s most controversial aspect. There existed general surgery risks— infection, allergic reactions to medications and anesthesia. However, the donor’s chance of death was near zero, and the chance of complications less than 5 percent. For the recipient, the benefits well outweighed the risks. A transplant from a living donor meant that the recipient wouldn’t have to risk infection or death while waiting for a cadaver organ. It also meant that the recipient would likely be healthier at the time of transplant, which would lead to better outcomes over time. “From the minute we heard about it, we knew we wanted to contact them,” Teri said.
New frontiers in transplant surgery
In the next few months, the transplant team, an internist and psychiatrist all evaluated Teri to ensure she matched Alyssa’s blood type and that her liver met healthy standards. Teri also signed two informed consent forms verifying that she knew all the potential risks involved but wanted to undergo the surgery regardless. Meanwhile, the Smith’s family, friends, church and coworkers busied themselves raising money. The people closest to them wanted to make sure the Smiths had enough to cover incidentals—flights, babysitters and funds lost from being out of work during the surgery and recovery. “Alyssa and Teri were just the right patients to begin with. I never forget their trust and confidence in our ability to do the right thing,” Broelsch said. Later, after operating on many other patients, Broelsch said he “grasped the tremendous courage of these people and the enormous trust to put their lives in the hands of a few people.” He called Teri the story’s hero, and credited her courage to “American pioneerism in her blood.” Teri remained calm as she packed suitcases for herself and Alyssa. They would be gone for six weeks, from November through January, but Teri didn’t let that bother her. It was simply fact: Alyssa needed a liver, and Teri was going to give her one—or at least part of one. There was nothing to worry about, Teri told herself. But as their plane flew north from Texas, Teri became airsick, despite having flown multiple times before without incident. On the morning of the surgery, as Broelsch ate breakfast at home with his wife, Bianka, the newscaster on the radio announced that the University of Chicago would be conducting the first living liver transplant procedure between a mother and her child that day. “Isn’t that your procedure?” Bianka asked casually, eyeing Broelsch. “I believe you have to go now.” The Smiths arrived at the medical center on November 26, 1989. At 7:30 a.m. on November 29, Broelsch escorted Teri into the operating room. “(We) were at the same time calm and excited with anticipation because of the extensive preparation that had gone into initiating the living donor program,” said Thistlethwaite, who assisted in the operations. The medical
Christoph Broelsch, MD, chief of the Medical Center’s liver surgery service in 1989 when he performed the transplant.
Teri and Alyssa Smith at the closing ceremonies for the U.S. Transplant Games in Louisville, Ky. in 2006.
center’s communications office arranged for radio and television stations to tape the procedure. “This was quite unusual, but since so many efforts went into the preparation, we had no objections to this kind of publication—in p articular, because the hospital administration was extremely supportive in many ways. Thus, the team was calm, well organized and mentally prepared.” During 13 and a half hours, surgeons removed Alyssa’s liver in its entirety and replaced it with one-third of her mother’s—specifically the left lobe. By 9 p.m., Alyssa’s new liver was in place—the artery, veins and bile ducts sutured, and the organ functioning. As Teri and Alyssa recovered in the Intensive Care Unit, their family, friends, surgeons, nurses and the rest of the world waited. Though the Medical Center team had found a low likelihood of any danger, nobody knew for certain how the operation would turn out. Alyssa’s older brother was there for the transplant, and other family members flew in and out over the weeks following the surgery. Media from across the country, among them CNN, “Good Morning America,” The New York Times and National Public Radio, covered the story. First Lady Barbara Bush called to wish Teri well. And later, when reporters asked her how she had decided to risk her life for her daughter, Teri responded, “Once you’ve given someone a big piece of your heart, it’s easy to throw in a little bit of liver.”
Going home and growing up
Alyssa remembers none of this. She knows only what she has read in newspapers, seen on television and heard in stories. “I knew that I had a scar and other people didn’t, but we were raised as normal kids, as normal as possible,” she said, referring to herself and her brother. The Medical Center faculty and staff, however, do remember. “Afterward there was a sense of elation because of the successful operations, but also relief to have achieved a long-anticipated goal,” Thistlethwaite said. Broelsch agreed: “While we performed the first one in the United States and subsequently 20 others at the University of Chicago, the ground was laid to expand into the world.” The operation went smoothly except for bleeding from Teri’s spleen, which had to be removed. The six weeks the Smiths spent in Chicago recovering led to sad and heartfelt goodbyes as Teri invited the entire team to Alyssa’s graduation (to take place 16 years later). They headed back to Texas. Drums boomed and horns blared as Teri and Alyssa deboarded the plane. The school district marching band had come to welcome them home, and Teri returned to work at the Wiederstein Elementary School a few days later. Each week when she had to leave her fourth grade class in order to take Alyssa to the hospital for lab work, the school’s principal substituted so that Teri didn’t have to find someone to cover for her. “We come from a small community. Everybody knows everybody. It was a really big deal in our town,” Teri said. Fall 2009 11
The experience has changed the Smith family,
and it has changed the Medical Center as well.
Twenty years later, Teri said she rarely talks about the transplant anymore, though it never leaves the back of her mind. “It’s gotten to the point that I forget that many people in our lives don’t know. I’ll mention something in passing and they’ll say, ‘Wait…what?!’” In high school, Alyssa played clarinet in the same band that greeted her when she returned from Chicago. She joined sports teams and took dance lessons. Sometimes, she and Teri spoke about their transplant experience at organ procurement conferences or meetings, but those engagements have slowed down significantly. In May 2006, Alyssa graduated high school. And Broelsch, who left Chicago to return to a university in Germany, wrote to congratulate her. He said he encouraged Alyssa to “forget about the past and look upon her future as a complete normal, charming individual, because she really looked great and beautiful in her photograph.” Alyssa said “It was really cool to get that letter because I don’t remember meeting him.” Teri added that her daughter “is getting to an age where she’s just starting to understand the magnitude of it.” The overall experience “doesn’t play a major role (in my life) anymore, but it has shaped my career choice,” Alyssa said. She’d like someday to open a support facility for children who have undergone transplants and their families. Citing high levels of stress and divorce rates among the parents of transplant children, Alyssa said, “That’s my big passion—the kids.” Though she has a year of school left at Meredith College in Raleigh, N.C. (where she majors in social work and minors in dance), Alyssa speaks passionately and rapidly about her plans. She envisions the center as a place children can feel comfortable hanging out and meeting other kids, where siblings of transplant patients can meet other siblings who have been through the same thing, and where parents can talk to other parents without any “doctor jargon.” “It all sounds good in my head,” Alyssa said, “but we’ll see.” Alyssa’s own experience in support groups in Texas inspired her. One offered college scholarships to high school teenagers who attended a certain number of meetings. The group arranged trips to plays and other events that many families could not otherwise afford after transplant surgery expenses; they also discussed the importance of complying with medications in order to survive (a serious challenge with teens). Alyssa started out on prednisone and cyclosporin, but by age 5 physicians took her off the prednisone and by 15, she was able to stop taking medications altogether. The Smiths also visited with other families through the program who were in the early stages of the transplant process. “We’d show them that you can have a normal life. We’d say, ‘right now maybe isn’t that great, but it will get better,’” Alyssa said, adding that the parents have to work at their relationship as a couple all the while making sure they’re not losing focus on any of their other children. The experience has changed the Smith family, and it has changed the Medical Center as well. Thistlethwaite said that because of living donor transplantation, the incidence of infant death while waiting to receive transplants has fallen to below 2 percent at the Medical Center.
He added that the transplant program “became the preeminent referral center for pediatric transplants, with families traveling from throughout the United States and the world to receive care here.” Surgeons from far corners of the earth also come to the Medical Center to train in living donor liver transplantation, learning essentially the same techniques that Broelsch developed two decades ago. Broelsch said that he believes the procedure and the ethical protocol that the Medical Center team created have “changed transplant surgery to a great extent.” He added that former critics have incorporated the procedure and helped expand it for adults. And in Texas, where a family first believed in Broelsch and decided to put their lives in his hands, life goes on.
Alyssa on the steps of the Medical Center a year after her surgery. Photo by James L. Ballard
12 University of Chicago Medicine on the Midway
for treating an
by Cheryl L. Reed
When U.S. Supreme Court Justice Ruth Bader Ginsburg’s pancreatic cancer was discovered by accident, she was able to have surgery, a treatment available to less than 10 percent of pancreatic cancer patients. Actor Patrick Swayze wasn’t so fortunate. By the time doctors diagnosed Swayze in March 2008, his stage IV pancreatic cancer had already spread to his liver. Surgery wasn’t an option. Ginsburg and Swayze are the most recent notables who have contracted pancreatic cancer—others include Cardinal Joseph Bernadin, Randy Pausch, author of The Last Lecture, and Luciano Pavarotti—but their differing paths to diagnosis illustrate the prognosis and treatment available to pancreatic cancer patients. Ginsburg’s prognosis appears somewhat promising; she is back at the bench after surgery in February; Swayze’s treatment included aggressive chemotherapy and an experimental drug. He died September 14 at the age of 57. About 42,500 Americans are diagnosed with pancreatic cancer every year; fewer than 4 percent will live five years after diagnosis, only those whose cancer is operable. Pancreatic cancer is the fourth leading cause of cancer deaths in America and has the lowest survival rate of any solid tumor. But new treatments, clinical trials and drugs are offering patients and doctors hope that the disease may not be so dire in the near future. “I don’t think people should be nihilistic about it,” said Mitchell Posner, MD, chief of General Surgery and Surgical Oncology at the University of Chicago Medical Center. “There’s a lot of effort being put into changing the direction we’re going. There is interest in the medical community to begin to explore new technology, new clinical approaches and new treatments for pancreatic cancer.”
For most people, the pancreas is a complete mystery. Located deep in the abdomen, the pancreas is an oblong flattened gland, sandwiched between the stomach and the spine. It is an integral part of the digestive system, secreting enzymes for protein digestion and producing insulin, and often goes unnoticed until problems occur. Because tumors can rarely be felt, many symptoms of pancreatic cancer do not appear until the tumor grows large enough to interfere with nearby structures, such as the stomach, duodenum (beginning of the small intestine), liver or bile duct. Most pancreatic cancer occurs in people over the age of 60. About an equal number of men and women are diagnosed. The disease can run in families, like President Jimmy Carter’s. Certain genes, like the BRCA-2 breast cancer gene, increase the risk. Smoking appears to be the most common contributor, but even then, only 30 percent of pancreatic cancer patients smoke. There is no single test to determine whether someone has pancreatic cancer. Often patients have no symptoms or vague symptoms, such as abdominal pain and weight loss. The best early indicator is if a patient appears jaundiced. Sometimes the onset of diabetes can be an early symptom. Acute pancreatitis and pancreatic cysts also can be contributing factors. Fall 2009 13
Several large, dilated pancreatic ducts.
“There’s a lot of effort being put into changing the direction we’re going. There is interest in the medical community to begin to explore new
technology, new clinical approaches and new treatment of pancreatic cancer.” Another symptom may manifest itself as a psychological condition but actually is physically based. Pancreatic cancer produces a factor that also can make a patient depressed. “You can become depressed six months before you find out that you have pancreatic cancer, then you find out that you have this advanced cancer, and, of course, you are really going to be depressed,” explained Hedy Kindler, MD, director of Medical Oncology at the Center for Gastrointestinal Oncology. Unfortunately, usually by the time a patient has enough symptoms to see a doctor, the cancer already has spread.
Patients have treatment options Pancreatic cancer patients at the Medical Center are treated at the Center for Gastrointestinal Oncology where a team of specialists, including medical, radiation and surgical oncologists diagnose and determine whether a patient can have surgery, chemotherapy, radiation or a combination. Through the use of minimally invasive procedures, like MRIs and endoscopic ultrasounds—in which a long flexible tube with a sensor at the end is inserted into the digestive tract—doctors can diagnose the stage of a cancer without having to perform surgery. The technology of endoscopic imaging has improved so that doctors now can obtain clear images of the interior of organs, take small biopsies, and even inject pain medications in the nerves surrounding the pancreas without a large incision. The number of pancreatic cancer patients seeking treatment at the Center for Gastrointestinal Oncology has nearly tripled in the last three years, said Posner. Because treatment and surgery for pancreatic cancer are so complicated, studies have shown that patients have better outcomes when treated at an institution that handles a high volume of pancreatic cases. But the dire statistics can sometimes discourage patients from seeking treatment. Occasionally even family doctors don’t know the extent to which the disease can be treated and don’t refer patients. “Doctors have a bias about pancreatic cancer because they don’t understand that the surgery can be done safely and it can be effective,” said Posner. “Recent published evidence suggests they’re not sending patients for surgery, even patients with early stages of the disease.” Oncology surgeons at the Medical Center are expanding the circumstances under which they will perform surgery, even operating for precancerous lesions. “That has had a significant impact,” Posner said. “We’re identifying patients with early stage disease and in some instances preventing their cancer from either occurring or recurring.” That doesn’t mean the operations are simple. To access a pancreatic tumor, surgeons must displace several major organs while working around major blood vessels. “It’s a small space with complicated real estate,” Irving Waxman, MD, director for the Center for Endoscopic Research and Therapeutics, explained.
14 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
Age is not a factor in determining who can have surgery. “I’ve operated on people in their thirties and people in their eighties and even in their nineties,” Posner said. There also are positive developments for those whose tumors are inoperable – the majority of patients. The Medical Center is part of a national study based on laboratory research by Ralph Weichselbaum, head of the Medical Center’s Department of Radiation and Cellular Oncology, and funded by the biopharmaceutical company GenVec that involves injecting genetically modified viruses loaded with the cancer-killing protein TNF into pancreatic tumors. TNFerade, a GenVec product, has received fast-track product designation by the U.S. Food and Drug Administration, and targets tumors in patients with advanced inoperable pancreatic cancer that has not spread. Interim results reported in June showed that patients were living eight months longer using TNFerade. TNFerade also is being evaluated for potential use in the treatment of other cancers, including esophageal, rectal, and head and neck cancers. “It’s a dramatic improvement,” said Waxman. “Fortunately, the time of blasting cancer and disintegrating everything is gone.” Located deep in the abdomen, the pancreas is an oblong flattened gland, sandwiched between the stomach and the spine.
From left: Irving Waxman, MD, director for the Center for Endoscopic Research and Therapeutics; Mitchell Posner, MD, chief of General Surgery and Surgical Oncology; and Hedy Kindler, MD, director of Medical Oncology at the Center for Gastrointestinal Oncology. Photo by Bart Harris
Chemotherapy more gentle For now, the standard treatment remains chemotherapy with the drug gemcitabine, which is relatively gentle, says Kindler. Gemcitabine can actually make patients feel significantly better, but it only improves survival by a few weeks. “Given the very modest results achieved by standard chemotherapy, the standard of care for patients with advanced pancreatic cancer should be a clinical trial, if possible,” Kindler said. The Center for Gastrointestinal Oncology offers patients the opportunity to participate in several institutional and national pancreatic cancer clinical trials, including one that is studying the effectiveness of pre-operative chemotherapy with patients who have operable pancreatic cancer. Another uses a vaccine that tries to stimulate the patient’s own immune system to help the body fight the cancer. A new study evaluates a novel antibody which targets the pancreatic cancer stem cell in patients whose disease has metastasized. GI oncologists at the Medical Center also are evaluating several novel targeted agents in clinical trials. These drugs attack the biology of the cancer by targeting various growth factor pathways within the cancer cell. “That way, it doesn’t do as much damage to the body and hopefully is more targeted to the cancer itself,” Kindler said. Despite the prospect of new treatments, fighting pancreatic cancer is challenging. Patients diagnosed with metastasized pancreatic cancer live, on average, six months. Those who have advanced, but inoperable, pancreatic cancer that has not yet metastasized when diagnosed, live, on average, 10 months. Patients whose tumors are operable live the longest; at five years, 20 percent of surgical patients are still alive. “There aren’t as many fundraising walks to the same degree for pancreatic cancer because there aren’t that many survivors,” said Kindler. But that only increases the determination of physicians to come up with more effective treatments. “It’s very frustrating because no one has cornered the market on what’s going to be right in treating this disease,” said Posner. “That doesn’t mean that people aren’t enthusiastic about treating it. Any little incremental benefit can have a huge effect when so many people are dying.”
While waiting for his oncologist, Randy Pausch, a 46-yearold Carnegie Mellon computer science professor, peeked into his medical records on the exam room computer. “My goose is cooked,” he told his wife. When his physician entered the room, Pausch confessed: “I know.” Pausch, a father of three young children, chronicled his battle against pancreatic cancer in his popular book, The Last Lecture. The news that his cancer had metastasized months after surgery and rounds of high-dose chemo and radiation was difficult to hear, but Pausch admired his physician’s empathy: “Look at how he’s doing this,” he wrote. “He’s obviously done this so many times before, and he’s good at it. He’s carefully rehearsed and, yet, everything is still so heartfelt and spontaneous.” Telling patients that they have months to live is among the more difficult conversations a physician can have, and doctors at the University of Chicago Medical Center say they try to offer as much “rational hope” as they can. “How do you tell someone that their plane is going to go down in about six months? ” said Mitchell Posner, MD, chief of General Surgery and Surgical Oncology at the University of Chicago Medical Center. “I don’t know how you do it right or wrong. I know I have to do it all the time. It’s horribly difficult. You try to give them realistic expectations of what is going on.” Posner and other Medical Center physicians who treat pancreatic cancer discourage their patients from dwelling on the statistics. “I tell them the odds aren’t important. If I had asked them six months ago: What are your odds of getting pancreatic cancer? They would have said: Near zero. But they got it. We take them as individuals, not numbers. We help them with their symptoms, help them understand their disease and help them understand there is treatment at every level.” Hedy Kindler, MD, director of Medical Oncology at the Center for Gastrointestinal Oncology says she tries to include the patient’s family in the care. “If the patient has eight months to live, it happens so very quickly that they often don’t have a chance to think it through. They are very ill. You have to prepare them for that and provide hope.” When pancreatic cancer patients whose cancer has metastasized want to know how long they have to live, Kindler asks them how long they believe they have. “They usually are pretty aware,” she said. Both Kindler and Posner say that by the time most pancreatic patients are in their office, they’ve done an enormous amount of research on the Web. That was certainly the case for Prof. Pausch: “It would take me just ten seconds on Google to discover how bad this news was,” he wrote in his book. Pausch died in July 2008. Because there’s a preponderance of grim prognoses, Posner tries to offer another view. “My job is to give them rational hope,” he said. “They already know how bad pancreatic cancer is, so why shouldn’t they hope that they are the one that’s going to do well? Everybody I treat, I think will do well. Is that my way of dealing psychologically with it myself? Probably.”
Fall 2009 15
With 95 percent of his body surface burned, Manoj Rana survived through sheer determination and the dedication of his skilled Medical Center team. By Susan Chandler and Philippe Tapon
n the night of July 1, 2005,
Steven Craig Allen and his wife were drinking in their ground-floor apartment on Tanglewood Drive in Hammond, Ind. Allen was reportedly upset because he couldn’t go to Florida with his girlfriend who was heading south the next day, and he was ready for a break. He had been saddled with childcare duties for his three-month-old daughter since his wife had returned to work a month earlier. Around 4 a.m. on July 2, Allen walked around the apartment spreading gasoline. Then he ignited the fuel and ran outside to watch the blaze. Three floors above, Manoj Rana and his roommate Prabhat Singhal were asleep. Both were engineering students. Rana was from Noida, a suburb south of Delhi, and Singhal was from Aligarh, 82 miles from Delhi. Both were finishing their degrees at Purdue University Calumet in Hammond. As tourists, they had seen the skyscrapers and the Cloud Gate sculpture in Millennium Park, and were told about how the grid pattern of the city had been made possible by the Chicago Fire. Rana and Singhal had gone to bed late, having returned from a birthday party that had started at midnight in accordance with Indian tradition. Singhal was sleeping on a couch next to the balcony window. The heat of the flames woke Singhal and he woke Rana and called 911. By then, black suffocating smoke had engulfed the staircases, and the balcony outside their slidingglass door was on fire. The apartment was getting hotter and smokier, making it difficult to breathe. Singhal had already made two 911 calls and realized that it was going to be a while before the fire department would arrive. He called a close friend and begged him to please come soon and save him and Rana: “We are going to die.
Rana remembers being put onto a gurney. He remembers the paramedic saying, “This guy doesn’t have a chance.” The paramedic could have said that about Singhal, who wouldn’t survive the blaze. Singhal was dead—wet in the bathtub, where he had taken refuge from the heat and smoke. Rana was first taken to St. Margaret Mercy where physicians determined he had been burned over 95 percent of his body surface, not counting the burn in his lungs. He needed to be transferred to a burn center.
Rana remembers the paramedic saying, “This guy doesn’t have a chance.”
There are three burn centers in the Chicago area: Stroger Hospital, Loyola University Medical Center, and the University of Chicago Medical Center. In Illinois, the Medical Center and Loyola are the only two facilities that have been verified by the American Burn Association as providing optimal care for burn victims from injury through rehabilitation. At the Medical Center, the Burn Center Director is Lawrence J. Gottlieb, MD, a plastic surgeon. Plastic surgery, in the days of “nip/tuck,” has a somewhat mercenary reputation. But Gottlieb is uninterested in patients who want facelifts, tummy tucks, and Botox. He prefers to see the patients who have no faces, or no throats, or no hands, or who have been hurt so grievously no one else will take them—the patient who “doesn’t have a chance.”
A lot can happen in 10 minutes. An egg, for example, can be cooked in about three minutes. We are going to die,” Singhal repeated into the phone. Rana ran for it, charging bare-footed down a staircase poised above the fire. The staircase collapsed, and Rana was stuck in the fire for about 10 minutes. A lot can happen in 10 minutes. An egg, for example, can be cooked in about three minutes. It can be hard-boiled in about seven minutes. The temperature in the downstairs apartment was at least 1,100 degrees Fahrenheit, because the aluminum in the kitchen pots melted. Where Rana lay, the temperature was much cooler, perhaps somewhere between 300 and 600 degrees. Left: Manoj Rana, 26, four years after the fire that burned 95 percent of his body surface. Photo by Dan Dry. Right: Rana in the operating room being treated while warmed with lights.
16 University of Chicago Medicine on the Midway
Fall 2009 17
The emergency doctors at St. Margaret’s called Gottlieb. They explained that this guy was a “John Doe . . . inhalation injury . . . house fire . . . 95 percent.” Gottlieb said: “Yes. We have a bed. We’ll take him.” The helicopter ride aboard the university’s UCAN helicopter, took nearly 12 minutes but it cost roughly $8,000. Rana had student insurance, excellent for vaccinations, check-ups or even broken bones. The maximum expense was an impressivesounding $100,000. But Rana’s care went through that money in a matter of days. He was admitted to room D-201 in the University of Chicago Burn Center. Rana’s skin was coming off in shreds, like a costume coming apart at the seams. Machines were breathing for him, collecting his urine, watching his heart. Working closely with Gottlieb, anesthesiologist and intensive care specialist Avery Tung, MD, along with anesthesia resident Rishi Taneja, MD, and surgery resident Ariel Spencer, MD, guided Rana through those first harrowing 16 days, which included eight trips to the operating room. Assisting them was a multidisciplinary team of nurses, nutritionists and therapists. Burn wounds look simple, but burn patients suffer in ways that seem quite mysterious. As the burned lie in their beds, they consume vast amounts of calories while they rebuild tissue—5,000 a day—comparable to what long-distance cyclists expend. And yet they do nothing but breathe. The patients can starve without moving a muscle. Because burn patients leak huge volumes of fluids from their wounds, they need tremendous amounts of intravenous fluids. But pumping in all that liquid can kill if it builds up in a patient’s lungs, causing them to essentially drown in their own fluids. Given the extent of Rana’s burns, Tung and Gottlieb knew that managing his fluid levels was going to be crucial. They decided to try something controversial—infusing Rana right away with albumin, a protein solution derived from blood, which leaks out slower than simple saline solution. Most burn patients aren’t treated with albumin until later for fear that leaking protein would worsen fluid buildup in the lungs and tissues. But Tung and Gottlieb sensed that slowing fluid leakage in Rana was the top priority.
“God has put some wonderful people in Rana’s path up there at the University of Chicago Medical Center.” John Burke, Lake County Deputy Prosecutor
“It was so successful we now routinely resuscitate this way for major burns,” Tung said. As the team worked frantically, some good news emerged. Under ashes and blood, physicians found that 10 percent of Rana’s skin had been spared, mostly near his groin, on his 18 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
Rana completed a half-marathon May 3, 2008 in Indianapolis, just a week after a surgery that left incisions in both shoulders. His occupational therapist, Shannon Hendricks, is running next to him. Photo provided by Manoj Rana
scalp and also a little on his back. The skin from the few places that had not been burned was allowed to regrow, and was then harvested again, and again. Burned skin was cut off and replaced with temporary grafts of pig or cadaver skin, each lasting for only a few weeks. During Rana’s first month, he needed dressing changes twice a day and dozens of surgeries. Not surgery to make him look pretty—surgery to save his life by removing dead skin before it could become infected and cause sepsis. Each surgery was a tremendous challenge, requiring careful choreography just to transport Rana to the operating room, which had to be heated to 85 degrees to keep him warm. In all, Rana had 35 operations at the Medical Center. While the physicians and nurses were fighting to save Rana’s life, a hospital social worker, Pamela Oberlie, was battling for him on other fronts. She worked to extend Rana’s student visa and helped him successfully appeal his initial Medicaid denial. That effort was critical because without a successful appeal, Rana would have been repatriated to India after he was stabilized and likely wouldn’t have survived. Eventually, a Medicaid reimbursement came in for about $1.3 million, but Rana’s care at the Medical Center totaled nearly $5 million. An additional $700,000 in physician charges were written off.
Rana’s brother Deepak requested to walk faster and faster—and then leave from his university in India to run. With Hendricks running and flew over to keep vigil in his and sometimes walking alongside older brother’s room. Deepak could him every step of the way, Rana speak no English. Rana could not completed a half marathon in the speak at all because he was in a coma summer heat of Indianapolis in and remained unconscious for four 2008. He managed to run 13.1 miles, months. Ronald McDonald House, even though his grafted skin had set up to provide free lodging to no sweat glands. He did this a week parents of children who were ill, graafter a surgery that left eight-inch ciously offered Deepak a place to stay. incisions on both his shoulders. He There is an old burn unit yarn that returned to a nursing home that he around Christmas patients act up. increasingly was outgrowing, and And although Rana was Hindu, at was discharged to live on his own. the winter solstice, he had his darkRana is now working on his MBA est days. After five months of keeping from the Kelley School of Business at mostly clear of infections, he became Indiana University in Indianapolis. septic as bacteria moved into his In his most recent accounting bloodstream. The bacteria seemed to course, he got the top grade in his resist everything, and Rana came even class. closer to dying than he had been the In March, Steven Allen was found night of the fire. For a few tense days guilty of three counts of murder it looked like all the months of work and two counts of arson. On June had been for nothing. But, again, he 25, 2009, Rana and Hendricks went made a hair’s breadth escape. Some to Allen’s court sentencing. Before drugs finally kicked in, bacteria was he handed down his sentence, killed and his blood became clean. Lake County Superior Court Judge That was the turning point. From Rana in his apartment in Indianapolis. Photo by Dan Dry Clarence Murray said that Rana was December onward, it was clear to the an inspiration and a “testament to medical team he was going to live. the ability of the human spirit to In 2006, Rana got better, stronger. He opened his eyes, he persevere in the face of great adversity.” Then he pronounced started to move. He made what physicians call in their restrained Allen’s sentence: 220 years—60 years each for the murder of language “a remarkable recovery.” Allen’s wife, daughter and Singhal, plus 40 years for the aggraWith 95 percent of his skin grown back, he was transferred vated arson that left Rana so severely injured. not to India—there would be no hospital to take him there— Lake County Deputy Prosecutor John Burke, who handled but to the acute rehabilitation program at Wishard Memorial the Allen case and has gotten to know Rana over the past few Hospital in Indianapolis. There, he met Shannon Hendricks, years, called him “a great kid” and in an ironic way, a lucky one. an occupational therapist, who could see that under his scars “God has put some wonderful people in Rana’s path up there at was a man who wanted to be rehabilitated. Eventually, Rana was the University of Chicago Medical Center,” Burke said. discharged to a nursing home where he lived day by day, sharing Allen is appealing his conviction. In April, Judge Murray rooms with people who were dying or suffering from demenapproved Allen’s request to marry the girlfriend whose Florida tia. Under the influence of daily morphine to control pain, he trip set the stage for the tragedy. The marriage has since learned again how to stand and walk. After a year, he was able to taken place. start bringing a spoon to his mouth. Rana has decided to remain in America. He is currently here At the time of the fire, Rana was one course shy of completunder a U visa, which grants temporary legal status and work ing a degree in computer engineering at Purdue University. The eligibility to victims of crimes. Eventually, he would like to last requirement was waived, and Rana was able to put on a obtain a green card, which would make him a permanent legal gown, stand up, walk, and receive his engineering degree. His resident. He has stated, “I came to America to have a better edumom flew in for his graduation. cation and a better life so I could provide for my family.” With Rana suffered a fourth-degree burn to his heel, down to his the surgeries behind him, Rana can at last begin reconstructing, tendons and bones, and had several toes amputated on his left not the better life he had imagined, but the best life he can have. foot. These were his only amputations: Gottlieb and his medical team had spared every other digit. Hendricks, who had seen many tough scrapes, but nothing as tough as this, coached him Fall 2009 19
JBK@100 Joseph B. Kirsner, MD, PhD, in his office at the Medical Center, where he still works twice a week. Photo by Bart Harris
by Susan Chandler
The Section of Gastroenterology, Hepatology and Nutrition at the University of Chicago Medical Center is world-renowned for its groundbreaking gastrointestinal research and its patient-centered care. Much of that is thanks to Joseph B. Kirsner, MD, PhD, who has spent the last seven decades building the program and raising awareness of debilitating digestive diseases such as Crohn’s disease and ulcerative colitis. Kirsner, who celebrated his 100th birthday in September, also has been a major force in raising money for research into inflammatory bowel disease (IBD) and is the force behind the founding of the Gastro-Intestinal Research Foundation. The foundation provides funding for equipment and laboratories, and supports investigators and young physicians in the Medical Center’s Section of Gastroenterology, which has been consistently ranked by U.S.News & World Report as one of the top 10 in the country. Because of his dedication and longevity, Kirsner has mentored and trained generations of new gastrointestinal (GI) specialists. One sign of how the field has progressed: the Medical Center’s gastroenterology training program receives about 400 applications a year for three to four fellowship positions, which are supported by the National Institutes of Health. David Rubin, MD, co-director of the Inflammatory Bowel Disease Center and one of Kirsner’s proteges, says a three-part focus on research, training and patient care is what Kirsner is renowned for. “He insisted on the highest quality research with patient-centric goals in mind. There was always a clinical question tied to a patient problem that led to specific research in the field,” said Rubin. Despite the diligent efforts of Kirsner and others to crack the code, there is still no cure for Crohn’s or ulcerative colitis and the cause of intestinal bowel disease remains a mystery. “The problem is still unsolved,” Kirsner said. “We need to do more research.” 20 University of Chicago Medicine on the Midway
Even so, Kirsner has seen major progress in a once obscure field of medicine that wasn’t recognized as a separate specialty. He still remembers an emaciated young woman who showed up at the beginning of his work at the University of Chicago in 1936. All they could do was give her fluids and nutrition. The woman soon died. Today, treatments range from surgery to genetically engineered treatments such as infliximab (Remicade), and many IBD patients can live virtually normal lives, despite the chronic nature of their conditions. Kirsner didn’t have those tools available to him when he traveled to Chicago from Boston to intern at Woodlawn Hospital on the South Side. There he met his future wife, Minnie, and decided to make Chicago his home. After he moved to the university, he began to be mentored by Walter Palmer, MD, an expert in peptic ulcers. Back then, inflammatory bowel disease was largely viewed as a psychiatric disorder aggravated by stress. Kirsner initially accepted the prevailing view, but his tours of duty as a doctor in the Army Medical Corps in Europe and the Pacific during World War II changed that. Surely the stress of war and deprivation would have contributed to an increase in ulcerative colitis, he reasoned. But Kirsner came across only a few cases. “I didn’t see ulcerative colitis after Normandy. When we liberated the Philippines, I didn’t see it. There was obviously more to it than nerves,” he said. When Kirsner came home from the war, he returned to his grueling seven-day-a-week schedule of research, hospital rounds
and patient clinics. Palmer remained primarhas long prided himself on being available to ily interested in peptic ulcers and stomach patients at any time of the day or night, giving acid levels. Kirsner was more interested in them his home phone number. He still receives intestinal bowel disease. calls and visits from patients he treated 30 years Research out of Australia tying peptic ago. ulcers to spiral bacteria would eventually “We became known for our compassionate prove that Kirsner had latched on to the more care of the sick,” Kirsner said. “Research is intractable problem. Since ulcers have been important but the combination of research treated with antibiotics, they largely have and compassionate care is the best way. It still gone away. Not so with ulcerative colitis and is the best way.” Crohn’s, which is on the rise for reasons that Since 2000, the Medical Center’s GI secaren’t completely understood. tion has been headed by Stephen Hanauer, Kirsner, who took over as head of the GI MD, one of Kirsner’s residents from the section in 1962, reigned for decades as one 1970s. Rubin and Russell Cohen, MD, are of the world’s leading specialists in digestive co-directors of the section’s Inf lammatory diseases. He wrote more than 800 papers and Bowel Disease Center. Even at 100 years old, Dr. Kirsner’s friend and colleague, traveled to Morocco 55 times to treat King Kirsner still comes into his Medical Center James L. Franklin, MD, authored Hassan II, who suffered from irritable bowel office two days a week. this lively biography published in April 2009. syndrome. “On this particular day, I’m not as well More than just the advances in treatment, informed as Rubin, Hanauer and Cohen. I don’t Kirsner is proud of the way he and other Medical Center doctors need to be,” Kirsner said. “I always felt my responsibility was to treated patients as people, not just experimental subjects. He leave a proper group of physicians to carry on and advance.”
Joseph Kirsner, MD, PhD, and David Rubin, MD, still collaborate; here, the two are working together on a Grand Rounds lecture. Photo by Bart Harris
a mentor and a friend When David Rubin, MD, was heading to the Pritzker School of Medicine as a first-year student in 1990, his grandmother told him to look up her doctor, Joseph Kirsner, MD, PhD. “She said, ‘Go see if my doctor is still there. He saved my life,’” Rubin recalls. When he asked her what Kirsner had treated her for, she replied Crohn’s disease. It was the first time Rubin had heard of it. He followed her instructions and boldly tracked Kirsner down in his office. Kirsner, who was then 80, was still keeping a heavy workload, treating patients and mentoring young physicians. He kept his eye on Rubin as his medical education progressed and when Rubin was considering specialties, Kirsner told him, “We need you in GI. Don’t go into cardiology.” Rubin followed his advice. It was the beginning of a long relationship and deep friendship that continues today. Rubin is now co-director of the
Inflammatory Bowel Disease Center in the Gastroenterology, Hepatology and Nutrition Section at the Medical Center. When Kirsner stopped seeing patients in 2004, Rubin took over for him and became his personal physician as well. Kirsner attended Rubin’s wedding. Rubin visits Kirsner at his Hyde Park home on Sundays and often brings him breakfast. The two worked together on a Grand Rounds lecture that Kirsner presented September 8, two weeks before he became a centenarian. “He has taught me the history of medicine and the special touches that make a difference in somebody’s life,” Rubin said. “He has taught me that being in a university is not just your career, it’s your life. We’d like to think we’re following in his footsteps every day, but there’s only one JBK.”
Fall 2009 21
Medicine off the Midway
By Suzanne Wilder
Before becoming a Pritzker medical student, Dan Krebs studied in Russia, worked as a financial analyst and helped treat HIV/AIDS patients in Zambia. Dan Krebs hadn’t expected things to be so bad. Visiting an Ethiopian orphanage in January this year where his soon-tobe-adopted 3-year-old son lived, Krebs found the children were malnourished, underweight and too short for their ages. The orphanage had few resources to provide nutritional supplements to the kids. Krebs remembered reading about a supplemental peanut butter called “Plumpy’nut,” which was affordable, didn’t require refrigeration, didn’t spoil quickly and tasted good. Faced with just a few days before he had to leave Ethiopia, he began a mission to get the peanut butter to the orphanage. The World Health Organization required a months-long procurement process to supply Plumpy’nut. But Krebs’ son, who could not yet come to the United States, and the other children at the orphanage would suffer months of malnutrition if they had to wait. Krebs made a call to the Plumpy’nut factory in Addis Ababa, the capital city. By the end of the week, he had picked up $400 worth of the supplement for the orphanage, set up a system for the orphanage nurse to weigh children and track their improvement, and arranged for future deliveries from the factory. After the visit, Krebs returned to Chicago, where at the time he was in his third year as a medical student at the Pritzker School of Medicine. At first glance, Krebs, 30, who is tall and pale with close-cut hair, seems like an ordinary medical student, but he has an unusual curriculum vitae. He twice studied abroad in Russia, helped provide HIV/AIDS care in Zambia and worked as a financial analyst in Washington, DC—all before arriving in Chicago to begin medical school. 22 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
Dan Krebs with his adopted son, Ferhan. Photo by Robert Knapp
Mentored by a country doctor When Krebs was 14, he began working for the local family physician in rural, upstate New York. Part of Krebs’ duties included cleaning out the doctor’s massive waiting-room fish tank and helping out at the doctor’s farm. That “country doctor,” Krebs said, “did everything.” He cleaned and dressed wounds, set broken bones, delivered babies and cared for patients of all ages with a wide variety of ailments. The experience with the doctor—whom Krebs calls “a really important mentor in my life”—began to shape Krebs’ outlook on his future. But there were several detours before Krebs began to think of medicine as a possible career choice. As a high school student, Krebs became a complete Russophile. He won a scholarship to study for several months at a Russian high school—and later went back to college. He majored in science technology and international affairs at Georgetown University, took Russian language courses and studied political science. Krebs met his future wife, Sandra Spadoni, while studying in St. Petersburg, Russia, in a Georgetown program; they married in 2002.
The grind of a financial analyst Krebs and his wife began volunteering at an orphanage, where they taught English lessons and played with children. After long discussions, they decided to adopt an 18-month-old girl, Josephine. Around the same time as he and his wife adopted their daughter in 2006, Krebs applied to and interviewed at several medical schools in the United States. He was accepted at many schools—including Harvard Medical School—but opted to take the offer at the Pritzker School of Medicine. He liked the campus atmosphere and the learning opportunities here. The family moved to Chicago in 2006, and his wife took a job as an international student adviser at the university. In his first year of medical school, Krebs met John Schumann, MD, assistant professor of medicine. Schumann specializes in issues related to health and human rights, and he could see that Krebs had an interest in social medicine and a desire to make the world a better place. “He stands above,” Schumann said, because he has a “deep and abiding interest in global health and social justice.” But Krebs, who is entering his fourth year of medical school, also is unique because he’s a parent— “most medical students don’t have kids,” Schumann noted. In addition to attending classes and doing clinical rotations, Krebs works as a resident head, which means he and his family live in a student dormitory. He is a symbolic parent to 60 undergraduate students who lived in Shoreland House last year. Being resident head has led to trips to the emergency room with the undergraduate students and frequent late-night fire alarms, but the family enjoys the experience of being around the students. He and his family recently moved to the University’s new dorm, the South Into Africa Campus Residence Hall, which opened to students this fall. The couple had never traveled to Though Krebs is settled happily Africa before and had never worked in Chicago for now, he is looking in a foreign country. When their ahead to where he’ll go in the plane landed in August, 2005, they future. He misses travel, and he could see bush fires burning in would like to incorporate internathe distance. tional medicine into his career in Krebs’ work in Zambia led to a some way. “International health is paper published in AIDS Care about something I really want to make the benefit of using community part of my career,” he said. members in African villages to visit This spring, he received word HIV/AIDS patients to follow up on Dan with his wife, Sandra Spadoni, and their adopted children, that he had been offered a Fogarty their care. That research demon- Josephine (left) and Ferhan. Photo by Robert Knapp Fellowship—a major award that strated that lay visitors could help gives graduate students the opportunity to conduct research in bring patients back to clinics for treatment and determine what foreign clinics—from the National Institutes of Health, but he happened to patients who stopped appearing for treatments. decided to decline. He was waiting for his newly adopted son to Through those visitors, Krebs discovered that many of those arrive from Ethiopia who arrived on June 27. “missing” patients had died. After graduation in 2001, Krebs began working as a financial analyst at an investment bank in Washington, D.C. He found the work unsatisfying. “I ultimately knew that I didn’t see myself doing this forever,” Krebs said. “When I woke up in the morning, I wasn’t excited about it. Towards the end, I couldn’t stand it.” During the three years he worked as a financial analyst, a back injury sent him to the hospital for several days. His experience at George Washington University Hospital was so positive that he volunteered at the hospital, “basically candy striping,” he said, “and I loved it.” In 2003, Krebs began searching for a career that could fulfill his desire to serve people. “The people I admired most put their community before anything else,” he said. He thought about his dad, a high school teacher, and about the country doctor for whom he used to work. Krebs realized that he wanted to pursue medicine, but there was a small hiccup: He had taken few science courses in his political-sciencefueled undergraduate program. He found a post-baccalaureate program at Goucher College in Baltimore, where he took the science courses he needed to prepare for the medical college admission test. The program encouraged its students to apply for medical school in the fall after they’d finished their coursework, which meant Krebs had the 2005-2006 year off before he officially would begin his new career path. He opted to apply for work with the President’s Emergency Fund for AIDS Relief, through a program at the University of Alabama. His wife also was hired, and the program sent the couple to Zambia. They would provide anti-retroviral medications to treat patients and study their use.
Fall 2009 23
Challenges to a Pioneer: James Bowman, MD By Katie Scarlett Brandt
Roughly 27 years ago, James Bowman, MD, applied for funding to study the use of bone marrow transfusions to treat sickle cell anemia. Bowman, currently Professor Emeritus in the Departments of Pathology and Medicine, said French researchers had published on the concept, but the medical community seemed to pay little attention. Bowman’s grant application was denied. Other researchers went on to demonstrate the technique successfully, and the practice was growing common when, five years later, Bowman chaired a symposium on bone marrow transfusions in sickle cell anemia. “There’s an old saying, ‘Don’t get mad, get even,’” Bowman said. He dug up the rejection letter and read it aloud at the symposium. The reviewers who had previously shot him down were in the room. “They just stared. I enjoyed that.” Bowman—who started at the University of Chicago Medical Center as director of the blood bank 47 years ago—has spent much of his life proving himself and his theories to skeptics. His determination has set him apart in a world where racial and societal barriers have held back others.
Photo by Dan Dry
24 University of Chicago Medicine on the Midway
Bowman was born in Washington, D.C. in 1923. As a teenager, he attended Dunbar High School, one of three schools for African Americans in the nation’s capitol. When Bowman told his father, a dentist, that he wanted to become a physician, the man was devastated. He wanted his son to follow in the family business. Years later when Bowman’s daughter, Valerie Jarrett—now a senior advisor to President Obama—chose law instead of medicine, Bowman accepted her decision. “She has her life and she should do it,” said Bowman, who added that he was extremely proud of what his only child has achieved. Bowman never doubted his own aspirations, either. His professors at Howard University, where he received his undergraduate and medical degrees, stressed that their alumni could compete with anybody. “So, I believed in myself.” Bowman chose to pursue pathology, tracing people’s diseases back to their roots. That path led Bowman to Chicago, where he worked as a fellow at St. Luke’s Hospital (now Rush University Medical Center). The hospital paid Bowman $100 per month, but banned him from residents’ quarters because he was African American, he said. His wages went to pay for a private apartment and streetcar fare. Bowman’s colleagues took care of him when they could. Physicians were allowed one guest for lunch in the hospital cafeteria, so throughout the week they rotated treating Bowman as their guest. “That’s one way I survived,” he said. Despite the fact that he was the only African American resident, Bowman felt comfortable at St. Luke’s. Near the end of his fellowship, administrators at Provident Hospital on Chicago’s South Side recruited Bowman as pathology department chairman. But he wasn’t focused solely on work. “I had thought when I came to Chicago that I would look around for many girls,” Bowman said, “but I saw Barbara and said yes.” Barbara Taylor had grown up in Chicago and left for Sarah Lawrence College to major in education. She and Bowman started dating during one of her visits home. The two married a couple of years later. Married now for 60 years, Bowman blushed when he spoke of Barbara: “She has six honorary degrees. I could talk about her more than I could talk about me.”
Bowman wondered if fava beans, like the anti-malarial drug, triggered anemia in people with the enzyme deficiency. “I started running around the country looking at this,” he said. He collected blood from people in big cities and tiny villages. “And of course we found it in Iran.” The Bowmans remained in Iran for six years—long enough for Valerie, at age 5, to ask her father: Who is the Shah of the United States? Above: James Bowman, MD, in his office in 1964. Left: 1979 issue of the Chicago Journal featuring Bowman and his research. Photos provided by James Bowman
One afternoon not long after they’d married, the Army draft board phoned. Bowman had graduated medical school on the Army specialized training track but went into the reserves after graduation. Army officials needed him to leave the reserves to serve as first lieutenant at a nutritional laboratory. The work took Bowman out of the autopsy room and into the laboratory. He couldn’t have been happier. “It’s too bad for a pathologist to say you don’t like autopsies. That’s sacrilegious; that’s how we learn—from the dead,” Bowman said. At his term’s end, Bowman began looking for where to go next. His discharged peers mentioned $25,000 salary offers, so Bowman called Provident Hospital to see what administrators there could offer for his return. A salary of $10,000, they said. Bowman declined. He passed up not only the city of Chicago, but the United States altogether. He headed for Iran, where the man behind the newly-established Nemazee Hospital in Shiraz asked foreign physicians to aid in its start. Bowman would chair the pathology department.
University life The family returned to Chicago via England, where Bowman spent a year as a fellow at the University College London. By 1962 they were back in Chicago, and Leon Jacobson, MD, thenchairman of medicine at the University of Chicago, offered Bowman a position at the Medical Center. Bowman became director of the university’s blood bank and continued in pathology and population genetics. Grants enabled him to travel to Ethiopia, Mexico, Turkey, Nigeria and Cameroon to collect blood. “When you’re in various populations, you have to think: What are we doing to these people? You have to think of their history and make sure you’re not harming them while you’re doing research,” he said. He learned Farsi in Iran, and read the Bible and the Qu’ran to help himself better understand the basis for many cultural mores. Before collecting blood, Bowman always explained to people what he was doing and why. In Ethiopia, a Nuer tribesman, his face covered in ritual scars, asked Bowman if he was going to hurt him. Bowman told him: “Not as much as those.” The mood lightened.
Life abroad At Nemazee Hospital in the 1950s, Bowman’s life changed. He was playing tennis one afternoon near hospital grounds when a guard rushed toward the court. A baby inside was dying, he shouted. Bowman ran after the guard and found the infant barely breathing, his skin jaundiced. Uncertain what was wrong, Bowman considered his options and took the baby to the blood bank for a transfusion. Within hours, the boy roused, jumping in his bed. They had saved his life, but Bowman had no idea why the transfusion worked. More babies began arriving at the hospital—yellow, pale, and barely alive. Bowman searched every book and journal for potential causes, and found an answer in one that mentioned “Baghdad Spring Anemia,” caused by eating fava beans—a European and Middle Eastern diet staple for centuries. Through further anemia research, Bowman discovered that halfway across the world scientists at the University of Chicago had found a specific enzyme deficiency that caused anemia similar to what he was seeing at the hospital in Shiraz. Enzymes are tiny molecules that cause chemical reactions within the body, and genes code for enzymes. Like a chain reaction, a defect in a gene might lead to a deficiency in an enzyme and subsequently render a chemical reaction faulty. The Chicago researchers found the enzyme deficiency after giving anti-malarial drugs to African Americans, who often developed a subsequent anemia. When the pathologists looked at their cells, they discovered the drug was triggering an anemic reaction in people who carried a deficient enzyme called glucose-6-phosphate dehydrogenase.
James Bowman, MD, with grandaughter Laura, wife Barbara and daughter Valerie Jarrett.
Today and throughout his career, Bowman’s look has remained constant in a bowtie and glasses. He has served on numerous committees and watched the university community evolve to include people of all races and cultures. Named in honor of Bowman’s continuing legacy, the University and the Pritzker School of Medicine joined together in 2005 to offer the Bowman Society and lecture series. It involves senior faculty, fellows, residents and guests, who share their knowledge regarding health care of minority communities, scholarship and activism. “I never envisioned all of this, and that’s life,” Bowman said. “Sometimes the best things are never planned.” Fall 2009 25
50 Years and Counting Call it the anniversary effect. The 1959 class of the Pritzker School of Medicine had the highest percentage turnout of class members during the 2009 Reunion Weekend, which took place June 4-7. The class, which was celebrating the half-century mark, also won an award for increasing charitable giving to the school.
“We’ve had reasonable turnouts before, but not like the 50th,”
said class chairman Coleman Seskind, MD ’59, who practices internal medicine in Chicago. “We were a small class. There were only 72 of us. With deaths we were down to around 56. I called everybody. I called in all kinds of markers.”
The Pritzker School of Medicine Class of 1989 at its class dinner. All photos by Tricia Koning Photography.
26 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
From left: Morton H. Goldstein, MD ‘59, Deanna G. Goldstein, Coleman R. Seskind, AB ‘55, SB ‘56, SM ‘59, MD ‘59, and Yoshio Oda, MD ‘59, at the Welcome Cocktail Reception.
Thirty-one class members, most accompanied by spouses or significant others, made it to the reunion from as far away as Hawaii, Maine, New Jersey and Washington state. “Everybody who came was very, very glad,” Seskind said. “Almost everybody had risen well in the profession. They were grateful for their educations and felt it was better than most. They felt they were treated well at the University of Chicago and they felt gratitude.” Although class members are now in their 70s, retirement wasn’t a hot topic. “Retirement is sort of a dirty word for people of my generation,” said Seskind. “Doctors don’t retire.” Another class celebrating a big anniversary—the Class of 1989—had a smaller but not insignificant turnout. Thirteen of 104 class members attended, according to class chair Christopher “Kit” Young, MD. Lively discussions ensued about the university’s growth and current status as well as President Obama’s proposed health care overhaul. The group also talked about its new Facebook group, which is intended to help class members stay in closer touch. “Our class was quite close but we lost our cohesion. I think this reunion was just what we needed to build up our cohort again,” said Young. “We think this could be the start of something big.” In total, more than 200 medical alumni and guests gathered for the three-day event, which included a tour of the recently completed Gwen and Jules Knapp Center for Biomedical Discovery and a presentation on the Medical Center’s Urban Health Initiative.
Above left to right: Andrew James Aronson, MD ‘69, Iris K. Aronson, MD, Anna H. Siegler, AB ‘66, PhD ‘80, and Mark Siegler, MD ‘67, at the Third Annual Alumni Leadership Celebration. Below: Two of the 2009 Alumni Distinguished Service Award recipients: Seth L. Haber, SM ‘58, MD ‘58,and Patricia G. Spear, PhD ‘69.
Fall 2009 27
“We are witnessing a battle for the soul of American medicine,” Atul Gawande, MD, told graduates. “You are our hope for how this battle will play out.” Gawande Motivates Pritzker Graduates In one way, doctors have been relatively unscathed by the nation’s worst economic downturn since the Great Depression: Unemployment among physicians is practically non-existent. But that doesn’t mean they can afford to be complacent, warned Atul Gawande, MD, (above right) surgeon and best-selling medical author, as he addressed more than 100 graduates of the University of Chicago Pritzker School of Medicine June 12. The ranks of the uninsured are swelling. Medical-related bankruptcies among patients are increasing. Hospitals that were losing money before the recession are considering desperate measures such as closing down. “We will be affected by what is going on in our country,” Gawande said. He pushed graduates to take a bigger role in controlling U.S. health care costs, a challenge that President Barack Obama has called “the biggest threat to our nation’s balance sheet.” In locations where health care spending is higher, Gawande noted, patients do not do better in terms of survival or functional ability. “If anything, they seemed to do worse,” he said.
Gawande also urged the new doctors not to view patients as “revenue streams” and encouraged them to study their peers who have found ways to keep costs low while providing quality, patient-centered care. The Pritzker medical class is well-prepared to embrace the interdisciplinary challenges facing the profession. Almost 20 percent of graduates also have earned master’s degrees or PhDs in fields as diverse as business and public health. “We are witnessing a battle for the soul of American medicine,” Gawande told graduates. “You are our hope for how this battle will play out.” The medical school and the Biological Sciences Division hold a joint graduation ceremony but have separate speakers who are selected by their respective students. This year, the 40 biological sciences PhD graduates were addressed by Kathie Olsen, PhD, senior advisor at the National Science Foundation. She urged them to consider a career path that would take them beyond the laboratory into areas of policy and administration. Photo (above left) by Tricia Koning; photo (above right) by David Christopher
Graduates of the Pritzker School of Medicine Take Their Next Steps as Doctors It’s one of the most nerve-wracking moments in the lives of medical students: Match Day, the day they find out where they will do their medical residencies. This spring, almost 30,000 medical students around the country participated in Match, a record number that included 110 students from the Pritzker School of Medicine. For the second year in a row, the largest number of Pritzker students—19—headed to the University of Chicago Medical Center. Nine became residents at Northwestern University Hospitals and seven were matched to Harvard-affiliated medical institutions, including two at Massachusetts General Hospital. The fourth and fifth most popular destinations for Pritzker students were Stanford University-related programs and University of Washington-affiliated hospitals. While the top three destinations for Pritzker students remained the same, there was a shift in the specialties they will pursue. Twenty-nine residents in the 2009 class will focus on internal medicine, up 20 percent from 2008. Fourteen students are specializing in pediatrics, almost double the number who chose that field a year earlier. Nine students in the 2009 class are pursuing orthopaedic surgery, up from four in 2008. 28 University of Chicago Medicine on the Midway
Jeffrey Eisen and Erica Aronson hold up their Match Day letters. Eisen was matched with Cambridge Health Alliance and Aronson was matched with the Medical Center. Photo by David Christopher
Stephanie Donald, 26, found out she would be starting her first year of residency in emergency medicine at Harbor-UCLA Medical Center. “I’m thrilled and relieved that this day is finally here and my match is everything I had been hoping for! It was a great four years, and Pritzker really prepared me well for this next step.”
Tragic Loss Two promising medical careers ended prematurely on June 11 when John Mislow, MD, PhD, and Andrew Swanson, MD, fell to their deaths while attempting to reach the summit of Mt. McKinley in Alaska’s Denali National Park. Mislow and Swanson met as students at the Pritzker School of Medicine and became fast friends who stayed in touch after graduation despite geographic distance. The two shared a love of mountaineering. The friends had climbed Mt. McKinley before. In 2000, Mislow and Swanson received the Denali Pro Award for safety, self-sufficiency and providing assistance to fellow climbers. The two had assisted several teams in distress that year and helped with some visitor protection projects, park officials said.
Swanson, 36, was an orthopaedic surgeon. He practiced with his father, Gene, and older brother, Kyle, at a clinic in Mankato, Minn., where he grew up. Swanson, who was single, made the 60-mile commute from Minneapolis. When he was on call, he stayed with his parents. Swanson graduated from Pritzker in 2000 and completed his orthopaedic surgery residency at the Hospital for Special Surgery in New York in 2005. “Andrew was a natural leader among his peers, respected, fair, ethical and always concerned about what was best for his patients,” wrote Thomas Sculco, MD, surgeon-in-chief at the Hospital for Special Surgery on a memorial Web site. “Andrew was a humanist in the true sense of the word.”
“Andrew was a natural leader among his peers, respected, fair, ethical and always concerned about what was best for his patients. He was a humanist in the true sense of the word.”
“John was a terrific person, an inspiration. He had a great work ethic. When he was your doctor, you knew he was going to be there with you day or night, completely committed.” Andrew Swanson, MD
Since their deaths, the award has been renamed the MislowSwanson Denali Pro Award, said Maureen McLaughlin, a spokesman for Denali National Park. Mislow, 39, was in his fifth year of a seven-year residency in neurosurgery at Brigham and Women’s Hospital in Boston where he was regarded as a rising star. He graduated from Pritzker in 2004 and was married to dermatologist Linda Wang, MD, JD, another Pritzker graduate. The couple has two sons. “He had an incredible passion and boundless enthusiasm for life, a deep sense of service and a wonderful sense of humor,” Wang said. “He could make me laugh no matter what kind of a day I was having.” Mislow grew up in Princeton, NJ. His father, Kurt Mislow, PhD, is professor of chemistry emeritus at Princeton University, and his mother, Jacqueline Mislow, MD, PhD, is a retired internist. “He was a terrific person, an inspiration. He had a great work ethic. When he was your doctor, you knew he was going to be there with you day or night, completely committed,” Arthur Day, MD, chairman of neurosurgery at Brigham and Women’s, told the Boston Globe. During the last two years of his neurosurgery training, Mislow worked as a postdoc in the Brown University lab of John Donoghue, PhD, on the BrainGate project, an effort to restore movement, control and independence to people with paralysis by directly connecting their brains to the outside world when they had been disconnected by disease or spinal cord injury.
John Mislow, MD, PhD
Swanson’s mother, Eydie Swanson, told the Associated Press her son loved donating his time twice a year in Africa, working with children with severe spine deformities. “He was so handsome, so kind, so irresistible,” she said. Swanson had completed eight trips to Africa, the most recent just a few weeks before his death. In one of his trips, he volunteered to visit the jungles of Sierra Leone to find the most crippled children afflicted with tuberculosis of the spine who would later benefit from complex spine surgery and be given a new chance at life. Swanson’s sister, Molly Britt said: “The world is a better place because both Andrew and John were here, although much too briefly. Their deaths are a great loss to all humanity, and especially to those who were lucky enough to have loved them.” In a letter to Pritzker faculty and staff, Holly Humphrey, MD, dean for medical education, said she had received an “outpouring of correspondence expressing concern and great sympathy for the families.” She added that “John and Andrew carved out exceptional careers for themselves.” A memorial fund is being established by the Pritzker School in memory of Mislow and Swanson. Contributions made to this fund will support biological sciences and medical education as well as research. The following memorial Web sites also have been set up for both men: www.web.me.com/wchutkow/John_Mislow_Memorial/Home.html www.andrewswansonmemorial.wordpress.com
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Class Notes 1940s Dorothy Warshaw Saxner, SB ’47, SM ’48, is the former vice president of American Hospital Publishing, Inc. She is retired and lives in Ann Arbor, Mich. with her husband Harold R. Johnson.
1950s Varda P. Backus, MD ’57, is retired and enjoying a life of leisure. John R. Benfield, MD ’55, was selected as “A Legend” by the faculty
Gordon M. Burghardt, SB ’63, PhD ’66, was a visiting professor at the Kyoto University Museum from June to October 2008, doing research in the Department of Zoology and at the Kyoto Primate Institute.
Robert W. Ridley, MD ’62, is working now as an ophthalmologist two days a week. He also is slowly working on a degree in accounting. Joseph R. Simpson, PhD ’67, is still working in radiation oncology as chief of Central Nervous System oncology services at Washington University School of Medicine in St. Louis.
and staff of the Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center. This award recognizes Benfield’s long-term positive influence from 1967 to 1977.
Joan Carlson Walson, MD ’62, is in her fifth season as “host mom”
Eric Edward Conn, PhD ’50, writes that after 41 years of teaching introductory biochemistry and plant biochemistry in the University of California at Berkley and Davis, he retired in 1993. Sadly, his wife, Louise (Kachel) Conn, AB ’44, died in 2002. He met Louise in Chicago, and after she worked for four years in Paris with the American Friends Service Committee, they married in 1959. Their two sons also live in Davis. They enjoyed sabbatical years in Cambridge, England (1960), Palmerston North, New Zealand (1965-1966) and Adelaide, Australia (1981-1982). His research on HCN-producing compounds in plants dictated the choice of those countries for research purposes. In 1988, he was elected to the National Academy of Sciences in recognition of his research.
Alvin S. Yusin, MD ’60, is the author of a new novel, Apple Hill: A Story
Howard Goldfine, PhD ’57, had a busy year as co-chair of Penn’s Year of Evolution. They enjoyed having a visit by Neil Shubin at the beginning of the year. All incoming freshmen were given his Your Inner Fish to read.
Sanford B. Krantz, AB ’54, SB ’56, MD ’59, retired in 2004 and is currently Emeritus Professor of Medicine/Hematology at Vanderbilt University Medical School. He and his wife, Sandra, have been traveling extensively with University Alumni to the Greek Isles, China, Egypt, South Africa and Russia. Sanford and Sandra celebrated their 50th wedding anniversary on December 28, 2008. They initiated the Sanford B. and Sandra R. Krantz Scholarship in the college of the University of Chicago because of all the college has done for them.
for the Florence Freedom, Frontier League Professional Baseball, specializing in pitchers. of Slavery and Civil War. Yusin is a retired developmental pediatrician with three sons and three grandchildren. He lives with his wife of 48 years in Los Angeles, Calif.
1970s Eugene C. Corbett, Jr., MD ’70, and his wife, Sue, continue to live on their small farm in rural Virginia and work at the University of Virginia.
Theodore M. Ingis, MD ’71, is happily semi-retired, working three days a week and not doing surgery.
Wynn K. Jackson, MD ’79, has been practicing psychiatry and psychoanalysis in Greenwich, Conn., for almost 20 years. Her husband, John Knopf, is a finance professor at the University of Connecticut, and her daughter, Elizabeth, is a freshman at Columbia. Ruediger Kratz, MD ’73, has been serving as the Director of Neurology Services at DuBois Regional Medical Center since 2003. Thomas D. Webb, MD ’79, is the vice chair of the Department of Anesthesiology at Cedars-Sinai Medical Center in Los Angeles, Calif., as well as medical director of the OR Operations.
Henry Rothschild, MD ’58, is working on a master’s degree in liberal
sciences at SMU.
John Metcalfe Blair, Jr., MD ’89, now has five kids with twin girls
Paul Slotwiner, AB ’55, SB ’56, MD ’59, is still in the practice of clinical neurology, though no longer running around hospitals or having to deal with hospital politics. His four boys, all college graduates of the University of Chicago, including three from the Pritzker School of Medicine, live close by and are keeping busy. The non-MD son is working for Google. Paul has seven grandchildren and counting.
Ronald R. Wemple, MD ’55, spent late May and June bicycle touring in Denmark, Norway and Sweden.
1960s William C. Allen, MD ’60, a Professor Emeritus at the University of Missouri School of Medicine Department of Orthopaedic Surgery, has established an endowment at the University of Missouri called the William C. and Kathryn E. Allen Distinguished Professor in Orthopaedic Surgery. A similar endowment was established in 2004. Judith T. Broder, SB ’60, MD ’63, founded and directs The Soldiers Project, which provides unlimited, free, confidential psychological services to all service members and their loved ones who have served in the Iraq/Afghanistan conflicts.
30 For more information, call 1-888-UCH-0200 or visit uchospitals.edu
born in October of 2008.
Mark Elliott Brecher, MD ’82, writes that after more than 20 years in academia, he is leaving his position as professor and vice chair, Department of Pathology and Laboratory Medicine at the University of North Carolina, to become chief medical officer of the Laboratory Corporation of America. His older daughter is a third-year college student at the University of Chicago. The late Ronald M. Davis, AM ’81, MD ’83, was honored with the Lifetime Achievement Award for his distinguished tobacco control efforts by the American Legacy Foundation. Former Surgeon General C. Everett Koop presented the award to Davis’ widow, Nadine Davis.
Robert A. Gluckman, MD ’82, was elected to the Board of Regents of the American College of Physicians, the national organization of internists. His three-year term began this year. Gluckman is chief medical officer of Teaching Clinics in the Providence Physician Division of the Providence Health System in Portland.
Keith A. Horvath, AB ’83, MD ’87, is working on cardiac stem cells, MRI-guided surgery and xenotransplants.
Stephen R. Lyle, AB ’88, SM ’88, PhD ’93, MD ’95, was promoted
Geoffrey Braden, MD, (internal medicine, 1975-1978), is heavily involved with medical informatics. He works with Medscape Gastroenterology and is associate editor of online education for the American Gastroenterological Association.
to associate professor in the Department of Cancer Biology at UMass Medical School in February 2009.
Edward R. Sherwood III, MD ’94, was appointed director of the MD – PhD combined degree program at the University of Texas Medical Branch, Galveston. Sherwood is professor and vice chair for research in the Department of Anesthesiology and holder of the James F. Arens Endowed Chair in Anesthesiology. He also holds a joint appointment in the Department of Microbiology and Immunology.
2000s Pat Auveek Basu, MBA ’05, MD ’05, was named the 2009 Stanford Consultant Physician of the Year by the Emergency Departments of Stanford University and Kaiser Permanente. This award is given to the physician who, on a regular basis, acts in the best interest of patient care through clinical knowledge, action, teaching and leadership. Dawn Nicole (Wilson) Dlugosz, SM ’05, writes that she married Joe Dlugosz in 2007. She worked at Children’s Memorial Hospital for three years, where she conducted epilepsy research.
Jesse M. Ehrenfeld, MD ’04, was elected vice speaker of the House of Delegates of the Massachusetts Medical Society at the organization’s May 2009 meeting. Ehrenfeld is on the faculty at Harvard Medical School, as well as an assistant in anesthesia in the Department of Anesthesia and Critical Care at Massachusetts General Hospital.
Alberto Gedissman, MD, MMM, FAAP, (pediatric residency 1972), writes that his latest effort has been to combat the childhood obesity epidemic by creating a center for comprehensive intervention.
In Memoriam 1940s Hillier L. Baker, Jr., LAB ’40, SB ’44, MD ’46, passed away in December at the age of 84. After graduating from medical school at the University of Chicago, Baker joined the Mayo Clinic in 1953, and then served for two years in the Army Medical Corps at West Point. A staff radiologist and professor of radiology at Mayo for more than 40 years, he was a pioneer in computer tomography. In 1973, Baker brought the first CT scanner in the country to Mayo. He was the recipient of numerous honors and awards from medical societies. Baker’s wife and son preceded him in death. He is survived by two daughters and two granddaughters. Walther W. Meyer, MD ’47, passed away in March.
Jay William Zimmerman, MD ’02, has a second daughter, Bryn,
Frederick P. Zuspan, MD ’51, an internationally recognized authority in the field of maternal-fetal medicine, died of prostate cancer in June. Zuspan was the former chair of the Department of Obstetrics and Gynecology at the University of Chicago and an expert on preeclampsia. In the 1960s, he pioneered the use of intravenous magnesium sulfate to prevent convulsions in women with preeclampsia, a protocol that was adopted internationally and is still in use. He also was an outspoken advocate for a woman’s right to choose, arguing publicly for faster and more sensitive pregnancy tests, insurance coverage for abortions, and improved access to the procedure. Zuspan came to the University of Chicago in 1966 and remained until he was recruited back to the Ohio State University College of Medicine, his alma mater and home state, in 1975. He stepped down as department chair in 1987. He is survived by two siblings; his wife of 66 years, Mary Jane Cox; three children and seven grandchildren.
born on January 10, 2009. He and his wife live in Burlingame, Calif. Zimmerman works in the Bay Area as a dermatologist with the Berman Skin Institute.
Laura Anne Hanyok, MD ’03, finished her residency and chief residency in internal medicine at Johns Hopkins Bayview Medical Center. She now practices internal medicine at Bayview and is an assistant professor at Johns Hopkins School of Medicine.
Benjamin Kyle Potter, MD ’01, is currently the director of musculoskeletal oncology and orthopaedic surgery liaison to the Amputee Patient Care Program at Walter Reed Army Medical Center. He cares for patients with cancer and amputees and other combatinjured service members from Iraq and Afghanistan. He is married to Michelle DiVito, MD ’01 with two children, Hazel, 2, and James, 1. Nirav Dinesh Shah, JD ’07, MD ’08, is currently teaching a seminar at Pritzker on Global Public Health and is hoping to make the jump into the world of global health care soon.
Medicine on the Midway A publication of the University of Chicago Medical Center Fall 2009, Volume 1, No. 2 Editor Cheryl L. Reed Contributing editors Denise Alamad, Director of Publications; and John Easton, Director of Communications Editorial contributors Katie Scarlett Brandt; Suzanne Wilder; Susan Chandler; Philippe Tapon; Robert Mitchum; Kelly Smith; Casey Reid; Stacy Lindau, MD; Alison Szot; Greg Borzo; and Ashley Quirke Design firm Words&Pictures, Inc. Editorial committee Chairwoman Chris Albanis, AB ’96, MD ’00; Lampis Anagnostopoulos, SB ’57, MD ’61; John Benfield, MD ’55; Arnold Calica, SM ’61, MD ’75; James Hopson, PhD ’65; Patricia Martin, AB ’74, MD ’78; and Jerrold Seckler, MD ’68; Coleman Seskind, AB ’55, SB ’56, SM/MD ’59
Paul R. Hyman, MD ’62, passed away in April.
Medicine on the Midway is published for friends, alumni and faculty of the University of Chicago Medical Center, the University of Chicago Biological Sciences Division and the Pritzker School of Medicine. Articles may be reprinted in full or part with permission of the editor. We welcome your comments and letters to the editor. Address correspondence to Editor, Medicine on the Midway University of Chicago Medical Center American School Building 850 E. 58th Street, Room 106 Chicago, IL 60637-1470 Telephone (773) 834-8089 Facsimile (773) 702-3171 E-mail editor firstname.lastname@example.org E-mail class news email@example.com Find us on the Web www.uchospitals.edu/midway
© September 2009. University of Chicago Medical Center, Division of Communications and Marketing
Fall 2009 31
Cancer Patients seek help with sexual problems
By Stacy Tessler Lindau, MD
While sexual dysfunction is well understood and addressed by physicians treating prostate cancer, patients with gynecological and breast cancers rarely receive attention, research shows. Yet nearly 3 million women in the United States are survivors of gynecologic or breast cancers, and these cancers and their treatment directly affect the sexual organs. In our population and registry-based research on sexuality at the University of Chicago Medical Center Program in Integrative Sexual Medicine (PRISM), we find that older women and women with cancer value sexuality as an important part of life just as younger and healthy women do. As a group, sexually active older women have sex about as frequently as sexually active younger women. We also have found that older women and women with cancer are receptive to discussing sexuality issues with a physician, but believe that physicians ought to initiate the discussion. In one study of women with vaginal and cervical cancers, we found that survivors rated their cancer care very high overall, but satisfaction with care for sexual matters was significantly lower.
32 University of Chicago Medicine on the Midway
“It seems unbelievable to me that a surgeon would remove one’s sexual organs and never talk about sex.”—30-year vaginal cancer survivor In that study, nearly two-thirds of survivors reported that no physician had ever discussed the effects of cancer or cancer treatment on sexual life or function, even though most patients had undergone removal and/or radiation of their sexual organs and had been in care for more than 20 years. Some women in our study had been treated for cancer shortly after puberty, before they had initiated sexual activity or childbearing. Several commented that lack of sexual experiences prior to diagnosis and treatment, and avoidance of these issues in their medical care, left them without a frame of reference for “normal” sexual functioning. In fact, women reporting that a physician had discussed the sexual effects of their cancer were nearly three times less likely than others to exhibit complex sexual problems 20 to 30 years later. We also found that very long-term survivors of vaginal and cervical cancer participate in sexual relationships and activities at a rate similar to a population-based comparison group. Sexuality among genital tract cancer survivors is strongly related to health and quality of life. Half of survivors, versus 18 percent of an age-matched national sample, reported three or more concurrent sexual problems including painful intercourse (57 percent), difficulty with vaginal lubrication (69 percent), reduced interest in sex (70 percent) and inability to experience orgasm (43 percent). Lack of communication with female cancer patients about sexuality can make treatment choices harder, increase anxiety about care, and threaten relationships. In the past several years, physicians have become more attuned to issues of fertility and the need for counseling in girls and women undergoing cancer treatment. The negative impact of illness and medical treatments on sexual functioning can be strong, but concern for sexual matters remains largely on the margin of medical care, particularly for girls and older women. This is likely attributable to a combination of factors: the lack of straightforward treatments for most female sexual problems; physicians’ belief that sexuality is not a primary concern for women with cancer; lack of physician experience talking to girls with cancer about sexual development and stereotypical attitudes about older women being asexual. Many physicians, of course, can recognize the importance of intimacy and
sexuality for women with cancer, and feel frustrated by their inability to adequately address these issues due to lack of time or expertise. If discussions about female sexual concerns are rare during breast and gynecologic cancer care, they are even less likely to occur where the connections between disease or treatment and sexual functioning are less obvious. In October 2008, based on more than 30 combined years of gynecology, oncology, nursing care and several years of research, PRISM initiated a multidisciplinary Clinic for Women and Girls with Cancer. PRISM is one of the only academic, multidisciplinary treatment programs in the United States with a specific focus on sexuality issues in women and girls
Stacy Tessler Lindau, MD, assistant professor of Obstetrics and Gynecology. Photo by David Christopher
with cancer. The program creates a new paradigm in the approach to care of the growing portion of the American public living and aging with a cancer diagnosis. It also advances the University of Chicago Cancer Research Center’s commitment to comprehensive and leading-edge research and care. In preparation for the clinic, a study of more than 350 gynecologic cancer patients showed that nearly half had sexual concerns and only 8 percent had recently sought advice for these concerns. Since it opened, the program has seen nearly 50 new patients, including individuals with ovarian, uterine, cervical, vulvar, breast and rectal cancers as well as lymphoma. The typical patient experience at the PRISM clinic begins with an initial counseling visit where the patient discusses her medical, sexual and relationship history with the medical team. A key element of the counseling visit is helping patients understand the causes of their symptoms,
validating that they are not alone and providing hope for recovery. In addition to common problems such as painful intercourse and lack of sexual desire, some patients suffer from a shortened/narrowed vagina due to radiation, distress regarding body image, loss of breast or clitoral sensation and lack of basic knowledge about female sexual anatomy, functioning and masturbation. The medical team also asks about current or past sexual abuse and domestic violence, exposure to a partner with risky sexual behavior, concerns about HIV or other sexually transmitted infections, issues of sexual orientation and identity and contraception. The second visit involves a physical examination and an initial treatment plan. Many patients benefit from psychotherapy, sex therapy, couples and marital therapy, group therapy and/or physical therapy. Unfortunately, clinicians with specialized expertise of both female sexual medicine and oncology are very difficult to find, so the Medical Center works closely with psychologist Shirley Baron, PhD, and with physical therapist Judith Florendo, PT. Baron works as a sex and marital therapist at Northwestern University, and Florendo is a community-based expert in pelvic physical therapy and its applications for treatment of sexual problems. Staff actively interacts with and refers patients to community cancer wellness centers, including our own Cancer Resource Center. We have found most patients experience notable physical and psychological improvement after just a few visits to the PRISM Clinic. Research is absolutely critical to the PRISM program and the development of a strong foundation of evidence and best practices for the field. PRISM staff hope the program will soon offer clinical trials to evaluate new treatments for sexual problems specific to women with cancer. “This is the first time I have heard of physicians caring for women this way,” wrote one woman in the margin of a study questionnaire. Another wrote: “Cancer disrupts many lives, yet as women we’re expected to put it all back together.” PRISM aims to add a new dimension to caring for women and girls with cancer, ideally from the time of diagnosis, so sexual function and important intimate relationships hold together during and following treatment. When a woman’s sexual life is disrupted, PRISM ensures that women don’t have to repair it alone. Fall 2009 33
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