Biological Sciences Division
ON T H E M I DWAY
Chicago Medicine U N I V E R SI T Y OF
features Genetic isolation An immigrant colony isolated on the prairie for more than a century could refine scientists’ understanding of genetic traits in disease. by Katie Scarlett Brandt________________________________________
A different kind of OR The da Vinci robot offers more precision for surgeons and less recovery time for patients. by Megan Seery______________________________________________
Worming its way into evolution
Few of us imagine our brains bear the slightest resemblance to those of worms wriggling in mudflats. Chris Lowe does. He looks to creatures crawling in the Tahitian soil to study the inner workings of the human mind. “Studying the vertebrate brain itself won’t tell you anything about the evolutionary origins of our brain,” said Lowe, PhD, an evolutionary biologist at the University of Chicago. “You need to conduct research from before our brain even existed.” The worms Lowe studies, Saccoglossus kowalevskii, are hemichordates, meaning they share some fundamental similarities with both vertebrates—like us—and echinoderms, like starfish and sand dollars. Rather than a central nervous system, which in vertebrates acts as a command center for the rest of the body, these worms have a diffused nervous system spread throughout their bodies. It is sometimes referred to as a “skin brain.” “There are two hypotheses,” Lowe said. “Did our common ancestor have a central nervous system and lose it in many groups, or did the common ancestor have a diffuse nervous system, which vertebrates modified to become a central nervous system?” In search of an answer, Lowe journeys to farflung spots like Australia and Tahiti to collect worm eggs. “We’re asking evolutionary questions of an animal that would never have been picked to study developmental biology” because its specimens are so difficult to obtain, he said. Despite the geographic challenge, Lowe said the effort is well worth it if it leads to better understanding, not only about the worms but also about other animals. “One of the biggest surprises in evolutionary biology has been that even though the morphology wasn’t conserved between two animals,” he said, “the genetic map was.” —Megan Seery
On these pages: Hemichordates, including the worm-like structure above, Saccoglossus kowalevskii. Christopher Lowe studies this species, specifically their “skin brain.” Photos courtesy of Chris Lowe and Peter Parks/ imagequestmarine.com On the cover: Hutterites of South Dakota. Photos by Jason Smith
The changing face of medicine The faces that stare from medical school class photos have changed drastically in the past three decades, better reflecting the patients they serve. by Suzanne Wilder____________________________________________
departments Midway News Catch up on the latest research and news in medicine and biology at Chicago, plus the latest books by faculty and alumni.________________
Medicine off the Midway Mr. Dehgan goes to Washington—with experience from Iraq and Afghanistan that is a little unusual for a biologist. by Catherine Gianaro_________________________________________
36 Class Update_________________________________________ 40 Perspective Paleontologist Neil Shubin shares an excerpt from his new book, which chronicles our evolutionary history to help us discover our “inner fish.” by Neil Shubin_______________________________________________
Midway News Research charts sexual problems among older adults, cancer survivors “It seems unbelievable to me that a surgeon would remove one’s sexual organs and never talk about sex.” —Cancer survivor, survey participant Sex. There. Now we’ve said it. This ubiquitous biological process has remained among the least discussed in medicine. But new medical research is exploring the implications of sexuality in everything from aging to cancer treatment. Two groundbreaking studies at the University of Chicago recently pointed out the importance of such considerations even when patients are being treated for other conditions. In the first comprehensive national survey of sexual attitudes, behaviors and problems among older Americans, researchers from Chicago’s National Social Life, Health and Aging Project (NSHAP) found that sexuality remains an important part of life for most people ages 57 to 85. Data reported in the Aug. 23, 2007, issue of the New England Journal of Medicine showed that the frequency of sexual activity among older adults—for those who remain active—declines only slightly from the 50s to the early 70s. Many men and women who remain sexually active continue to
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participate in vaginal intercourse, oral sex and masturbation well into their 70s and 80s, the researchers said. “We found that older adults remain interested and engage in sex, yet many experience bothersome sexual problems that can compromise both health and relationships,” said lead author Stacy Tessler Lindau, MD, assistant professor of obstetrics and gynecology and of medicine. With baby boomers now entering their 60s, older adults are the fastest growing segment of the U.S. population. Yet the “lack of reliable information about how sexual activity and function might change with age and illness, combined with taboos around discussing sex in later life, contributes to worry or even shame for many older adults,” Lindau said. NSHAP, funded by the National Institutes of Health, was created to discover how social relationships, especially intimate relationships, influence health as people age. Between July 2005 and March 2006, the researchers interviewed 3,005 people ages 57 to 85 in their homes. They asked about social
and marital history, sexual activity and function, and physical and mental health. Many medical conditions and treatments can interfere with sexuality. American men spend more than $1 billion a year on medications to improve sexual function. Yet few older men (38 percent) and even fewer women (22 percent) had discussed sex with a physician since age 50, the researchers found. Men were more likely to do so, perhaps because effective drugs are available. Nearly one in seven men (14 percent) reported taking medication to improve sexual function. The NSHAP team assessed participants’ vision, hearing, sense of touch, taste and smell and gathered data on how older adults perceive social relationships. In a departure from previous surveys, they also collected physiological specimens such as spots of blood, saliva and vaginal swabs. In followup studies, the researchers will use “biomarkers” from these specimens to obtain evidence about hormone levels, prevalence of diseases such as heart disease or diabetes, and the frequency of human papillomavirus, a sexually transmitted disease. Despite the personal nature of many of the questions, study participants were very forthcoming. Seventy-five percent of those approached agreed to participate. Overall, only 2 to 7 percent declined to answer direct questions about sexual activities or problems. (Fourteen percent did not answer questions about masturbation on a self-administered questionnaire.) “Participants were more likely to refuse questions about income than they were about sex,” Lindau said. Many of those who were sexually active found ways to remain active, despite worsening health. The proportion of sexually active couples that engage in oral sex, for example, hovered at around 50 percent for those under 75. More than half of men and a quarter of women, whether they had a sexual partner or not, acknowledged masturbating.
“Although sexuality has long been thought to deteriorate inevitably with age, we found that health is a more important indicator for many aspects of sexuality than is age alone,” Lindau said. “This suggests that older adults with medical problems, or those considering treatment that might affect sexuality, should be counseled based on health status rather than just their age.” The most common reported reason for sexual inactivity among individuals with a spousal or other intimate relationship for men (55 percent) and women (64 percent) was the male partner’s physical health. Women, especially those who were not in a current relationship, were more likely than men to report lack of interest in sex. “We hope our findings improve public health by countering harmful stereotypes and allowing older individuals to view their experience relative to others,” Lindau said. “It may comfort people to know that they are not alone in enjoying sexual activity as they age or in experiencing sexual problems, some of which could be alleviated with medical attention.”
Let’s talk about sex, cancer survivors say In a separate study also conducted by Lindau, long-term survivors of genital-tract cancer reported they were pleased with the quality of their cancer care but less satisfied with the emotional support and information they received about dealing with the effects of the disease and treatment on sexuality. Sixty-two percent of women who had undergone “severe compromise to their reproductive and sexual organs” said their physicians had never brought up the effects of their treatment on sexuality, even though 74 percent of the women in this study believed that physicians should initiate a discussion about sex. “It seems unbelievable to me,” said one cancer survivor in the survey, “that a surgeon would remove one’s sexual organs and never talk about sex.” Women who had not had such frank discussions with their doctors were three times as likely to suffer from multiple sexual problems at the time of the survey,
the researchers reported in the August 2007 issue of Gynecologic Oncology. “We found that these women valued sexuality and participated in sexual relationships and activities at a rate similar to women who had not been through cancer treatment, but they were not adequately prepared for the sexual issues that their cancer or its treatment introduced,” Lindau said. “Discussions with a physician about sexual consequences of cancer and cancer treatment matter a great deal to many of these patients,” she said. “But survivors report that such conversations infrequently occurred. If such discussions are not happening in this context, we suspect that they are even less likely to occur when the connections between disease or treatment and sexual function are less apparent.” Lindau and colleagues surveyed 219 women who had been treated for a rare form of vaginal or cervical cancer. The women were contacted through the Registry for Research on Hormonal Transplacental Carcinogenesis, established in 1971 by Arthur L. Herbst, MD, professor and former chairman of obstetrics and gynecology at Chicago. The registry tracks the medical history of patients with specific gynecologic cancers who may have been exposed to diethylstilbestrol or other synthetic hormones while still in their mother’s womb.
The researchers found that the cancer survivors—now in their late 40s and 50s—were just as likely as a control group to be married and to be sexually active, despite a remarkably higher prevalence of sexual problems. They were also four times as likely to have health problems that interfered with sex “all or most of the time” (17% vs. 4%). More than one third complained that their treatment, though life-saving, had left them with surgical scars, frequent bladder infections or incontinence after sex that made them feel unattractive. Those who reported a conversation with a physician about the sexual effects of cancer treatment were three times less likely to have “complex sexual problems” (defined as three or more concurrent sexual problems). Previous studies found that patients typically will not initiate such a conversation. This study showed that although the vast majority of long-term cancer survivors believed physicians ought to initiate such a discussion, the majority of physicians did not do so. “Strong evidence for the negative impact of medical illness and treatment on sexual functioning exists,” the authors note, “but concern for sexual matters remains largely on the margin of medical care, particularly for older women.” —John Easton Spring 2008 3
Unpaired, vulnerable cell channels invite toxins
Would you like fries with that?
Scientists know that smoke and other toxins
“Simply by changing the timing, taking this medication with a meal instead of on an empty stomach, we could potentially use 40 percent—or even less—of the drug.”
damage. But now they’ve pinpointed the
These small portholes, called hemichannels,
—Mark Ratain, MD, professor of hematology and oncology
can seep into lung and heart cells, causing spot where such toxins breach the cells. normally function in pairs, helping cells exchange chemical signals. But some of these hemichannels are unpaired and vulnerable,
Coelacanth fossil sheds light on fin-to-limb evolution “Part of the reason why this is an interesting discovery is that people think of coelacanth animals as archetypal living fossils.” —Matt Friedman, PhD student in evolutionary biology A 400 million-year-old fossil of a coelacanth fin fills a shrinking evolutionary gap between fins and limbs, according to University of Chicago scientists whose paper was highlighted on the cover of the July/ August 2007 issue of the journal Evolution & Development. The first finding of its kind, the fossil shows that the ancestral pattern of lobed fins closely resembles the pattern in the fins of primitive living ray-finned fishes, the scientists said. “This ends intense debate about the primitive pattern for lobed fins, which involves the ancestry of all limbs, including our own,” said author Michael Coates, PhD, associate professor of organismal biology and anatomy at Chicago. The fossil’s pattern is similar to the branching arrangement still embedded in the fins of paddlefishes, sturgeons and sharks, Coates said. “Part of the reason why this is an interesting discovery is that people think of coelacanth animals as archetypal living fossils,” said Matt Friedman, an evolutionary biology graduate student at Chicago and lead author of the paper. “But it’s a common misconception. If you look deep in the fossil record to the first members of that group, they are really different and very diverse.” Until now, many biologists have looked at lungfish as a primitive model of the evolution of tetrapods, four-limbed vertebrates like ourselves. However, “to understand the developmental evolution of the limbs of tetrapods, we shouldn’t be looking at the fins of our nearest living fish relatives—lungfishes
and coelacanths—because they’re far too specialized,” Coates said. “If you’re going to figure out how limbs evolved, you need to have a good idea about pre-conditions,” Friedman said. “You need to know what the ancestral morphology was. With things like this [fossil], we’re beginning to hone in on the primitive conditions of fins that gave rise to limbs later on.” Named Shoshonia arctopteryx after the Shoshoni people and the Shoshone National Forest, the fossil was excavated from Paleozoic sediments at Beartooth Butte in northern Wyoming. Shoshonia also supports recent work by Chicago’s Neil Shubin, Marcus Davis and Randall Dahn that showed genetic expression of developmental patterns in fish fins and tetrapod limbs are conserved (Nature, May 24, 2007). “With this fossil, we have a conservative pattern in a close relative of tetrapods that is actually conserved in other fish groups outside of this immediate group,” Friedman said. Not only does this fossil bridge the gap between primitive ray-finned fish and limbed animals like Tiktaalik roseae, the new data forces scientists to reassess the characteristics of the coelacanths, Friedman said. Coelacanths were dubbed “Old Fourlegs,” because of their husky, limb-like fins.
The first finding of its kind, the fossil shows that the ancestral pattern of lobed fins closely resembles the pattern in the fins of primitive living ray-finned fishes.
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“When they first discovered them in the 1930s, people made all sorts of inferences about them,” Friedman said. “They assumed that it would use its fins to walk around on the bottom of the sea floor.” Rather, these distinctive blue fish swim with their heads down, hovering just above the sea floor using an organ in their nose to detect living things in the mud. “It was astonishing luck that we found it,” Friedman said, adding that the fossil had fallen off a cliff a couple of hundred feet high and landed in a different set of rocks. The 4-inch-long specimen details the fin of the animal, which the scientists approximate would have been about 18 to 24 inches long. “‘Living fossils’ are a problematic concept,” Friedman said. “Often times the fossils look like living animals because the fossils are so poorly studied. Once you start to go in depth with the fossils, you start highlighting differences.” The scientists will return to Wyoming next summer to collect more samples. Postdoctoral researcher Philip Anderson also contributed to the paper. —Catherine Gianaro
Scientists discovered the fossilized fin from a 400 million-year-old coelacanth, Shoshonia arctopteryx. Photo and illustration by Matt Friedman
One man’s trash is another man’s treasure, the saying goes. And where highpriced, high-tech cancer treatments are concerned, one scientist’s dosing problem could be another’s opportunity. Such is the argument presented by a pair of University of Chicago oncologists in the July 16, 2007, issue of the Journal of Clinical Oncology when they suggested that exploiting interactions between food and drugs could dramatically lower the cost of several anti-cancer drugs—and perhaps many other medications. In a commentary, Mark Ratain, MD, and Ezra Cohen, MD, called attention to recent studies showing how certain foods can alter absorption or delay breakdown of precisely targeted anti-cancer drugs. Instead of viewing such studies as highlighting a dosing problem, Ratain and Cohen argue they should point researchers toward a partial solution: a novel way to decrease medication costs while increasing benefits from these effective but expensive drugs. The commentary was inspired by a study presented at the 2007 annual meeting of the American Society for Clinical Pharmacology and Therapeutics. Researchers from Dartmouth showed that taking the breast cancer drug lapatinib with food—instead of on an empty stomach as suggested on the label—resulted in more of the drug being absorbed and available to treat the cancer. Patients currently take five 250 mg lapatinib tablets on an empty stomach. The study found that taking the drug with a meal increased the bioavailability of the drug by 167 percent. Taking the drug with a high-fat meal boosted levels by 325 percent. “Simply by changing the timing, taking this medication with a meal instead of on an empty stomach, we could potentially use 40 percent—or even less—of the drug” to achieve the same result, Ratain said. “Since lapatinib costs about $2,900 a month, this could save each patient $1,740 or more a month.” Topping off that meal with grapefruit juice, “which may also increase plasma concentrations” according to the package insert, could increase the savings to 80 percent, the authors suggested, “minus the cost of the food and juice.”
according to a study by nano-microscopist Ratneshwar Lal. “We were surprised to find out how little it took to cause such damage,” Lal said. “We expect that this mechanism could play a major role in the onset of diseases such as emphysema.” Researchers now are looking into creating drugs to protect those unpaired channels or even prevent them from being created in the first place.
Addiction: It may be all in your receptors Addiction-prone people may have an especially sensitive receptor that triggers the
“We expect the one 250 mg lapatinib pill accompanied by food and washed down with a glass of grapefruit juice may yield plasma concentrations comparable to five 250 mg pills on an empty stomach,” Ratain said. Such a “value meal,” the authors add, may have other benefits. The major toxicity associated with lapatinib is diarrhea, probably caused by unabsorbed drug. So taking a lower dose with food should “reduce the amount of unabsorbed drug, and therefore theoretically also reduce the frequency and severity of diarrhea.” Ratain and Cohen are currently conducting a phase I trial of the combination of oral sirolimus (rapamycin) taken with grapefruit juice, which contains substances that delay the breakdown of many drugs. Dozens, perhaps hundreds, of drugs should be studied in this way, the authors said. “If we understood the relationship between, say, grapefruit juice and common drugs, such as the statins, which are taken daily by millions of people to prevent heart disease, we could save a fortune in drug costs,” Cohen said. “And patients would get a little vitamin C to boot.” “The rapidly escalating price of medications (especially for cancer and other lifethreatening diseases) has provided incentives to explore pharmacological approaches to lower the costs of drugs,” the authors wrote. “As we enter an era of ‘targeted’ anti-cancer agents with a monthly cost measured in thousands of dollars, we should view drugdrug or drug-food interactions as opportunities to lower costs.” —JE
brain’s reward center, according to neurobiologist Daniel McGehee. He found that rats with more responsive nicotinic acetylcholine receptors were more likely to self-administer addictive drugs than rats with less responsive ones. The same rats also were more likely to explore a new environment for a prolonged period of time, McGehee said. “This study raises the possibility that nicotinic receptors may be important targets for the treatment of multiple additions, not just nicotine. But blocking those receptors may also interfere with healthy behaviors that depend upon the same brain circuitry.”
NIH sows research harvest A five-year, $23 million grant from the National Institutes of Health is part of an effort to “transform how clinical and translational research is conducted” by eliminating barriers among academic disciplines, between laboratory and clinical research, and among scientists. With the Clinical and Translational Science Award to the University of Chicago, scientists from the biological, physical, behavioral and social sciences, physician-scientists from the medical school, and faculty from the schools of public policy, social service administration and business will collaborate on translational and clinical research. Residents of the diverse neighborhoods surrounding the campus also will be brought into the program. The grant will speed the transition of new knowledge from laboratory bench to patient bedside and push the boundaries of personalized medicine.
Spring 2008 5
Crossing research boundaries Four Chicago faculty members have won National Institutes of Health grants to pursue biological sciences research crossing disciplinary boundaries. In the BSD, psychiatrist Kristen Jacobson and hematologist/oncologist Dorothy Sipkins each received $1.5 million grants. Jacobson will study the effects of individuals, family, peers and neighborhood on adolescent problem behavior. Sipkins will investigate molecular characteristics of
Microscopic views of normal (left) and stressed prostate cancer cells. Photos (above) by Nancy Kedersha, Science Faction; (background) by Dan McCoy, Rainbow, both courtesy of Science Faction
Fighting prostate cancer in African-American men
microenvironments within bone marrow and
“A group that underestimates the risk of having cancer is likely to underestimate the value of early detection and thus skip the whole process.” —William Dale, MD, PhD, assistant professor of medicine
cells compete with malignant cells to occupy
how normal, healthy hematopoietic stem these coveted niches. Physicist Margaret Gardel and chemist Rustem Ismagilov were awarded $2.5 million each. Gardel will study differences between living, biological matter and inert, physical matter, which could lead to
Prostate cancer, the second leading cause of cancer death in American men, disproportionately strikes those of African descent. African Americans have a higher incidence rate, are diagnosed later, and have a higher mortality rate from the disease than those of other lineages. Two recent University of Chicago studies examine the problem both from distinctly different angles: the patients’ genes and their points of view. In one study, many African-American men radically underestimated the likelihood
that having a needle biopsy for suspected prostate cancer would result in a cancer diagnosis, according to researchers who presented their findings at the American Society of Clinical Oncology annual meeting. “A group that underestimates the risk of having cancer is likely to underestimate the value of early detection and thus skip the whole process,” said study author William Dale, MD, PhD, assistant professor of medicine, “which may explain, in part, why African-American men are so often diagnosed later and thus have worse outcomes.” Dale and colleagues collected data on 243 patients waiting in a urology clinic. They asked what these patients expected from their biopsies and how anxious they were about the results. In general, African Americans were less likely to believe they were at risk for cancer
and less anxious about the possibility. In fact, even while awaiting a prostate biopsy, more than half the African-American patients said they believed they had a 0 percent chance of having the disease; only 20 percent of Caucasians gave the same response. “These data suggest that, while men of both races underestimate their chances of having prostate cancer, African-American men are even more likely to do so. Such beliefs may cause these men at highest risk for prostate cancer to delay the pursuit of a diagnosis,” Dale said. “With this data, we can’t say why the estimates are so low. We want to conduct more research to better understand the reasons for the overly low estimates,” he said. “That would hopefully lead to greater attention to prostate cancer for those at highest risk such as African Americans.”
With his straight-edged muzzle and tiny scissor-like jaws, this prehistoric creature suctioned up plant food like a “Mesozoic cow,” according to its discoverer Paul Sereno, a University of Chicago paleontologist who is currently National Geographic Explorer-in-Residence. Unlike most of its contemporaries that had forward-pointing muzzles, this 110 million-year-old dinosaur kept its snout close to the ground. And though its spine was more air than bone and its vertebrae paper thin, this creature nevertheless coped with the everyday stresses of life on earth. Sereno found its skeletal remains in the Sahara and named it
new therapies for cancer and other diseases. Ismagilov studies microfluidic technologies— the flow of fluids through channels thinner than a human hair—for aging and disease research. Human geneticist Rick Kittles, PhD. Photo by Dan Dry
Gene mixing In Greek mythology, the Chimera was a
A new genetic variant
fire-breathing she-monster with a lion’s
Separate research at the university has uncovered two tiny genetic variations that may help scientists find more precise ways to estimate prostate cancer risk and improve screening and early detection for men of African descent. Researchers from the University of Chicago and the Translational Genomics Research Institute (TGen) in Phoenix, Ariz., reported the results in the December 2007 issue of the journal Genome Research. The researchers set out to determine whether results from four previous studies that linked genetic variations on one region of chromosome 8 to increased prostate cancer risk among Caucasians also were valid for men of African heritage. In the process, however, they found an additional genetic variation among African-American men that was an even stronger marker for cancer risk for these men. That variation is located within a gene that plays a role in DNA repair. A malfunction in DNA repair could contribute to cancer development. “This finding emphasizes the importance of ancestry in studying genetics,” said study author Rick Kittles, PhD, associate professor of medicine.
Research groups led by Kittles and by John Carpten of TGen analyzed the region of chromosome 8 highlighted by the earlier studies done on Caucasian men. But this time they searched for tiny genetic differences between 490 African-American men who had been diagnosed with prostate cancer at Howard University Hospital in Washington, D.C., and 567 African-American men without cancer. The researchers were able to replicate the link between one of the markers detected by previous studies and increased risk. More important, they found a new genetic marker, known as rs7008482, that was even more strongly associated with prostate cancer in African Americans. This marker was located within a gene that is involved in DNA replication, recombination and repair. Altering this gene could confer an “inherited predisposition to genetic instability,” Kittles said. “This could lead to increased cancer risk. By studying this region, we may be able to develop molecular targets for improved screening, early detection and possibly treatment.” —Scot Roskelley and JE
head, a goat’s body and a serpent’s tail. But the latest incarnation is much fuzzier—and smaller—than the original. University of Chicago researchers have teamed up with Chinese and British scientists to create hybrid offspring of a field mouse and a wood mouse. This chimera marks the first time researchers have used stem cells from two mammalian species to create a third, new species. Though both are rodents, the wood mouse and the house mouse have evolved separately for up to 20 million years. Their genes differ by as much as 18 percent—about 12 times the difference between human and chimpanzee. “We’re going to continue with these animals for a while to see if we can understand the developmental cues and learn how to manipulate the system,” said geneticist Bruce Lahn. Researchers also plan to merge stem cells from mice and rats, which have vastly different body sizes and a 20 percent genetic difference.
Nigersaurus taqueti. Details were published in PloS ONE, the online journal from the Public Library of Science, and in the December 2007 issue of National Model photo by Mike Hettwer, illustration by Todd Marshall—courtesy of Project Exploration, © 2007 National Geographic
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Geographic magazine, called “Extreme Dinosaurs.”
“This finding emphasizes the importance of ancestry in studying genetics.” —Rick Kittles, PhD, associate professor of medicine
Spring 2008 7
“Herpes” for your heart Herpes sounds like the last thing anyone would want, but for some people with heart problems, it could be a lifesaver. A recent study shows that a genetically engineered herpes simplex virus, primarily known for causing cold sores, has the potential to keep arteries open
For some diabetics, burden of care rivals complications of disease
after balloon angioplasty, lowering the risks of
“It is hard to convince some patients to invest their time and effort now in rigorous adherence to a complex regimen with no immediate reward, just the promise of better health years from now.” —Elbert Huang, MD, assistant professor of medicine
placed in the artery to keep it open. Vascular
scarring from the balloon and the stent that is surgeon and lead author Christopher Skelly discovered that there was significant narrowing of the artery in rabbits after angioplasty alone; however, rabbits exposed to the engineered virus during angioplasty showed
Many patients with diabetes say that the inconvenience and discomfort of constant therapeutic vigilance—particularly multiple daily insulin injections—has as much impact on their quality of life as the burden of intermediate complications, researchers from the University of Chicago reported in the October 2007 issue of Diabetes Care. A typical diabetes patient takes many medications each day: two or three different pills to control blood sugar levels, one or two to lower cholesterol, two or more to reduce blood pressure, a daily aspirin to prevent blood clots, plus diet and exercise. As the disease progresses, the drugs increase, often including insulin shots. “The people who care for patients with a chronic disease like diabetes think about that disease and about preventing longterm complications. The people who have a chronic disease think about their immediate lives, which includes the day-to-day costs and inconvenience of a multi-drug regimen,” said study author Elbert Huang, MD, assistant professor of medicine. “The consequences are often poor compliance, which means long-term complications, which will then require more medications.” Despite growing reliance on such complex multi-drug regimens, large proportions of patients with type 2 diabetes continue to have poorly controlled glucose (20 percent), blood pressure (33 percent) and cholesterol (40 percent). “This tells us that we need to find better, more convenient ways to treat chronic illness,” Huang said. “It is hard to convince some patients to invest their time and effort now in rigorous adherence to a complex regimen with no immediate reward, just the promise of better health years from now.”
Huang and colleagues conducted hour-long, face-to-face interviews with a multi-ethnic sample of 701 adult, type 2 diabetes patients attending Chicago-area clinics between May 2004 and May 2006. They asked patients to rank the benefits of various treatments and the daily quality-of-life burdens of diabetes-associated complications. Patients were asked to express their preferences in a series of trade-offs. The surveyors asked, for example: Would you rather have six years of life in perfect health, or 10 years with an amputation? As expected, patients were most distressed by end-stage complications, especially kidney failure, a major stroke or blindness. They were slightly less concerned about amputaThe complex regimen of daily care proves too much for tions or diabetic retina damsome diabetics. age, and still less about angina, diabetic nerve or kidney damage. Patients also disliked intensive treatments, especially intensive glucose control, had experience with a specific medication with multiple daily insulin injections, and or complication saw them as having less of what the authors called comprehensive an impact on quality of life than did those diabetes care, which was intensive glucose without such experience. control plus other medications. But many patients found both complicaOn average, patients ranked the burden tions and treatment onerous. Between 12 of comprehensive diabetes care and intenand 50 percent were willing to give up eight sive glucose control as equal to the burden of 10 years of life in perfect health to avoid of angina, diabetic nerve damage or kidney life with complications. More surprising, damage. between 10 and 18 percent of patients were Patients varied widely in how they ranked willing to give up eight of 10 years of healthy treatments and complications. Those who life to avoid life with treatments. “Our study results show that taking multiple medications on a routine basis represents a significant burden for many patients,” Patients were asked to express their preferences in a series of trade-offs. the authors conclude. “Quality of life related The surveyors asked, for example: Would you rather have six years of life to treatments will be likely to improve if we in perfect health, or 10 years with an amputation? can simplify or modify treatments.” —JE 8 University of Chicago Medicine on the Midway
Internists prescribe placebos as treatment “Placebos have been used in medicine since ancient times, and remain both clinically relevant and philosophically interesting.”
—Rachel Sherman, fourth-year medical student
minimal arterial change. Treated rabbits also had a lower risk for blood clot formation, common in angioplasty patients. Human trials are the next step.
New hope in cancer care Pediatric cancer patients have new options for
Some doctors are putting the phrase “mind over matter” to use in their medical practices. Almost half of the Chicago internists who responded to a recent survey said they have given their patients prescriptions for placebos. Of the 231 local physicians, 45 percent had prescribed placebos at some point during their practice. “Placebos have been used in medicine since ancient times and remain both clinically relevant and philosophically interesting,” said Rachel Sherman, a fourth year student at Pritzker Medical School who coauthored the study with John Hickner, MD, MSc, professor of family medicine at the University of Chicago. “In addition to their recognized use as controls in clinical trials, this study suggests that placebos themselves are viewed as therapeutic tools in medical practice.” Of the respondents who reported using placebos in clinical practice, 34 percent introduced the placebos to the patient as “a substance that may help and will not hurt.” Nineteen percent told their patients that “it is medication,” and 9 percent said “it is medicine with no specific effect.” Only 4 percent explicitly said, “it is a placebo.” In addition, 33 percent of the physicians reported they gave other information to patients, including, “this may help you but I am not sure how it works.” The study, the first of its kind to examine American physicians’ use of placebos in clinical practice in the 21st century, was published in the January issue of the Journal of General Internal Medicine. It “indicates a need for greater recognition of the use of
placebos and unproven therapies and discussion about its implications,” the authors said. Only 12 percent of respondents said that placebo use should be categorically prohibited. The authors acknowledge the controversy involving placebos. Some critics, citing informed consent, caution against their use. Others say placebos can be used in ways that don’t pose ethical dilemmas. The study also revealed that many physicians believe a person’s mindset can impact the health and well-being of the body. Rather than using placebos to differentiate between patients who were faking their symptoms and those with genuine symptoms, as the majority of physicians did according to research several decades ago, 96 percent of physicians in the study said they believed placebos can have therapeutic benefits for patients. The physicians most commonly defined a placebo as an intervention not expected to have an effect through a known or specific physiologic mechanism. Researchers then asked physicians about the possible benefits of other treatment and factors that may influence health according to this definition of a placebo. Physicians responded to questions about whether there might be psychological or physiological benefits to meditation, yoga or relaxation techniques; biofeedback; prayer or spirituality; a good social support system; having good doctor-patient rapport; and interior design of the health care environment. In most cases, the majority of physicians believed in both psychological and physiological benefits. —SR
treatment with the introduction of phase I clinical trials at the University of Chicago Medical Center. “Ultimately, these trials will deliver new pediatric cancer treatments more quickly,” said pharmacogeneticist Mark Ratain. The trials, available to adolescents age 14 or older with certain refractory or relapsed cancers, bring together the pediatric cancer specialists with the adult cancer research program. Physicians and scientists will compare pediatric and adult patients and monitor the effectiveness of the pharmacokinetics and the toxicity of the drugs. In phase I trials, physicians begin by using small doses and gradually increase to assess toxicity and determine the best dosage.
Religious doctors miss calling Religious physicians may describe medicine as a calling, but many don’t answer the call to help the underserved, according to a study co-authored by internist Farr Curlin. “This came as both a surprise and a disappointment,” Curlin said. “We found that religious physicians were not more likely to report practice among the underserved than their secular colleagues.” Those who strongly agreed that religious beliefs influence their practices were more likely to practice among the underserved, he said. However, 35 percent who described themselves as non-religious practiced among the underserved, compared with 31 percent who were more “generally religious.” In a separate study, Curlin found that psychiatrists are the least religious of all medical specialties but take the most interest in their patients’ religions.
Spring 2008 9
Therapy fails broken hearts Therapy may help a broken heart, but it won’t improve them all, according to a study
Self-described “country doc” named executive vice president, associate dean
of cardiac resynchronization therapy, or CRT. “This is a valuable therapy for carefully selected patients,” said John Beshai,
“Eric Whitaker has an unrivaled track record for understanding the broader health care needs of the underserved and finding imaginative and remarkably effective ways to meet those needs.” —James Madara, MD, dean of the Biological Sciences Division Eric Whitaker, MD, MPH, a nationally recognized public health authority, expert on minority health issues and, in his own words, “country doc” for some of the city’s poorest communities, has been appointed executive vice president for strategic affiliations and associate dean for communitybased research, a new position at the University of Chicago Medical Center. Whitaker, 42, comes to Chicago from the Illinois Department of Public Health, where he has served as director since 2003, overseeing three state labs, seven regional offices, 200 programs, 1,200 employees and a $420 million budget. Under his direction, from 2003 to 2007, the agency placed special emphasis on emerging issues such as bioterrorism and emergency preparedness, as well as health disparities, patient safety and the creation of the Illinois Regenerative Medicine Institute to support stem cell research. Prior to that, Whitaker was a senior attending physician at Cook County Hospital and founder and director of Project Brotherhood, an innovative, award-winning barbershop-based program designed to
improve the often-neglected health of black men. “Eric Whitaker has an unrivaled track record for understanding the broader health care needs of the underserved and finding imaginative and remarkably effective ways to meet those needs,” said James Madara, MD, chief executive officer of the medical center, dean of the Biological Sciences Division and vice president for medical affairs at Chicago. “He understands how people with fewer resources make decisions about their health, how to lead people toward better decisions and how to put programs in place—on the personal level as well as the state level—to make it all work.” Whitaker will be a key player in implementing the Urban Health Initiative (UHI), the medical center’s long-range plan to build and maintain a network of community partnerships to provide patient care, conduct community-based clinical research and broaden medical education. He will help set up strategic alliances to create and sustain the UHI, secure government and private sources of financing, and
study leader and director of pacemaker and defibrillator services, “but further research will be necessary to determine which additional groups might benefit.” CRT devices are surgically implanted and deliver electrical impulses
Eric Whitaker, MD ’93, MPH Photo by Dan Dry
build patient confidence in and familiarity with the proposed network of independent health care providers—a system designed to improve access, quality, efficiency and coordination of health care services. “The University of Chicago Medical Center has demonstrated an ongoing and increasing dedication to the rigorous intellectual pursuits of academic medicine, as well as an unfailing commitment to improving the health and well being of those who reside on the city’s South Side,” Whitaker said. “This position appealed to me as an opportunity
to make a real and lasting difference in the lives of thousands of Chicagoans.” A graduate of Grinnell College and Chicago’s Pritzker School of Medicine, Whitaker also earned a master’s degree in health policy and management from the Harvard School of Public Health and studied health services management at Northwestern’s Kellogg School of Management and corporate strategy at Chicago’s Graduate School of Business. He completed his residency in internal medicine at the University of CaliforniaSan Francisco in 1996 and then served a two-year fellowship in the Robert Wood Johnson Clinical Scholars Program at Chicago. While an attending physician at Cook County Hospital, he joined the faculty at Rush Medical College in 1996 as an instructor in medicine and in 2000 became an assistant professor of medicine and then of preventive medicine. In 2003, he left Rush and joined the faculty at the University of Illinois-Chicago School of Public Health. Whitaker gained national attention as founder and director of Project Brotherhood:
A Black Men’s Clinic. In 1998, he developed a new clinical model for that combined health care and disease prevention with vocational and spiritual guidance, all in the setting of a barbershop. Using the lure of free haircuts to bring in black men—who despite high rates of preventable disease and premature death tend not to seek regular medical care—this widely recognized South Side clinic brings primary care services, health advice, wellness programs, and emotional and spiritual support to thousands. “In the United States, thanks to our world-renowned research centers, we have access to the best medical care in the world, but not everyone has the same access and not all of our health care resources are being used efficiently,” Whitaker said. “I see my role as trying to find new and innovative strategic ways to reduce health care disparities and inequities.” He lives on Chicago’s South Side with his wife, Cheryl, their son, Caleb, and daughter, Caitlin. —JE
that improve the heart’s pumping efficiency. The therapy benefits the 10 to 15 percent of patients with moderate to severe heart failure, but failed to improve peak oxygen uptake during exercise testing for patients with moderate heart failure. This larger group of heart patients—about 40 to 50 percent of the 550,000 new cases diagnosed each year— experienced increased activity levels and decreased discomfort, but reported no improvement in the other parameters.
Two-in-one PhD program Typical graduate programs involve long nights in one lab, working with one adviser in a specific field of study. But a new Chicago program will give PhD candidates the chance to study with two mentors, in two labs, and earn a dual degree in biological and physical sciences. “We’re training students who will be able to walk in both worlds,” said Tobin Sosnick, director of the PhD program in biophysics and synthetic biology. Four students entered the first class this past fall. Eventually the program will house about 55 PhD candidates, or about 12 new students a year. Forty-seven faculty from a variety of departments—including biology, physics, chemistry and medicine—will teach classes, mentor students, supervise research and act
Goo-goo and ga-ga may not be exclusive to humans. Dario Maestripieri, PhD, associate professor in comparative human
Dinosaurs and pre-dinosaurs (called dino-
as thesis advisers.
Unclogging medical procedures
saurmorphs) frolic on the Pangea
development and on the committees on evolutionary biology and
Standards for the use of ultrasound as a screen-
land mass: Their bones were found
ing tool to measure narrowing of the carotid
neurobiology, discovered that some female monkeys use special
together in the Hayden Quarry
artery may be too aggressive, resulting in
vocalizations to interact with infants, similar to human “motherese.”
of North Mexico at the fossil-rich
some needless follow-up tests and procedures
Maestripieri and a group of researchers analyzed the vocalizations
grounds of Ghost Ranch. This discov-
according to a recent study. Vascular surgeon
among adult female macaques on an island near Puerto Rico and
ery challenges a long-held theory
Hisham Bassiouny found that ultrasound
found that grunts and other specific sounds increased when a baby was present. “Adult females become highly aroused while observing the infants of other group members,” explained study researcher Jessica Whitham, a recent PhD graduate of Chicago. Unlike humans,
that dinosaurs diversified and replaced their predecessors relatively quickly in the late Triassic Period. The report in the July 2007 issue of the journal Science suggests that dinosaurs and dinosaurmorphs coexisted for
produced similar results to CT angiography and nearly identical measurements of the arteries. The findings allow doctors to consider eliminating an ultrasound after the patient has a CT angiography, which would save money
the macaques did not direct such noises toward their own offspring.
at least 15 to 20 million years. Nathan Smith, a University of Chicago graduate
Researchers speculate they are familiar with their own offspring and
student in evolutionary biology, was among the researchers who found the
use the sounds with others because they are excited about seeing a
bones. The team also discovered a new species of dinosaurmorph and named
vascular lab,” Bassiouny said. “We hope these
it Dromomeron romeri after Alfred Sherwood Romer, the paleontologist who
new standards will be adopted everywhere.”
and reduce unnecessary procedures. “As a result, we’ve changed the standards in our
first described dinosaurmorphs in the early 1970s. Illustration by Donna Braginetz for UC Berkeley—courtesy of Science magazine
10 University of Chicago Medicine on the Midway
Spring 2008 11
Diabetes cost-benefit analysis improves An ounce of prevention isn’t just better than a pound of cure. It’s also cheaper and better for you. A new Chicago-based study of 34 community health centers in 17 states found
Trials yield hope for thyroid cancer drug
several initiatives—including the federal
“This is exciting. Until now we really didn’t have anything to offer thyroid cancer patients with advanced disease that was refractory to standard measures.” —Ezra Cohen, MD, PhD, assistant professor of medicine
processes for managing diabetes, such as test-
Health Disparities Collaborative—enhanced ing for blood glucose, and improved patients’ health. Quality improvements at the clinics cost less than $500 per patient each year, the study found, and reduced the incidence of diabetes complications that can cost $44,000
Recurrent genetic deletion tied to autism “By disturbing the network of affected genes, this loss of selected genes may underlie the development of autism.”
—Susan Christian, PhD, associate professor of human genetics
The loss of a small portion of chromosome 16 is significantly associated with autism, according to a study published Dec. 21, 2007, online by the journal Human Molecular Genetics by University of Chicago researchers working with the colleagues at the University of Illinois-Chicago and the Roswell Park Cancer Institute. The genetic “microdeletion,” which occurred in only four of 712 study subjects with autism, is the second most common recurrent genomic disorder associated with autism. The deletion, called 16p11.2, results in the loss of about 25 known genes. “Twelve of those genes appear to be part of a single genetic network that includes genes involved in cell-to-cell signaling and interaction,” said first author Ravinesh Kumar, PhD, postdoctoral scientist in human genetics at the University of Chicago. “At least three of the deleted genes are primarily expressed in the brain and are thought to influence behavior, which makes them very promising candidates for autism.” The authors suspect the lost or damaged genes also may be involved in other cognitive, language and social impairments. “We suspect that 16p11.2 microdeletions are a risk factor for autism spectrum 12 University of Chicago Medicine on the Midway
disorders generally and may cause mild autism in some families,” said study author Susan Christian, PhD, associate professor of human genetics at Chicago. “By disturbing the network of affected genes, this loss of selected genes may underlie the development of autism.” To find genes linked to autism, the researchers scanned the entire genomes of 180 subjects with autism searching for submicroscopic pieces of DNA that either were lost or mistakenly duplicated in patients diagnosed with autism. They first found that two out of those 180 (1.1 percent) had a deletion in region 16p11.2, on the short arm of chromosome 16. None of the 372 control subjects had the same deletion. For confirmation, the researchers screened DNA from 532 additional subjects with autism. They found two more with the same deletion (0.4 percent), which was seen in none of the 465 controls. Combining the two samples produced a total prevalence of 16p11.2 deletions of 0.6 percent. The 16p11.2 region is flanked on both sides by bands of segmental duplications, short strings of nearly identical DNA that predispose to the loss, shuffling or amplification of this region during genetic
recombination. “Many human diseases are caused by these types of chromosomal rearrangements, however, this is the first recurrent microdeletion in autism too small to be seen under a microscope,” Christian said. The most common known genetic cause of autism, linked to about 1 to 3 percent of cases, is a much larger duplication of part of chromosome 15, involving about a dozen genes. The chromosome 15 abnormality is associated with autism as well as intellectual disability (www.idic15.org). The chromosome 16 deletion, by contrast, is not consistently associated with intellectual disability. “Although this only explains about onehalf of 1 percent of autism, it provides the best clues yet for finding the specific genetic changes that lead to the disease,” said coauthor William Dobyns, professor of human genetics and pediatrics at Chicago. “This is a small region with a limited number of genes, including several strong candidates, each of which merits a closer look. The next step is to find the specific gene or genes involved. There may be one gene within that deletion that is at the core of the problem.” —JE
A new drug shows promise in the treatment of advanced thyroid cancer, a disease that the American Cancer Society accounts for more than 1,500 deaths in the United States each year, University of Chicago researchers report. The investigational drug axitinib produced tumor regression or stable disease in almost three of four patients with advanced thyroid cancer, the research team reported at the annual meeting of the American Society for Clinical Oncology in Chicago. In an exploratory phase II trial, 18 of 60 patients (30 percent) had their tumors shrink by 31 to 83 percent. Another 25 patients (42 percent) had stable disease, with no tumor progression or slight reduction in size, when measured at four months. Many of those patients still have stable disease. “This is exciting,” said study presenter Ezra Cohen, MD, PhD, assistant professor of medicine. “Until now we really didn’t have anything to offer thyroid cancer patients with advanced disease that was refractory to standard measures.” Although the drug did not produce complete responses, it appears to have caused “significant tumor reduction in most subjects,” Cohen said. “Axitinib has prevented the disease from progressing in most patients, and in a lasting way.” In this trial, which began nearly three years ago, “the median duration of stable disease has not been reached,” he said. “Twentyfour patients are still in treatment.” Axitinib is a small molecule designed to prevent tumors from acquiring the blood supply they need to grow. It blocks all three known receptors for a substance that tumors release in order to grow new blood vessels. The study confirmed that the drug significantly reduced the presence of these receptors.
More importantly, it prevented tumor growth. In only 10 of 60 patients (17 percent) did the tumors continue to grow. Another 18 patients left the trial for other reasons, including toxicity. Five of them withdrew because of treatment-related adverse events. The most common side effect was fatigue, affecting 50 percent of patients, but only 5 percent had severe fatigue and only one patient left the trial for this reason. Axitinib also caused hypertension in about 28 percent of patients and a range of digestive disorders, including diarrhea (47 percent), nausea (32 percent), consequent weight loss (23 percent) and vomiting (13 percent). Several patients complained of headaches or rash. All patients in this trial had advanced thyroid cancer. Many had already been given standard therapy—such as surgery or treatment with radioactive iodine. Others, because of their advanced disease, were not candidates for standard treatments. “It’s a relief to have a real option for these patients,” Cohen said. “The standard chemotherapy for refractory thyroid cancer is not very effective and can have multiple significant side effects. It appears, in this early study, to keep the cancer from growing for a significant period for the majority of patients without doing any real damage to their quality of life.” A follow-up trial testing axitinib in patients who have not responded to standard chemotherapy is ongoing. Pfizer, the maker of axitinib, funded this trial. —JE Scan of cancerous thyroid.
per patient each year. “A small investment in upgrading the delivery of health care brought about a substantial improvement in health that justified the costs of the program,” said Chicago’s Elbert Huang, MD, study leader. Studies show poorly managed type 2 diabetes costs the U.S. health system an extra $22.9 billion a year in direct medical costs.
Super molecule fights cancer There’s a small but powerful RNA molecule you want to keep in your anti-cancer arsenal. Called let-7, this microRNA molecule targets a particular gene—HMGA2—in a variety of cancers. HMGA2 is less prevalent in people with higher amounts of let-7, said cancer researcher Marcus Peter. Let-7 puts the brakes on the expression of selected genes, appearing to prevent human cancer cells from reasserting their prenatal capacity to divide rapidly, travel and spread. “Expression levels of let-7 can discriminate more effectively between more and less advanced stages of cancer than any other microRNA,” Peter said. “We suspect that loss of members of the let-7 family may be a major determinant of cancer progression.”
Pulling teeth All it took was a tooth to name a new species in honor of Leigh Van Valen, a University of Chicago evolutionary biologist. Researchers from India identified the hoofed mammal, which they named Kharmerungulatum vanvaleni, after finding a single lower molar interbedded in lava in Central India. The fossil is the only one of its kind in India and possibly the Old World, Van Valen said. Paleontologist Ashok Sahni was among the fossil finders and said the species name is a nod to Van Valen’s groundbreaking work with cretaceous mammal teeth in the 1960s. “In view of Leigh’s continuing romance with early mammals and the whole process of evolution,” Sahni said,
Axitinib blocks all three known receptors for a substance that tumors release in order to grow new blood vessels.
“we decided to name the species after him.”
Spring 2008 13
Bookmark Your Brain on Cubs: Inside the Heads of Players and Fans Dan Gordon, ed. Dana Press, 2008
Gene mutations can cause neonatal diabetes “If we could detect the disease early enough and somehow silence the abnormal gene or just protect insulin-producing cells from the damage caused by misfolding, we might be able to preserve or restore the patient’s own insulin production.” —Louis Philipson, MD, PhD, professor of medicine
Mutations in the insulin gene can cause permanent neonatal diabetes, an unusual form of diabetes that affects very young children and results in lifelong dependence on insulin injections, researchers from the University of Chicago and Peninsula University (Exeter, UK) reported in the Sept. 18, 2007, issue of the Proceedings of the National Academy of Sciences. This is the first time that an insulin mutation has been connected to severe diabetes with onset early in life. The researchers describe 10 mutations, found in 21 patients from 16 families. They suspect that the mutations alter the way insulin folds during its synthesis. They suggest that these improperly folded proteins interfere with other cellular processes in ways that eventually kill the cells that produce insulin. “This is a novel and potentially treatable cause of diabetes in infants,” said study author Louis Philipson, MD, PhD, professor of medicine at Chicago. “It’s exciting because each of these patients has one normal insulin gene as well as one mutated gene. If we could detect the disease early enough and somehow silence the abnormal gene or just protect insulin-producing cells from the damage caused by misfolding, we might be able to preserve or restore the patient’s own insulin production.” The effort to learn more about possible genetic causes of neonatal diabetes followed a flurry of publicity last September.
Philipson and colleagues at Chicago— using a protocol developed by co-author Andrew Hattersley, MD, professor of molecular medicine at Peninsula—were able to wean a young diabetes patient with a known, treatable mutation in an ion channel protein essential for insulin secretion, off of insulin. This was one of the first such cases in the United States. Media coverage of that case and outreach by the Juvenile Diabetes Research Foundation stimulated parents of other children diagnosed as infants with type 1 diabetes to contact one of the two centers to request genetic testing. These tests uncovered more than a dozen patients with the same treatable mutation. The publicity also brought calls from the families of more than 70 patients who had been diagnosed with diabetes at less than one year of age but who, as it turned out, did not have a known mutation. In one family with four affected individuals, tests for known mutations were negative. A combination of linkage studies and candidate-gene testing, however, traced the problem to an abnormal insulin gene. Further tests identified 10 different insulingene mutations in patients from 15 other families.
Even though neonatal diabetes is rare, identification of genes causing it has led to important knowledge about pancreatic development and function, as well as to more precise diagnosis and improved management of patients.
14 University of Chicago Medicine on the Midway
All 10 are “missense” mutations: They code for a different amino acid than the one normally found at that position. Such mutations can prevent a protein from folding into its customary shape. “Insulin mutations are an important cause of neonatal diabetes,” accounting for about 20 percent of cases of this rare disorder, the authors said. Most cases tied to insulin mutation were diagnosed in the first six months of life, with an average age at diagnosis of only 13 weeks. Three of the cases were diagnosed between six months and one year after birth. Neonatal diabetes is considered a genetic disorder by many, Philipson said. Mutations in known genes explain 50 to 60 percent of cases and research teams in the United States and Europe are trying to identify a genetic cause of diabetes in the remaining patients. Even though neonatal diabetes is rare, identification of genes causing it has led to important knowledge about pancreatic development and function, as well as to more precise diagnosis and improved management of patients. —JE
How can a batter hit a 90-mile-per-hour fastball that has barely enough time to register visually? Why are there more left-handers on baseball teams than in the general population? What makes a sports fan remain loyal year after year? Finally, a book examines the brains of fans and players alike, probing the science of talent, the depths of fan loyalty and the neurology behind hitting a home run. Even those who aren’t Cubs fans should enjoy the authors’ approach to understanding America’s favorite pastime. University of Chicago neurologists Steven Small, MD, PhD, and Ana Solodkin, PhD, co-authored the book’s third chapter: “Why Did Casey Strike Out? The Neuroscience of Hitting,” with computational neuroscientist John Milton, MD, PhD. They claim a hitter’s decisions begin even before the ball leaves the pitcher’s hand. The batter’s brain must prepare the neuronal program for the movement involved in swinging the bat and then interpret the movement of the pitcher in order to predict where the ball will go. Your Inner Fish: A Journey into the 3.5-Billion-Year History of the Human Body Neil Shubin, PhD Pantheon, 2008 What does the human hand have in common with a fly’s wing? Can we trace the evolutionary origin of ailments as varied as cancer and hiccups? Neil Shubin answers such questions in a new chronicle of evolutionary history that helps us discover our “inner fish.” His new book demonstrates how worms, fish and even flies hold secrets to the inner workings of our own bodies and the origins of many of today’s common diseases. Shubin explores the ancient origins of teeth, head, ears, eyes and explains how just a few cells containing a creature’s DNA can assemble a complete individual. Scientists and people with only a layperson’s knowledge of evolution can learn from this book that shows us how the distant past is deep within our DNA. Shubin is professor and associate dean for organismal and evolutionary biology at the University of Chicago and provost of the Field Museum. (See excerpt from book on page 47.)
Speciation in Birds Trevor Price, PhD Roberts and Co., 2008 The mysteries of large numbers of tropical bird species—including the roles of geography, ecology and sexual selection—are explored in this beautifully illustrated book by one of the leading experts in the field. Trevor Price has created an authoritative and modern synthesis on the subject of bird speciation, exploring the integration of behavior, ecology and genetics. This text is recommended reading for bird lovers or anyone interested in natural history, evolution and biology. Price is a professor of ecology and evolution at the University of Chicago. Teaching Atlas of Vascular and NonVascular Interventional Radiology Brian Funaki, Jonathan Lorenz, AB ’87, MD ’93, and Thuong Van Ha Thieme Medical Publishers, 2008 A resource for residents as well as experienced radiologists and endovascular surgery experts, this comprehensive atlas covers the full range of nonvascular and vascular interventional procedures performed in clinical practice. Its 75 cases are organized with brief summaries of clinical presentation, radiologic studies, diagnosis and treatment, and guide the reader through each stage of management. The authors, all from the University of Chicago, provide essential background for each case on the etiology of the problem, and offer lists of noninvasive imaging workup, therapeutic options and possible complications. Brian Funaki is associate professor and section chief of vascular and interventional radiology; Jonathan Lorenz directs the vascular and interventional radiology fellowship program; and Thuong Van Ha is assistant professor of interventional and vascular radiology. Thoracic Surgery Atlas Mark K. Ferguson, MD ‘77 Saunders, 2007 Highly illustrated and comprehensive, this 325-page review of general thoracic surgery guides the practitioner through details of complex procedures, demonstrating ways to avoid common problems
and to manage complications when they occur. Each chapter is illustrated with original line drawings that depict relevant anatomy and steps associated with each procedure. Mark Ferguson is a cardiothoracic surgeon and professor of surgery at the University of Chicago. Dialysis without Fear: A Guide to Living Well on Dialysis for Patients & Their Families Daniel Offer, MD ‘57, Marjorie Kaiz Offer, Susan Offer Szafir Oxford University Press, 2007 Written by a psychiatrist and dialysis patient and his wife and daughter, this book offers advice on how to live well on dialysis. Drawing on his long experience in the medical profession and with kidney disease, Daniel Offer dispels many misconceptions surrounding this treatment. He explains how to adapt to the new diet and continue to travel, work and participate fully in life’s celebrations and joys. Daniel Offer is a professor of psychiatry and behavior sciences at Northwestern University. The author of 16 books and 200 scientific articles, he has been on dialysis since 1999. His wife, Marjorie Kaiz Offer, is a research assistant in Northwestern’s Department of Psychiatry and Behavior Sciences. Their daughter, Susan Offer Szafir, is a freelance writer and marketer. Robbins Basic Pathology Vinay Kumar, MBBS, MD; Abul K. Abbas, MBBS; Nelson Fausto, MD; and Richard Mitchell, MD Elsevier Science, 2007 Now in its 8th edition, this 960-page hard-cover classic pathology text comes with Student Consult online access (www.studentconsult. com). Current, succinct and user-friendly, this primer is written for medical students and course directors, or anyone interested in studying pathology. The text includes state-of-the-art gross and photomicrographic illustrations to help readers understand complex principles, and provides clinicopathologic correlations that highlight the relationships between basic science and clinical medicine. Its authors are all practicing pathologists: Vinay Kumar, at the University of Chicago; Abul Abbas, at the University of California-San Francisco; Nelson Fausto, at the University of Washington; and Richard Mitchell, at Brigham and Women’s Hospital.
Spring 2008 15
Story by Katie Scarlett Brandt Photos by Jason Smith
A small community in South Dakota could hold the key to understanding many common diseases Sanjiv Shah, MD, glanced up from his ar terial tonometer as his next subjec t appr oached . “Gi ve me t wo mar k s on t he paper, Doc t or,” Donny Waldner entreated as he took his seat. “No, I can’t cheat,” Shah replied, and returned to his work with the tonometer, a non-invasive method to measure the central coronary ar tery. Shah’s was one of 11 stations spread like the face of a clock around the school gymnasium, and Donny would have to collect check marks on a form showing he had visited each of them before the day’s end. Physicians and researchers would test his sense of smell, his vision, his lungs and, of course, his central coronary ar tery. The battery of tests brought a range of medical care that isn’t always available to Donny and his neighbors in this remote corner of South Dakota. But that’s not the only reason Donny—and Shah and his medical colleagues—had gathered in the drafty gym this cold winter morning. These tests would be more than a thorough checkup for the families in this farming communit y: They would add to over a half century of research that has amassed medical and genetic data on the Hut terites, a small religious communit y whose very isolation is helping scientists make discoveries that could af fect the health of millions. 16 University of Chicago Medicine on the Midway
A Hutterite boy has blood drawn by technician Rob Stanaker at one of 11 stations set up in the school’s gymnasium.
interrupted the lull with a forceful throat clear, and with his head slightly lowered, raised his eyes toward Shah. “I did it on purpose, to see if it’s gonna go up,” he said, referring to the line dancing across the screen. From behind his glasses, Shah returned Donny’s guilty glance. “OK, try to hold still. You want to get out of here, don’t you?”
Sickness, inside and out The Hutterites are private people, but Steinberg and now Ober have offered them a chance for tailored health exams and discussions that would otherwise cost thousands of dollars. While the Hutterites receive individual medical attention, Ober’s group reaps the benefits on a much grander scale: They maintain a nearly 13,000-person database, and they have studied more than 1,000 people related to each other in a single 13-generation pedigree. That information has led to dozens of important discoveries, one of which proves that Hutterites and the larger European-derived populations have very similar gene frequencies and common phenotypes. “It makes the studies we do in Hutterites very relevant to other populations,” Ober said. “No one [on the outside] will care if we find a gene for heart disease in the Hutterites,” unless it’s applicable to outside populations.
“In my lab, you can do molecular work at the bench, patient recruitment and evaluation in the field, and statistical and theoretical work at the computer,” Ober said. “It’s really nice because they get to meet the subjects whose blood samples they study in the lab and they’re involved in all components of the research through to the end.” Research for Ober’s lab team involves more than just a coded number on a tube. During the Millbrook trip, graduate student Gülüm Kosova sorted, labeled, spun and prepped blood samples, but back in the lab, she also ran the analysis programs and interpreted the data. She was looking specifically at fertility patterns among the women, which was Ober’s original interest in Hutterites. “We’re relatively understaffed for a project this huge. Other studies of this magnitude have much larger teams,” Ober said. But her researchers—about a dozen in all—are dedicated, and they manage. They’ve published in Nature Genetics, Science, the American Journal of Human Genetics and now the New England Journal of Medicine.
Though the different research teams study various aspects of the Hutterites’ health, all their findings will join a Hutterite gene bank that builds on almost 60 years of research. For one weekend in December, Carole Ober, PhD, a University of Chicago human geneticist, led a group of researchers from the University of Chicago, Northwestern University and Children’s Memorial Hospital to the Millbrook Colony of Hutterites for a follow-up to a study she began a decade ago, funded by the National Heart Lung and Blood Institute (NHLBI). In three days, physicians and researchers tested 130 of the 150 people who live in the colony’s rows of connected gray houses. The closest town is Mitchell, S.D., population 14,558. Roughly 15 minutes away by car, it lays claim to the world’s only Corn Palace, the Dakota Discovery Museum and the Enchanted World Doll Museum. Millbrook is one of more than 30 colonies scattered across South Dakota that Ober has visited to collect data on asthma and fertility. Though the different research teams in Ober’s group study various aspects of the Hutterites’ health, all their findings will join a Hutterite gene bank that builds on almost 60 years of research.
Science meets Hutterites The Hutterites’ relationship with scientific visitors goes back to the 1950s when biologist Arthur Steinberg from Case Western Reserve University first visited the colonies. He saw the isolated population as harboring excellent potential for genetic study. He knew that 1,265 of them had arrived in North America in 1874, and could trace their ancestry to fewer than 90 people. The Hutterites could tell Steinberg virtually every detail of their ancestors’ trip overseas because those ancestors had kept meticulous records. They recorded them all in a single book, Das grosse Geschichtsbuch. All 612 pages of it survive today in a South Dakota colony not far from Millbrook. Steinberg considered the Hutterites an ideal population for biological research. Such a small population limits genetic diversity and 18 University of Chicago Medicine on the Midway
their communal lifestyle eliminates environmental variability. “The Hutterite environment is so remarkably uniform,” Ober said, adding that its members eat the same food, share all goods and receive the same education. So for two more decades, Steinberg continued his research, handwriting family trees in dozens of notebooks. After years of continuing Steinberg’s work, Ober now keeps those notebooks. She first encountered them in 1979, when she was looking for a post-doc position. Then at Northwestern, geneticist Alice Martin, MD, offered Ober a job in her lab studying genetics and population structure among the Hutterites. Having written her dissertation on the social structure and gene distribution of a Rhesus monkey population, Ober’s background in anthropology and genetics fit Martin’s needs perfectly. Ober first traveled to the colonies later that year. Ober took a position in obstetrics and gynecology at the University of Chicago in 1988. And now she organizes her own trips—roughly three a year to conduct these follow-up studies. Her group goes during the winter months, when the earth is gray and dry and the Hutterites aren’t so busy with farm duties. On this trip, Shah took Donny Waldner’s blood pressure as he held very still, his back straight, and watched. 122 over 72. “What happens if you get excited? Wouldn’t it be off? If somebody would be scared or something?” Donny asked. “Yeah, that would make it higher,” Shah said. A few seconds passed as white lines against a black background peaked and valleyed across Shah’s computer screen. Beeps rose occasionally from the carotid artery monitors. From behind partitions in the room’s back corner, there was the soft swoosh of blood flowing through hearts on the echocardiogram machines. Suddenly, Donny
In April, Ober’s group published their most significant finding yet related to asthma research. The New England Journal of Medicine ran the article, about a protein called YKL-40. Researchers already knew that YKL-40 is elevated in people with asthma and poor lung function; Ober’s collaborators at Yale University had published on that in NEJM last November. But at Chicago, Ober’s group measured YKL-40 in Hutterite blood they’d collected 10 years ago, and performed a genome-wide study to find the gene that caused YKL-40 elevation. Within months, they identified a variation in the gene that encodes the protein and showed that the variation was associated with asthma and reduced lung function among the Hutterites—a finding that the researchers successfully replicated in non-Hutterite populations as well. “This actually went pretty fast because of the infrastructure we have in place,” Ober said. After they collect data from the colonies, Ober’s group searches the Hutterites’ genotypes for indicators of certain diseases—also called genetic markers or SNPs (single nucleotide polymorphisms). These mapping and association studies involve places in the DNA sequence where people can have one or two different nucleotides. Certain nucleotides at specific positions in the DNA are associated with the prevalence of particular diseases. Ober’s lab uses homegrown software to run these studies. Geneticist Mark Abney, PhD, and geneticist and statistician Mary Sara McPeek, PhD, developed the program on-site at Chicago.
Masses of data More research groups have joined Ober’s study with independent sources of funding. Some go on the trips with Ober, others put in requests to use the database or blood samples. The researchers with Ober on this trip collect blood; take respiration and heart readings; conduct allerg y, smell and vision tests; and ask dozens of questions on items like sleep, restless leg syndrome, Parkinson’s disease and migraine.
At right: Hutterite girls stand with their mom in the entrance to the gym, taking a moment to assess the 35 visitors who have commandeered not only their school, but all conversation. Left: As they sit for their tests, the Hutterites watch the researchers’ every move.
At right: Carole Ober (standing in background) talks with a line of girls as they wait their turns at the blood-draw station. Ober, who has visited the colonies regularly since 1979, organized the trip, bringing together research groups from the University of Chicago Medical Center, Northwestern University and Children’s Memorial Hospital. Below: Graduate students in Carol Ober’s lab, Gülüm Kosova (front) and Minal Çalis¸kan, cap and label tubes of blood with assorted colors—purple, red, blue, green and yellow—to denote specific tests.
In his Chicago lab, ear, nose and throat specialist Jayant Pinto, MD, said it has taken his group two years to enroll 80 patients in a clinical trial. In contrast, the 80 patients he saw in merely three days at Millbrook yielded unparalleled data for his allergy, olfaction and sinusitis research. “This is great for me,” Pinto said as he set up his acoustic rhinometer for measuring nose volume in a corner of the gym. “I can see people we studied on prior trips, see how their sense of smell has changed with aging. And it’s practical. Everyone has ear, nose and throat problems at some point in their lives—allergies when they’re young, hearing and olfactory loss when they’re old, sore throats, breathing problems.” Finding genetic variation that underlies these common complaints remains Pinto’s goal.
Meanwhile, Pinto assessed each nose’s volume, looked inside for inflammation, polyps or deviations, and asked questions about allergies, nasal symptoms and smell. He also conducted cognitive analyses. When Donny Waldner sat down for his survey, he told Pinto he’d never noticed any problems with allergies, though he had tested positive for mugwort and ragweed. They discussed Donny’s work as a welder and scraper, and the kinds of chemicals to which he’s been exposed, and then Pinto asked him to remember three words: banana, door and baby. This was part of a cognitive evaluation. Loss of smell is an early sign of neurodegenerative diseases, Ober had told the Hutterites during their information session the night before. Pinto was checking for that.
The researchers with Ober on this trip collect blood; take respiration and heart readings; conduct allergy, smell and vision tests; and ask dozens of questions on items like sleep, restless leg syndrome, Parkinson’s disease and migraine. Pinto first came on the Hutterite trip seven years ago as a postdoctoral fellow in Ober’s lab for studies on chronic sinusitis and olfaction prevalence. Now, his research goes hand-in-hand with Ober’s, as allergies go hand-in-hand with asthma and sinus problems. Next door, Gorka Alkorta-Aranburu, a graduate student in human genetics, blindfolded people, held scented markers to their noses and asked them to identify the smells. There were fruits, garlic, fish and 13 other scents.
Next he told Donny to draw the face of a clock and label it 11:10. Donny drew two hands—one pointing to the 11, one to the 10—and then spat back the words Pinto had asked him to remember: banana, door and baby. “Give me a challenge,” he said.
‘Organized chaos’ The Hutterite lifestyle falls somewhere between that of the Amish (which they pronounce Ay-mish), who follow stricter rules, and the Mennonites, who live more freely. Women alternate weeks cooking in the common kitchen, wear long dresses with white short-sleeved shirts and black scarves over their hair, and aren’t permitted to drive. Though the older generations haven’t been educated past eighth grade, a few of the women professed an interest in biology and medicine when speaking to their visitors from Chicago. Ober was the first of those visitors to arrive. On Thursday, Dec. 6, she flew into Sioux Falls, S.D., on the state’s eastern border with Iowa, where she rented a van and drove the 60 miles west to Millbrook. The remaining researchers—32 of them—arrived Friday. Their supplies awaited them in boxes piled across the concrete floor of the Millbrook school gym. “Organized chaos,” Ober said. “It’s complete organized chaos and so much fun.” Friday night, Ober presented the schedule for the next three days to the Hutterites. After dinner in their shared dining hall—where men took their food from a spread in the room’s middle before sitting on one side, and the women filled their plates in the kitchen— Ober set up her PowerPoint presentation in the chapel, adjacent to the dining hall. “On the outside, diabetes, asthma and heart disease have skyrocketed,” she told them near the beginning of the 30-minute presentation. “Why? Is the same thing happening with the Hutterites?” Saturday morning, researchers awoke in darkness in their Mitchell hotel rooms. The sky stretched black and starless outside their windows. They wrapped themselves in layers of clothes: The average temperature during the trip reached 14 degrees Fahrenheit, sharp and cold. The visiting women attempted to dress like the women in the colony—modestly and with scant jewelry or makeup. The men
tried, too, and without much difficulty. Millbrook men dress much like any others in the area: black pants, suspenders and long-sleeve button-down shirts. That morning, Ober’s van left first. Instead of going directly to Millbrook, she had to pick up a 15-year-old girl from another colony, Ruth Waldner. (Many Hutterites share the same last name.) The two had met on one of Ober’s previous trips, and Ruth had proven so helpful—organizing papers, directing stragglers and running errands—that Ober again requested her assistance. Down seven miles of straight road, shadowy fields and dark sky straddling either side, Ruth lived with her mother, father and seven siblings in a house they’d moved into the day before Ober arrived. Spotless wooden floors led from the kitchen to the living room. The younger kids shared bedrooms scattered between two levels, while the older siblings had their own rooms. In the room they’d spared for guests, Ruth’s mother, Leah, planned to lay a quilt across the bed once they’d cleared out the moving boxes. Each of Ruth’s aunts had contributed a square, and Leah could illustrate her family’s recent history through the patches: The sisters had left for different colonies, married and raised children. Angels represented those lost to illness or accident, like Ruth’s brother Elias who died in a farming accident. The family donated his liver, kidneys and eyes—every organ that could be saved. And when Leah talked about the girl who received his liver and the letters the girl had written to say she’d gone to school and had a baby, Leah smiled. Ruth was ready when Ober arrived. After a night of restless sleep, waking every hour out of fear that she wouldn’t wake up on time, Ruth wanted to get to Millbrook.
A fresh look Jake Waldner, a smallish man in bifocals, was one of the first to arrive for his tests on Saturday, and his first stop was the ophthalmologists’ corner. The ophthalmologists came from Children’s
Memorial and tested for color blindness, vision loss, eye length, pressure and curvature. Ophthalmologist Nils Loewen, MD, handed Jake a pair of glasses and asked him to count how many dots shone from a special flashlight Loewen held. “What does that tell you?” Jake asked, watching Loewen put the flashlight to one side and pick up a book of numbers. “That tells us if you have suppression in the eye.” Once Jake had identified the correct numbers in the seas of floating dots, Loewen put drops in his eyes to dilate his pupils. “Where you’re from, is it cold like it is here?” Jake asked. He’d discovered earlier that Loewen originally hailed from Germany. “Not as cold, no. South Dakota is extreme,” Loewen said, smiling. Jake nodded, but kept his eyes trained on Loewen. “Germany, if you look on the map, is almost the same height as South Dakota,” he said, pride in his voice. “Coldest I’ve seen it here is probably 30 below.” The ophthalmologists are among the more recent groups to join the Hutterite research trips. They’d return home to pore over their data. Other groups, though, never left the lab. Graham Coop, PhD, in human genetics at Chicago has never seen a Hutterite face, but he knows their blood. Coop recently was lead author on a paper in Science. After discussions with Ober, he spent two years looking at the genetics of Hutterite pedigrees to determine where along their chromosomes recombination occurred. Recombination takes place during meiosis, a special kind of cell division that occurs in the testicles and ovaries. In the process of making sperm or egg cells, the parent-to-be combines the chromosomes inherited from each of their parents and reshuffles them, swapping parts of one chromosome for the matching segments of the other version of that same chromosome. This results in the parent passing down a mosaic of genes, shuffled in new combinations. “I was interested in doing something like this, but didn’t have any Spring 2008 21
idea how. I knew the Hutterites would be a good resource,” Ober said of conversations she’d had with Coop and co-investigators Jonathan Pritchard, PhD, and Molly Przeworski, PhD, also in genetics. Przeworski, Pritchard and Coop ran the study using Ober’s resources. They looked at DNA samples from 725 Hutterites, representing 82 nuclear families. And they found, through looking at half a million genetic markers along each chromosome, that chromosomes
“You have to weigh those things. The more our people are exposed to the outside way of life, the more they forget about community,” he said. “I enjoy our way of life. Not everyone does. We have our problems, and we work through them all the time.” Even though Ober’s research brought whole groups of people in from the outside, the Millbrook Hutterites looked forward to the weekend of tests. The thousands of dollars worth of diagnostic testing they each received didn’t require travel beyond a few feet from their front steps. Ober’s current research interest grew from a call the NHLBI put out 15 years ago for genetic studies on allergy and asthma. Ober applied, described the Hutterites as her subjects and received five years’ worth of funding. That funding has continued ever since. But her studies don’t end with allergy and asthma. The lab looks at myriad phenotypes. In their study on sex-specific effects on human quantitative traits, Ober, Abney, Lin Pan and former graduate student Lauren Weiss, PhD, analyzed Hutterites’ systolic blood pressure,
Thanks to the group’s previous findings, they can demonstrate that these thousands of test results could show the outside population something about life, disease and genetics as well. from the mother averaged around 40 recombination events and those from the father, 26. Their work confirmed a previous finding that older mothers contribute more recombination events, while the father’s age is immaterial, but showed for the first time that heredity determines where recombination occurs along the chromosome.
A delicate balance Like ophthalmologist Loewen, the Hutterites’ speak German, though a dialect not necessarily understood by High German speakers. Their first language is Hutterish, a mishmash of Tyrolean and Austrian dialects with words adopted from Russian. Around age 6 they learn English, and speak it with an accent. Teachers from outside the colony, dressed in jeans and sweaters, come to teach the 38 students enrolled as part of the local public school district. Paula Pecenka has taught 7th and 8th grade at Millbrook for nine years. Her classroom looks like any other—bright posters and colorful artwork on the wall, a marker board at the front, desks set in rows. Pecenka teaches the “same exact” curriculum as the local public school, and the students take standardized tests. “Kids are kids,” she said. “The thing I like best here is the parental support at home. You get immediate feedback because they’re there.” In most colonies, children begin working after 8th grade. Girls baby-sit and learn to sew and cook; boys work with farm equipment or in the machine shop. But Millbrook instituted high school three years ago. Students take most courses online, in the school’s flat-screen-clad computer room, but for some subjects, such as geography, teachers come in from the local high school to teach. The first graduating class will walk the stage next year. In Ruth’s colony, there is no high school yet. That’s why she was able to assist Ober during this round of tests. David Waldner—“the boss” (secretary and treasurer) of Millbrook and a white-haired man with a voice like Sean Connery—said that finding balance between outside exposure and the inside collective is key. Millbrook’s small circle of male leadership deemed high school OK, but they sold a geothermal manufacturing business because it was drawing the colony’s members too far from the collective. 22 University of Chicago Medicine on the Midway
height, fasting insulin, triglycerides, lipoprotein, serotonin, age at menarche and cholesterol. “We reasoned that because their external environment is so similar, we’d have a good shot at picking up sex-specific effects, if they exist,” she said. It was already well known that in fruit flies genes interacted with their sex, so Ober wanted to reproduce that study in humans. In doing so, they were able to show that the X chromosome plays some role, but even genes on the non-sex chromosomes affect these traits differently in males and females. Thanks to the group’s previous findings, they can demonstrate that these thousands of test results could show the outside population something about life, disease and genetics as well.
Klocksieben replaced the methacholine tube with albuteral, a nebulizer, and Verna leaned back in her chair breathing the clean air. She’d first been diagnosed with asthma in the ’90s, during the Ober group’s initial study. The doctor then asked her if she felt tightness in her chest when she breathed in cold air or exercised. “Doesn’t everybody?” she asked. Next to Verna, Klocksieben coached an older woman through the challenge. Born in 1929, Elizabeth Waldner was a mother with 13 children, 60 grandchildren and 28 great-grandchildren who she had “counted, but not lately.” Elizabeth sat in her black and white polka dot dress, with her hands crossed in her lap and looked at Klocksieben from under her headscarf with a little smile on her face. “If you feel lightheaded or dizzy, it’s not the test,” he joked with her. “It’s my male magnetism.” The PFT tests were the last. By noon Monday, the researchers had finished their work and packed their vans for the drive back to Sioux Falls. “I’ll see you again, maybe, in 10 years,” David Waldner said in his Sean Connery voice. “But I won’t forget your faces for a long time.”
Clockwise from top left: Scientists study various aspects of the Hutterites’ health; their findings will add to nearly 60 years of research. In one of the gym’s side rooms, ophthalmologist Marilyn Mets looks into a patient’s eyes after they’ve been dilated. At one of the asthma stations, research assistant Susan Kuldanek measures nitric oxide in the airways of a Hutterite man.
Goodbye—for another decade To the right of the allergy table, blue partitions walled off the pulmonary section. Jim Klocksieben, supervisor of the adult pulmonary function lab at Chicago, performs tests for asthma. His station at Millbrook consisted of a single table—a far cry from the private rooms with giant machines he usually employed in his Hyde Park lab. Klocksieben put a plug over Verna Waldner’s nose and asked her to hold a tube to her mouth and breathe in methacholine, a substance that would cause her lungs to tighten if she was asthmatic, like an asthma attack. After a few breaths, he set a timer and asked her to wait for three minutes in order to let the methacholine take root in her lungs. She then exhaled into another tube so he could see if the methacholine had any affect. All of the tubes were connected to the computer that displayed arcs corresponding with Verna’s breathing. Klocksieben watched the screen, put a hand on her back and encouraged her to “blooooooooooooow” with all her might. “It’s like wringing out a sponge,” Klocksieben explained. He wanted every last drop. Verna failed the challenge. The methacholine mimicked an allergic reaction in her lungs that indicated she was asthmatic. In a nonasthmatic’s lungs, there would’ve been no reaction. Spring 2008 23
A DIF F E RE N T K IND OF
BY MEGAN SEERY
WHEN HE FAC ED A C ORONAR Y BYPASS, JOE SISON NEVER IMAGINED THE SURGERY WOULD BE DONE BY A
But when a stress test revealed that one of his three stents was fully blocked, Sison balked at open-heart surgery. “There was no way I was getting my chest cracked open,” Sison said. “I didn’t want to be lying around [recuperating] for months.” Desperately seeking an alternative, the 60-year-old discovered a procedure that would allow him to get the bypass he urgently needed without having a surgeon saw through his sternum. All that would delve into his body would be the arms of a robot. “It sounded good,” he said. “I’d never heard of it before.” Many people haven’t. Few doctors in the world are capable of using a robot to perform bypass surgery, and no one has performed as many as Sudhir Srivastava, MD. “The work is to truly change the direction of cardiac surgery,” said Srivastava, who joined the University of Chicago Medical Center in July 2007. “We want to create a phenomenon where surgeons will have to learn this technique.” Srivastava estimates that 97 percent of coronary bypasses are still performed conventionally, by cutting the breastbone to access the chest. About 70 to 75 percent of those patients must have their blood routed to a heart-lung machine during the procedure. After operating, the surgeon wires the breastbone together. Sison knew he needed a bypass for more than a year but was adamant about keeping his chest intact. Then he found Srivastava and da Vinci. BENEFITS AND LIMITA TIONS
SURGEON SARAH TEMKIN USES THE DA VINCI ROBOT FOR GYNECOLOGICAL PROCEDURES, INCLUDING ENDOMETRIAL CANCER RESECTIONS. PHOTO BY DAN DRY
24 University of Chicago Medicine on the Midway
The da Vinci robot—which is used for many kinds of procedures, like removing cancerous prostates or performing hysterectomies—is an improvement from earlier minimally invasive surgeries in which the surgeon uses specialized instruments, such as a grasper and scissors, that have limited dexterity. The doctor views his or her work on a two-dimensional monitor located next to the patient. About 2 to 3 percent of U.S. bypass surgeries are performed this way, Srivastava said. Spring 2008 25
However, with the da Vinci robot, the doctor operates from eight feet away. Sitting at a remote console, the surgeon uses special gloves to manipulate the robot, providing a natural range of wrist motion while eliminating hand tremor. “There are almost 370 degrees of freedom, even more than with your own hands,” said Hisham Bassiouny, MD, director for the Non-Invasive Vascular Laboratory at Chicago, describing how the computer allows for more than a full circle of motion in one direction. “It emulates your own hands within the body.” The lack of depth perception in laparoscopy can make subtle visual findings, such as an instrument’s proximity to an artery, difficult to interpret, said Sarah Temkin, MD, an expert in gynecologic oncology. “Laparoscopy disconnects the surgeon from the tissue she is operating on,” said Temkin, who has performed 28 gynecological procedures, including endometrial cancer resections, with the da Vinci. Like earlier minimally invasive procedures, robotassisted surgery requires making dime-size incisions in the body to place sleeves that function as ports for a video camera and specialized instruments. The da Vinci robot is then docked to the ports. But unlike traditional minimally invasive surgery, robot-assisted surgeons see a three-dimensional view of the body made possible from a distinctly robotic feature: Because the robot doesn’t experience fatigue, it can hold a heavy, three-dimensional camera for long periods of time—and more steadily than possible in human hands. While the da Vinci system enhances surgery from the doctor’s perspective, Temkin finds that the true benefit of robotics is for the patients. “It’s usually a one-day hospital stay, as opposed to five days with conventional surgery,” she said of gynecological oncology patients. “It’s a lot easier to get started on chemotherapy or radiation therapy for cancer postoperatively if you had five small incisions during the procedure and then you can get out of bed the next day.” It’s easy to recognize the crossover appeal of shorter recovery periods. Departments that use the Medical Center’s two da Vinci machines—cardiology, gynecology, pediatrics, transplants, urology and vascular— performed 517 robot-assisted surgeries in 2007, ranging from removing prostates and cysts to replacing the vaginal vault and performing liver resections. The popularity of robot-assisted procedures has led to frequent logistical discussions during robotic surgery meetings.
FIRST HAND EXPERIENCE
Joe Sison checked in for the pioneering robotic cardiac surgery at 5:30 a.m. one Monday—with his wife, Nellie, by his side—in the Mitchell Hospital waiting area. Minutes later, an operating room transporter called him to pre-operative care. Sison’s would be a typical da Vinci surgery: The surgeon sits at a console across the room while the patient is hooked up to the robot through the tiny holes that function as ports. The adjoining patient cart looks like a six-foot-tall Transformer. On the cart’s monitor, tiny forceps move across the screen as Srivastava takes the internal mammary artery down. He glances up from his seat at the operating console and asks a nurse to change an instrument. The robot’s corresponding arm suddenly glows with a soft green light, which means it is ready for the new instrument to be inserted. A message appears on the attached monitor: “Ready. Prepare patient cart for surgery.” Normal-sized tools would look huge on the robot’s pencil-width instrument holders. Instead, the machine uses scaled-down instruments with regular tips. As the doctor operates, the machine’s long arms travel delicately; there are no big, grandiose movements here. Those slight, real-time actions are identical to those at the console, where Srivastava sits. To the distant eye, it appears he’s driving an arcade racing game with an invisible steering wheel. The console “windshield” is his three-dimensional monitor, which now shows an extremely close-up picture—magnified 12 times—of tiny veins on the pericardial sac. Srivastava’s feet press on two of the machine’s five foot pedals: harder on one pedal for the camera to focus, gently tapping another to move the da Vinci’s arms forward. He uses the foot pedals and hand controls simultaneously—as if he were driving—and cannot stare down at his feet or hands. His focus remains on the task before him. But Srivastava sometimes must leave the virtual surgery to get his hands dirty. About 10 to 12 percent of his patients are converted to conventional open surgery because they’re losing too much blood. Sison’s procedure went beautifully, Srivastava said. It lasted 90 minutes—shorter than average— and Sison was eager to get up and move around. He left the hospital only a few days later.
Like earlier minimally invasive procedures, robotassisted surgery requires making dime-size incisions in the body to place sleeves that function as ports for a video camera and specialized instruments.
NO ONE IN THE WORLD HAS PERFORMED AS MANY ROBOT-ASSISTED BYPASS SURGERIES AS SUDHIR SRIVASTAVA. PHOTO BY BART HARRIS
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Spring 2008 27
“I FEEL GREAT, I FEEL ALIVE. People look at me and they can’t believe that I just had surgery.” —Joe Sison
Until several years ago, such a rapid recovery was unheard of. Conventional bypass surgery—the gold standard for coronary artery disease—requires months for a patient to fully heal. Patients who would average a weeklong hospital stay with an open bypass instead can be back to their everyday routines in a matter of days with a robot-assisted bypass. There have been 72 robot-assisted coronary bypass surgeries at the Medical Center since Srivastava arrived last July. With nearly 350 da Vinci bypasses under his belt, Srivastava has performed more than any surgeon in the world. “This surgery is not experimental in our hands,” Srivastava said. “We’ve perfected our technique.” Although robot-assisted coronary by passes are relatively new, Chicago’s urology section has used the da Vinci since 2002. More recently, Bassiouny collaborated with Arieh Shalhav, MD, section chief for urology, on techniques to repair abdominal aortic aneurysms.
“Since urology had extensive experience, I worked with them to develop our protocol,” Bassiouny said. “Working from a team approach allows us to offer a minimally invasive procedure and still provide that gold standard of care.” Before working with the robot in an animal lab, Bassiouny, like all surgeons new to da Vinci, trained in a dry lab where he used the robot to sew artificial limbs. Bassiouny has performed five robot-assisted aortic repairs for aneurysms and blocked aortas and said this minimally invasive approach offers distinct advantages over conventional open repair or using stent technology. “Pure laparoscopy is like puppetry,” Bassiouny said, referring to earlier minimally invasive techniques. “With robotics, it’s a new dimension.” T HE HUMAN TOUCH
Despite the robot’s advantages, there are some situations in which nothing replaces the human touch. Surgeons like Greg Zagaja, MD, note the loss of haptics, or sense of touch, on the operating room floor. “The robot doesn’t deliver tactile feedback,” said Zagaja, assistant professor of surgery in urology. “There are patients, such as people with bulky tumors, who probably are best served to have the surgeon using his hands.” Feeling provides tactile information about how resistant tissue is to cutting or a blood vessel is to sewing. When using the
robot, surgeons must make judgments on how much force to apply based on visual assessment. If the machine pulls too hard, it can tear a patient’s tissue. Intuitive Surgical, which makes the da Vinci robot, is developing sensory gloves to allow surgeons to feel while they operate. The gloves greatly decrease the loss of natural touch, Zagaja said. Many surgical residents are learning from the technology that is currently available, said Donald Liu, MD, surgeon-in-chief for Chicago’s Comer Children’s Hospital. “Our residents will be trained to do things here that other residents will never, ever see,” Liu said. “The newest, coolest and best areas are here.” Still, some basics of surgery, such as familiarity with the body, are best learned firsthand. That’s why Zagaja advocates that all surgical residents possess a combination of robot-assisted and conventional operating skills. “We need to make sure that what they’re learning is supported by fundamentals,” he said. “The da Vinci is a tool we use, but the idea behind it was to make surgery more natural.” Exactly three weeks after his bypass, Sison was back in his natural element. Having already returned to his full-time job, he showed up in church soon afterward to perform with his gospel band, the Sacred Heart Prayer Group. “I feel great, I feel alive,” he said as he prepared to play keyboard. “People look at me and they can’t believe that I just had surgery.”
WHEN HER 11-YEAR-OLD SON BEGAN TO COMPLAIN OF MILD STOMACHACHES, DENISE GONZALES AT FIRST CHALKED THEM UP TO MERELY A SENSITIVE STOMACH. “He would only have the pain for an hour, and then it would go away,” Gonzales said. “I thought it might have been due to something he ate at school.” Working math problems in class one day, her son, Jaime Bazan, felt a discomfort he’d experienced more than a dozen times in his lower left abdomen. This time, however, when he tried to stand up and stretch to ease the soreness, the pain nearly paralyzed him. “I could barely walk, my side was hurting so bad,” he said. Jaime was diagnosed with a serious kidney blockage, the real cause of those persistent “stomachaches.” An X-ray later revealed Jaime’s left kidney resembled a “blown-up flower,” his mom said. Gonzales feared that diagnosis came too late to correct the blockage without scarring Jaime for life. Fortunately, a special, non-invasive procedure would quiet those fears and make Jaime the first Chicago pediatric patient to undergo robot-assisted urologic surgery. To Jaime and his mom’s surprise, he was born with this ailment. He had a malformed ureter, the muscular tube that carries urine from the kidney to the bladder, on his left side. A blockage where these two
structures meet, the ureteropelvic junction (UPJ), can inhibit the flow of urine. “It was similar to a pond,” said Mohan Gundeti, MBBS, director of pediatric urology at the University of Chicago Medical Center. “His body wasn’t able to clean the fluid out.” Left untreated, the fluid blockage could lead to infection and eventual kidney damage. Because this kind of deformity occurs at birth, patients are almost exclusively pediatric. Pyeloplasty, which involves cutting the abdominal muscle to access the pelvis and drain the kidney, often requires several weeks of rest for the muscle to recover. Significant work for any parent, Gundeti said, let alone Jaime’s mom who has extensive back problems of her own. “When a child is in the hospital, you have to organize for all the family dynamics,” he said. Fortunately, the doctor could avoid a major incision in Jaime’s stomach by performing a minimally invasive pyeloplasty and UPJ repair using a robot known as the da Vinci system. (See main story.) “I was a little hesitant at first,” Gonzales said, “but I was comforted that they would go in and do the open surgery if they
had problems doing the procedure with the robot.” Instead of cutting into Jaime’s side, as is done in a conventional pyeloplasty, Gundeti used special instruments and a tiny camera to operate through four tiny slits made in the boy’s body. With surgeon Gregory Zagaja’s help, Gundeti removed the part of Jaime’s ureter that had a kink, and then reattached it to his kidney and formed a new junction. A stent was put in to help the ureter remain open, allowing urine to flow to the kidney naturally. At his age, Jaime was old enough to be operated on using 8 and 12 millimeter instruments—the same size used for adults. Younger patients typically would be unable to undergo a robot-assisted procedure because the adult tools are too big for their bodies. That’s changing, Gundeti said. Smaller instruments came on the market this year. Greater accessibility to minimally invasive surgeries is great news for pediatric patients, said Donald Liu, MD, surgeonin-chief for Chicago’s Comer Children’s Hospital. “Besides having excellent cosmetic results where they look like they never had an operation,” he said, “we’re getting excellent operation results, and they go back to play much more quickly.” LESS TIME RECUPERATING ALSO MEANS THAT PEDIATRIC PATIENTS MISS LESS SCHOOL AND THEIR PARENTS TAKE LESS TIME OFF WORK.
Eleven days after his surgery, Jaime was playing again. In the first few days following his surgery, there were traces of blood in his urine. But Jaime felt OK and recovered quickly. A few weeks later, Gundeti removed the stent holding his ureter open. “You’d have to look hard to see [the scars],” Gonzales said, pointing to a tiny mark hidden by Jaime’s belly button. —MS
JUST A FEW DAYS AFTER RECEIVING ROBOT-ASSISTED BYPASS SURGERY, JOE SISON WENT HOME. TWO WEEKS LATER, THE 60-YEAR-OLD WAS PERFORMING IN HIS GOSPEL BAND AT CHURCH. PHOTO BY DAN DRY
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Spring 2008 29
When South Side native William McDade, MD/PhD ’90, arrived as a first-year medical student at the Pritzker School of Medicine, he wasn’t surprised to learn he was the only African-American student in his class. “It wasn’t really an unusual thing” at the time, he said. Consider the faces that stare out from class photos lining the hallways of the University of Chicago Medical Center. For dozens of years, the vast majority of those faces were white and male—just as they were at most medical schools. In many cases, a minority is nowhere to be seen. But now, more than 25 years after McDade matriculated, 22.5 percent of incoming Pritzker students come from backgrounds categorized by the Association
of American Medical Colleges as underrepresented in medicine: African American, Hispanic/Latino, American Indian, Native Hawaiian or Pacific Islander, or Native Alaskan. McDade, like many of his peers at the university, has taken an active role in talking about diversity and recruiting underrepresented minority students: He is associate dean for multicultural affairs and an associate professor at his alma mater.
William McDade, MD/PhD ’90, is associate dean for multicultural affairs for the Pritzker School of Medicine. Photo by Dan Dry
THE CHANGING FACE OF MEDICINE
By Suzanne Wilder
30 University of Chicago Medicine on the Midway
And the medical school—with increased diversity among the students, a groundbreaking course in health disparities and pipeline programs that introduce high school and undergraduate students to research—is making strides to show that diversity is a priority. Pritzker is part of a national effort to improve diversity in medicine by training more students from racial and ethnic groups that are underrepresented in the medical profession relative to their numbers in the general population. Some minority groups are drastically underrepresented in medicine, and cultural differences between races and ethnicities can change how patients and doctors communicate with each other. “If we’re going to take seriously the issues of educating doctors in the 21st century, we cannot do that in isolation from the ways the patient population is changing,” said Holly Humphrey, MD ’83, dean for medical education at Chicago. Humphrey said that with an increasingly diverse U.S. population, medical school leaders, students and physicians must learn to be culturally sensitive, aware of disparities and able to communicate with people from different backgrounds. “The general health care imperative is overwhelmingly compelling for diversity in education,” she said. For medical students, diversity is about more than patient populations with varied backgrounds. “One of the richest sources of
learning is being exposed to different points of view,” Humphrey said. If the students in a given medical class come from a variety of backgrounds—racial, ethnic, cultural or socioeconomic—they are gaining additional perspective and enriched discourse. And as an alumna of Pritzker who is now guiding students through their medical education, she can see through personal experience how diversity at the school has improved. Her medical class, she said, “was not very diverse,” and she takes pride in the growing number of underrepresented minority students enrolled at Pritzker. Diversity can be a delicate topic in higher education recruiting. In two notable cases against the University of Michigan, the U.S. Supreme Court in 2003 straddled a fine line on the role diversity, race and ethnicity play in college admissions. The case against the law school admissions policy, Grutter v. Bollinger, ruled in favor of Michigan using race and ethnicity as a consideration in admissions. “In order to cultivate a set of leaders with legitimacy in the eyes of the citizenry, it is necessary that the path to leadership be visibly open to talented and qualified individuals of every race and ethnicity,” the majority opinion stated. “All members of our heterogeneous society must have confidence in the openness and integrity of the educational institutions that provide this training.” But in Gratz v. Bollinger, involving undergraduate admissions to Michigan’s College of Literature, Science and the Arts, the court ruled against the university’s point-based system, which gave an
“As a young African-American male going into medicine, it was important for me to see other African Americans in medicine.” —Rashad Belin, PhD, first-year medical student
Chairman Joe G.N. “Skip” Garcia, MD, who created the Diversity Committee for the Department of Medicine, has been hailed as a leader in recruiting underrepresented minority students, faculty and staff. Photo by Andy Goodwin
automatic 20 percent score to minorities. The ruling stated that “preferring members of any one group for no reason other than race or ethnic origin is discrimination for its own sake.” The Supreme Court decisions offered the opinions that diversity helps create a better learning environment and is itself an educational tool. And the sentiment is certainly echoed at Pritzker. “Diversity is an essential part of our education process,” said Herb Abelson, MD, associate dean for admissions and chairman emeritus of pediatrics. Pritzker is competing with other medical schools for the best prospective candidates—both underrepresented minorities and majority students. Impressive clinical education, research opportunities and grant support, and prominent alumni have made the medical school competitive nationally, but its faculty and staff credit other factors, including a small class size, the diverse patient population and opportunities to work at free clinics in the area. According to Abelson, the faculty and its leadership also set apart Chicago from other top-tier institutions. “You bring this group of talented, energetic people together and they play off each other,” he said. “It’s a critical mass of people who want to be change agents. And if we can get our story in front of people, then we can get the very best students to come here.” The admissions staff work to bring that story across the country. They travel to different schools and association conferences to make sure the best students are familiar with the University of Chicago. “We try to get the word out that this is a place people should consider,” Abelson said. “We’re making a concerted effort to identify well-qualified students from every background.” Among the many people who have helped the institution’s diversity-building initiatives, Joe G.N. “Skip” Garcia, MD, chairman of medicine, has been hailed as a leader in recruiting underrepresented
minority students, faculty and staff—and in enhancing dialogue about diversity. “Almost everyone at a place like the U of C believes in the need for diversity,” Garcia said. “But it’s such an uphill struggle.” Recruiting underrepresented minorities—as students, residents, house staff and faculty—requires a critical mass effort, he said, adding, “I think we’re achieving that now.” Garcia, who came to Chicago in 2005, created the Diversity Committee for the Department of Medicine to have a formal place for dialogue and action. Co-chaired by assistant professors Robert Hoover, MD, and Monica Vela, MD ’93, the committee tackles recruitment and support issues, as well as scholarship, leadership and mentorship. But Garcia knows more is at stake than just calling attention to the topic. Debt, many say, is widely seen as one deterrent for medical students in general—and particularly at private institutions like the University of Chicago. “The more money we can get to support the educational tradition, the better we can deal with the debt load,” Abelson said. The Department of Medicine, with Garcia’s guidance, set aside money for two scholarships, worth $10,000 for each year of medical school here, to be used to increase class diversity. “A key piece of this is the amount of dollars we can put toward scholarships,” Garcia said, and to make sure students don’t leave medical school with a lot of debt. Departmental scholarships put a small dent in that. The Department of Pediatrics also offers a $10,000-per-year scholarship with the same goal in mind. And the dean of the Biological Sciences Division, James Madara, MD, has upped the ante: delegating more money for need-based scholarships in the division as a whole.
Photo by Dan Dry
Spring 2008 33
A Chicago native who grew up in the predominantly Hispanic Pilsen neighborhood, Monica Vela enrolled at Pritzker and stayed on to complete her internal medicine residency. “I was definitely committed to working with the underserved,” Vela said. “The patient population here was the patient population I wanted to work with.” After a few years working in the community, she returned to Pritzker because she missed teaching. As an assistant professor, she developed the idea of a health disparities course for medical students. The course covers such topics as defining race and culture, exploration of bias, and health literacy. In its first session during fall 2006, 66 students signed up for the then-elective class, which was held during orientation week. By the next year, the class was required for all incoming med students. Starting this fall, first-year students will take the course in a series of weekly sessions during their first eight weeks of medical school.
Monica Vela, MD ’93, assistant professor of medicine, developed a unique health disparities course for first-year Pritzker students. This summer and fall, the course will meet for weekly sessions during the first eight weeks of medical school. Photo by Dan Dry
The class has become a recruiting tool because it sets Pritzker apart from other medical schools. Prospective students hear about the course when they come in for interview days. The success with the class—students have responded positively for the past two years—has led to calls from other schools about how they might start similar courses, Vela said. This past fall, many of the students surveyed on their first day of the health disparities class remembered hearing about the course during visits to Pritzker. Of the underrepresented minority students, 72 percent remembered the course was mentioned, and of those, 78 percent said it had influenced their decision about attending the University of Chicago. Improving diversity at Pritzker and for medical careers in general is an issue that faculty and staff focus on long before students apply to medical school. Pipeline programs that are based here—and some that are scattered at Chicago schools—introduce high school students and undergraduates to medical and research concepts years before they apply for graduate work.
“We’re trying to get the word out that this is a place people should consider. We’re making a concerted effort to identify well-qualified students from every background.” —Herb Abelson, MD, associate dean for admissions and chairman emeritus of pediatrics For example, the Chicago Academic Medicine Program brings graduating high school seniors who have been accepted into college and freshman and sophomore undergraduates to the University of Chicago for a mini-medical school, while the Pritzker School of Medicine Experience in Research brings college juniors and seniors to campus to gain research experience. Both the Young Scientist Training Program and Training Early Achievers for Careers in Health Research expose high school students to health-related research in a summer program. And the Saturday Science Club teaches scientific method at a Chicago high school and helps prepare students for the citywide science fair. The BSD also hosts several other programs, such as the Summer Research Training Program, a nine-week program for undergraduates, and runs the Post-Baccalaureate Research Education Program, an opportunity for underrepresented minorities with recent bachelor’s degrees to work as lab technicians for one to two years. Students in the post-baccalaureate program must intend to pursue a PhD after finishing the program. Brandy Blackwell, a first-year medical student who grew up on the West Side of Chicago, came to Pritzker through a pipeline program here a few years ago. “I never, ever had a black physician,” Blackwell said. “The first exposure I got to even knowing that there were more minority physicians was being in that Summer Medical Education Program.” When Blackwell was finishing her undergraduate degree in biology at Illinois Wesleyan University, she turned to Pritzker as a possibility for medical school. “In general, in the medical field right now, there’s a need to be aware of the diversity of the population we’re facing,” she said. “It was important to me to seek a medical school that valued diversity.” In the health disparities curriculum for first-year students, Blackwell discovered that the attention to underserved and diverse patients aligned with her professional goals. “In general, it’s extremely important for me to be doing work that’s benefiting the people that need it the most,” she said. “Part of the reason I have stayed in Illinois is there’s so much need in Chicago.” The support and mentorship she saw in her summer experience here, as well as through Pritzker’s multicultural affairs office, was another factor in her decision. Blackwell sought a place where faculty mentors would be “truly interested in the betterment of your career.” Current medical students also play a role in recruiting: hosting applicants and making phone calls and e-mail contacts with prospects, Humphrey said. One medical alumnus who is now a resident here, Walter Conwell, MD ’07, formed the Multicultural Community for Advancement in Academic Medicine, which provides academic support, fellowship and scholarship. The group, open to all students, focuses on issues that may be of interest to minority students. “It has created a sense of community among minority students,” said Vela, who, along with McDade, helped Conwell create the organization.
“If we’re going to take seriously the issues of educating doctors in the 21st century, we cannot do that in isolation from the ways the patient population is changing.” —Holly Humphrey, MD ’83, dean for medical education at Chicago 34 University of Chicago Medicine on the Midway
McDade (left) works with undergraduate students in the Chicago Academic Medicine Program, or CAMP, which offers a glimpse of medical school. Photo by 20/20 Communications
Rashad Belin, PhD, a first-year medical student, said he chose Pritzker over several other regional schools because he wanted a school committed to recruiting and retaining underrepresented minority students. Belin, who had participated in summer research programs at another school when he was an undergrad, saw pipeline programs as a good sign of those diversity efforts. And there was another factor, too: “As a young African-American male going into medicine, it was important for me to see other African Americans in medicine,” he said. Belin, who grew up and now lives on the South Side of Chicago, knew he could find such mentors here because he had already met one. As a PhD candidate at the University of Illinois-Chicago, Belin met McDade at an event for the Sickle Cell Association of America. The two shared not only an interest in sickle cell disease (McDade’s research area as an anesthesiologist and critical care physician), but also a desire to help other underrepresented minorities enter medicine. Belin was working with the pipeline programs at UIC as McDade coordinated programs at Pritzker. It was McDade who helped guide Belin to Pritzker and coached him on his path to becoming an academic physician. Though still a medical student, Belin already is thinking about ways to help more minority students enter the field. He had a black physician growing up and was to some extent unaware of the underrepresentation of minorities in medicine. “Now that I’m in the field, I really do see the need,” Belin said. Mentorship also is important after medical students graduate. Underrepresented minorities often reach a professional plateau, particularly at academic centers. African Americans become full professors at a much lower rate than their white counterparts, according to a study published in the Journal of the American Medical Association, and many stay at the junior level for much of their careers. Three years ago, McDade started the Bowman Society, named after James E. Bowman, MD, the BSD’s first tenured AfricanAmerican professor and professor emeritus in the pathology and medicine departments to mentor students and faculty who traditionally are underrepresented in medicine. “The idea of a mentoring society came to my mind,” McDade said, adding that the group here emulates Harvard University’s Hinton Society, which has a similar purpose.
The Bowman Society brings faculty members from different facilities and sections—“in their own little hamlets,” McDade said— to talk about their work and create a network of peers and mentors. Its lecture series attracts faculty, staff and students to hear about research typically related to minority health or health disparities topics. The BSD’s Graduate Minority Committee works toward a similar goal—fellowship among minority students and faculty mentors— though in a less formal way. The committee provides a forum for minority students scattered among BSD departments to gather and find mentors or advice. When Carole Ober, PhD, became the chairwoman a few years ago, the committee asked students what problems they had. “A lot of them felt isolated,” Ober said. Faculty in the group support studentrun events to encourage students from different years and departments to socialize and discuss academic or personal issues. McDade, Belin’s mentor, knows there is more than conventional wisdom behind the power of seeing a peer at work in medical school. When McDade was a first-year medical student, he remembers explaining his work on an electron microscope to a group of high schoolers. Among the crowd was Eric Whitaker, a South Side teenager who found inspiration in seeing another young black man working in medicine. Whitaker earned a master’s degree in health policy and management at Harvard University before graduating from Pritzker in 1993. In recent years, he’s distinguished himself as the director of the Illinois Department of Public Health and founder of Project Brotherhood: A Black Men’s Clinic. He, too, returned to his South Side roots. In fall 2007, Whitaker became executive vice president for strategic affiliations and associate dean for community-based research at the University of Chicago Medical Center. (See story on page 10.) Yet it goes back to that one day 25 years ago, when a high school student watched another young black man working in a laboratory. “When he saw me doing that,” McDade said, “he saw himself. Sometimes, that’s all you really need.” Spring 2008 35
Medicine off the Midway CONSERVATION BIOLOGIST ALEX DEHGAN, JD, SM/PhD ’03, NOW WORKS IN THE NATION’S CAPITAL. PHOTO BY STEPHEN VOSS
A COLLECTOR OF SAK ER FALCONS AT A BAZAAR IN JALALABAD , AFGHANISTAN. PHOTO BY ALEX DEHGAN
RIS . PHOTO BY RICH HAR AN, AFGHANISTAN N OF THE WAKH GIO RE R MI PA BIG
MR. DEHGAN GOES TO WASHINGTON
THE WAKHAN CORRID OR IN THE BADAKHSHA N PROVINCE. PHOTO BY INAYAT ALI
BY CATHERINE GIANARO
AROUND WASHINGTON THESE DAYS, IT’S COMMON TO SEE EXPERIENCE IN AFGHANISTAN AND IRAQ ON THE RESUMES OF ADMINISTRATORS, DIPLOMATS AND MILITARY OFFICERS. IT’S NOT SO TYPICAL FOR A TROPICAL BIOLOGIST. But, then, Alex Dehgan is not a typical tropical biologist. This lawyer-turned-scientist-turned-policymaker currently works as a senior scientist and policy adviser for the Secretary of State and for the administrator of the U.S. Agency for International Development. His title brings with it a complicated charge: to develop science diplomacy initiatives for the Islamic world and policies on how to integrate science into U.S. foreign assistance programs. More simply put, to support scientific endeavors throughout the Islamic world. America leads the world in science, engineering and technology, and science is highly regarded throughout Islamic nations, Dehgan said. “The Islamic world was a cradle of science once: Islamic medicine and science led the world for centuries while Europe stagnated in the Dark Ages,” he said. “Science provides common language and values that cut across most religions and culture. We can work to support science and facilitate diplomacy simultaneously.” To do this, Dehgan looks strategically at how science can help achieve Washington’s diplomatic goals by incorporating science and 36 University of Chicago Medicine on the Midway
technology into foreign assistance and development programs for Islamic nations. “The focus of our foreign assistance is building economies, transforming agriculture and solving global health problems, as well as democracy building and supporting the rule of law,” he said. “Science and technology have a role to play in all of these.” For example, he said climate change “represents a fundamental threat to the national security of the United States in the coming century” because of its potential to affect and undermine many foreign-assistance goals. To focus on this threat within the Islamic world, Dehgan hopes to create a new organization, comprised of scientists, conservationists and international development experts. The group would focus on helping countries (failed and failing states) adapt to climate change and address environmental degradation by building scientific capacity to manage environmental problems and by training local scientists and officials to adapt to future environmental changes.
A ROAD LESS TRAVELED The words “uniquely qualified” are bandied about with ease in Washington. In Dehgan’s case, they actually seem true. The 38-year-old Iranian moved to the United States when he was 2. He earned his undergraduate degree at Duke University with a dual major in zoology and political science, glibly claiming “either way, I figured I was dealing with animal behavior.” He opted to follow political science first, studying law at the University of California. After graduating from Hastings College of the Law in 1993, Dehgan became a member of the California Bar and the Bar of the U.S. Court of International Trade, and clerked for the chief judge of the U.S. Court of International Trade. That’s when his career turned back to science: Dehgan earned a master’s degree and a doctorate in evolutionary biology at the University of Chicago in 2003. As part of his doctoral research, Dehgan directed the Ranomafana Fragments Project, spending two and half years in a tent in the southeastern rainforests of Madagascar. His research focused on the role of behavioral plasticity—why certain animals go extinct while others are able to survive changes in their habitats. More specifically, he studied the effects of tropical rainforest decline on 12 species of lemur. After graduating from Chicago, Dehgan received a diplomacy fellowship from the American Association for the Advancement of Science. He worked for the State Department to support scientific, environmental and legal aspects of U.S. policy in the Near East. In
2004, the State Department sent Dehgan to Baghdad to work with the Coalition Provisional Authority to help rebuild Iraq’s once-vital science and engineering culture. To help stabilize the nation and keep scientists from going to work for hostile forces, Dehgan recruited Saddam Hussein’s former weapons scientists for civilian work. Though he lived in the Green Zone, his work required him to travel throughout the city almost daily, which meant his time in Iraq was anything but calm: Dehgan narrowly avoided injury from a blast that destroyed many vehicles outside the Green Zone; was frequently being threatened by people clutching AK47s; and used his flak jacket as a blanket as he warily fell asleep in his quarters. Even as he left, “my plane and the airport came under fire,” Dehgan said in 2005. “The stress never stopped until I returned home—and even then, it took months before I could relax.” Dehgan’s work in Iraq didn’t go unnoticed. He received recognition from the departments of State and Defense with a Superior Honor Award and a Letter of Commendation, respectively. After returning to the States, Dehgan was posted in Washington as an adviser to the Secretary of State’s policy planning staff, working on Israel/Palestine, Syria/Lebanon and Western Sahara conflicts. But this scientist missed biology. So when the Wildlife Conservation Society (WCS) offered him a field job, he took it, even though it meant returning to a war zone. This time, Afghanistan. “It was a challenge,” Dehgan said. “But it was an opportunity to work on conservation in a country where nothing had ever been done Spring 2008 37
“SECURITY IS MUCH MORE THAN JUST BUYING GUNS. IT’S HELPING PEOPLE TO SURVIVE IN THE PLACE THAT THEY’RE IN.” A MAN WALKS DOWN A KABUL STREET WIT HA MOUNTED PERSIAN LEO PARD. PHOTO BY LISA YOOK
TRAVELING BY YAK IN KABUL. RVEY TRAINING BIODIVERSITY SU PHOTO BY ALEX DEHGAN
on conservation—no maps, no parks, minimal laws. The idea of being able to transition from what I was working on, as well as my prior experience, and then to bring in my scientific training was very intriguing to me.” Dehgan became the country director for the WCS’s Biodiversity Conservation Program. With a $6.9 million grant from the U.S. Agency for International Development and a staff that grew from two to 75, Dehgan’s projects in Afghanistan were as diverse as his background: The WCS conducted baseline surveys of the country’s wildlife populations; wrote legislation for Afghan environmental policies; began a science-based program in training and capacitybuilding; and helped the Afghan government build its national park system, curtail illegal wildlife trade and deforestation, and train communities to manage their natural resources. “Afghan people are very closely tied to their land,” Dehgan said, noting that 80 percent of Afghans are dependent on natural resources. “Their entire wealth, their entire survival in a very harsh part of the world is livestock and the few crops they grow to be able to feed that livestock.” When those natural resources are depleted, Afghans look elsewhere to survive, he said, adding that “the Taliban pays better wages than the Afghan national army.” “Security is much more than just buying guns,” he said. “It’s helping people to survive in the place that they’re in. This is the most fundamental aspect of security. If those natural resources are declining, you’re going to have a more serious problem no matter how many guns you buy.” Dehgan experienced those security problems firsthand. “When you’re in Kabul, you just don’t flock anywhere,” he said, describing the risks of kidnapping, bombings and other types of attacks. “You have to be very aware of your surroundings, which means you can’t do a lot of things that you may take for granted here.” Each staff member in Dehgan’s Afghan team was trained in advanced lifesaving techniques and in how to read mine maps and to work around landmines. Each field team was tracked via satellite phone and GPS, and there was a 24-hour evacuation plan no matter where they were in the country. And although each of the cars had $30,000 worth of upgrades, the drivers would flip a coin to determine which route to take traveling in Kabul. “If you can randomize it, you’re going to minimize your chances of becoming a target,” Dehgan said. Most importantly, “we remembered that we were guests of the community, and people respected us for it.” 38 University of Chicago Medicine on the Midway
Although his office was in Kabul, Dehgan and his staff conducted their field work mainly in three areas: the Wakhan, Nuristan and Band-E Amir regions. The far-reaching Wakhan, spared the country’s swelling violence, was a comparatively safe haven for travelers. But since the Wakhan is mostly roadless, each team member would spend a week on the back of a yak—a docile animal, Dehgan said—to get to the field site. “That one was a new one for me,” he admitted. Nuristan, made famous by Eric Newby’s A Short Walk in the Hindu Kush, is lush with deciduous and coniferous forests and mountains. Unfortunately, Dehgan didn’t get to travel in that area since it is home to the Taliban. Instead, he trained Afghans from that region to survey its wildlife. The third area, Band-E Amir, west of Kabul, is home to seven travertine lakes. Dehgan was working to build that area into a UNESCO (United Nations Educational, Scientific and Cultural Organization) World Heritage Site. This is one of many parks the WCS is working to establish throughout the country to develop tourism. Thirty years ago, tourism was the No. 2 source of income for Afghanistan. With 18,000-foot mountains that have never been climbed and a diverse wildlife that includes markhor, Marco Polo sheep, snow leopards, urials and Asiatic black bears, the country, Dehgan said, can once again become a popular place for eco-tourism. But Afghanistan’s rich wildlife also attracts a flourishing endangered species trade, part of which is supported by expatriates, U.S. and foreign military personnel and development organizations. “These people were doing good things going out there, but then buying things like snow leopard furs and driving the animals extinct,” Dehgan said. He fought back with a targeted advertising campaign, and he also worked with U.S. military police and officials since soldiers were unknowingly not only violating military regulations, but also breaking U.S. and Afghan laws. But the illegal wildlife trade wasn’t contained inside the borders of Afghanistan. According to Dehgan, small groups of Arabs and other foreigners would fly into the country on rented 737s and camp in the desert to hunt endangered birds—sometimes using the rare Saker falcon to hunt other endangered birds, like the Houbara bustard. Dehgan recalled a video he received that showed five men on a 737 with every row filled with the endangered animals. “You wonder how they can do this in the Kandahar and Hellman provinces, which are some of the most dangerous places in the world,” he said. “They do it by supporting the insurgencies.” Another challenge was recruiting staff, particularly women. “You just can’t go out and hire someone,” he said, “not just because there’s only an 11 percent literacy rate [among women], but there’s the additional problem of a very conservative social environment where the husbands won’t let the women out.”
A LAKE IN BAND-E AMIR, AFGHANISTAN. PHOTO BY CHRIS SHANK
Most of the staff in Kabul were Afghans. He recruited many scientists, including some who worked in the country 30 years ago and have returned to Afghanistan to work. With a 30 percent overall literacy rate in the country, training staff was a priority. “We brought in international experts, and we sent Afghans to other countries,” he said, recalling one group of Afghans—the first in 30 years—that traveled to Cambodia to learn how people there preserved environment and restored conservation efforts after experiencing the effects of a war-torn country. “It was a major culture shock,” he said. “We went to an indigenous village in Cambodia and introduced this group of Afghans, most of whom have never left their country. The first thing the indigenous villagers did was offer rice wine, which was a problem for devout Muslims. Our group tried to talk a way out of that faux pas at the time, but we had multiple language barriers.” Although Dehgan speaks Farsi—which is similar to the commonly spoken Dari language—most of the staff is trained in English. “We offered free English courses every morning. It may not seem to directly link to conservation work, but we thought it was key for people to reintegrate into science,” he said. Dehgan takes special pride in working toward the development of a proposed 15,000-square-mile transboundary peace park that includes Afghanistan, Pakistan, Tajikistan and China. “The basic idea was that if you can get people talking about science and environment and working together, maybe you can get people from these different countries to work together in other areas,” he said. “I think we made an incredible amount of progress in the time that we had. It’s not just an issue about environment,
which I think is intrinsically valuable in itself. It’s an issue about identity and security, and I think it’s important for people to realize that.”
CHANGING BATTLEFIELDS Dehgan often seems to take the road less traveled. For his vacation last year while serving in Afghanistan, he and his girlfriend, Kara Stevens, a former Peace Corps volunteer and colleague in Kabul, traveled to the jungles of the Bolivia Amazon. They hiked more than 140 miles of tropical rainforest in six days with 50-pound packs. “It was absolutely incredible,” Dehgan said. “We were bitten by every single type of insect. My girlfriend looked like a leopard when she was done because she had so many insect bites all over her body.” The highlight of the trip, according to this biologist, was spotting a different type of big cat: two jaguars in the wild, which “even the guide we were with had only seen one other one in 15 years,” he said. “We encountered two, which was pretty amazing.” After working and traveling in nearly 70 countries on five continents, Dehgan said he is enjoying his time back in Washington, and so is his family. “The entire time I was in Iraq, I told my mom I was working on the beach in Morocco,” he said. It wasn’t until he returned to the States that he told her where he really was. “But she was fine because she could see that I was still in one piece.” Now, to his mom’s delight, the only battles Dehgan fights are political. Spring 2008 39
Class Update 1940s Nicholas E. Collias, SB ’37, PhD ’42, was honored as a distinguished animal behaviorist for lifetime achievement in the field by the Animal Behavior Society. Colin G. Thomas Jr., SB ’40, MD ’43, completes his 56th year as a faculty member in the Department of Surgery at the University of North Carolina at Chapel Hill School of Medicine.
1950s John Jane was awarded the Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education. John Westley, PhB ’48, PhD ’54, professor emeritus of biochemistry and molecular biology at the University of Chicago, moved from Park Forest, Ill., to Hyde Park with his wife, Aiko Westley, SM ’54. They have three children. George G. Meyer, MD ’55, a life fellow of the American Psychiatric Association, teaches at the University of Texas Health Science CenterSan Antonio. A former University of Chicago psychiatry faculty member, Meyer continues to practice psychiatry in Texas three days a week. He and his wife of 54 years, Paula, have three sons and 10 grandchildren. John A. Jane, AB ’51, MD ’56, PhD ’67, co-founded Diffusion Pharmaceuticals LLC’s new scientific advisory board, which will provide scientific and medical advice on the company’s clinical development programs. He continues as director of the neurosurgical training program at the University of Virginia and recently was awarded the Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education. He also is editor of the Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics and the Journal of Neurosurgery: Spine. Max Forbes, MD ’57, received the 2006 President’s Award from the American Glaucoma Society. Charles S. Tidball, MD ’58, is a distinguished research scholar and co-director of the Tidball Center for the Study of Educational Environments at Hood College in Frederick, Md. He and his wife established the center after he retired from George Washington University in 1994, when he was designated a professor emeritus of computer medicine and neurological surgery. M.R. Koenigsberger, MD ’59, retired as director of child neurology at the University of Medicine and Dentistry of New Jersey and now leads the child neurology clinic at New York-Presbyterian Hospital.
1960s “For a motorcyclist, the peak is driving the Dragon’s Tail, a stretch of U.S. 129 with 318 turns in 11 miles.” —J. Curtis Kovacs, AB ’63, MD ’67
Judith (Tushnet) Broder, SB ’60, MD ’63, founded the Soldiers Project, which provides free psychological treatment to Operation
40 University of Chicago Medicine on the Midway
Iraqi Freedom/Operation Enduring Freedom active-duty service members. It’s made for “an amazing and time-intensive experience,” she said. Judith and her husband, Donald S. Broder, SB ’58, MD ’62, hope to stay in Los Angeles and spend time with their five grandchildren, ranging in age 9–16, who live nearby. Theodore Weis, MD ’64, completed his residency and fellowship in nephrology at the Michael Reese Medical Center and spent two years in the U.S. Army in Vietnam and at Walter Reed Army Medical Center. He then moved to Tucson, where he spent two years as a clinical assistant professor at the University of Arizona. Ultimately deciding to go into private practice, Weis moved to Walnut Creek, Calif., where, except for a few misguided attempts at retirement, he continues to practice part time. Past president of the medical staff at Mt. Diablo Hospital and the California Dialysis Council, he enjoys classical singing and performing major roles for Bay Area opera companies and orchestras. Michael L. Brownstein, SB ’62, MD ’66, practices as a plastic surgeon specializing in gender-related surgery. He serves on the board of directors and as chairman of the ethics committee for the World Professional Association for Transgender Health.
Edward Linn, MD ’74, serves as the 2007–2008 president of the Chicago Gynecologic Society. Last year, graduating residents from Rush University Medical Center named him Obstetrician and Gynecology Teacher of the Year.
Children’s Memorial Hospital in Chicago, Ill. Weese-Mayer, the center’s director, plans to have the newly constructed laboratory operational in April so she can “more comprehensively evaluate an expanded population of the special patient population” she serves.
David G. Ostrow, SB ’69, PhD ’74, MD ’75, published two major studies of factors contributing to HIV infections among men this past year. The first study, published in the journal AIDS and Behavior, showed the relationship between increasing rates of unprotected sex among men and reduced concern about HIV and safe-sex fatigue. The Journal of AIDS published the second study, co-authored by Ostrow and colleagues, about the affect of methamphetamines and volatile nitrites on HIV infection among susceptible men. Ostrow has chaired the MultiCenter AIDS Cohort Study Behavioral Working Group since 1999.
Nathan Moses Szajnberg, AB/MD ’74, was appointed as a visiting scholar to the Freud Center of the Hebrew University in Jerusalem, where he teaches courses in psychoanalysis and the representation of inner life in Western literature, from “Bible to Bellow,” he writes.
Julian J. Rimpila, SM/MD ’66, received the 2007 American Medical Association Outreach Award this past November.
Maga Jackson-Triche, AB ’71, MD ’75, moved from New Orleans to Sacramento, Calif. She serves as director of mental health for the VA Northern California Healthcare System. She is also professor of clinical psychiatry at the University of California-Davis.
Robert Rodnitzky, SB ’63, MD ’66, became head of the Department of Neurology at the University of Iowa Hospitals and Clinics and the University of Iowa College of Medicine, where he has taught since 1972.
W.K. Alfred Yung, MD ’75, begins his 26th year at the M.D. Anderson Cancer Center at the University of Texas. “Glad to see our brain tumor research program is growing extremely well,” he writes.
J. Curtis Kovacs, AB ’63, MD ’67, spends time cruising on a BMW K1200LT with his wife, Lucy. The couple recently trekked 8,001 miles on a motorcycle journey that included travels to the Maine coast, over the tops of New Hampshire and Vermont, and the entire length of the Blue Ridge Parkway. He wrote, “For a motorcyclist, the peak is driving the Dragon’s Tail, a stretch of U.S. 129 with 318 turns in 11 miles.”
Mark L. Friedman, AB ’73, MD ’77, recently was elected to life fellowship in the American College of Emergency Physicians and continues to practice as assistant clinical professor of trauma and emergency medicine at the University of Connecticut. He also serves as chief executive officer for Premium HealthCare Services, a medical cost containment consulting firm. Friedman lives with his wife, Mary, and their son, Glen, in Westport, Conn., where his pastimes are skiing, cycling and sailing. One son, Adam, works in Colorado and another, John, in Illinois. His daughter, Laura, attends the Art Institute of Chicago.
Judith Strommer, SB ’66, SM ’69, is a professor of plant agriculture at the University of Guelph in Ontario, Canada.
1970s During one volunteer stint with Habitat for Humanity at the Jimmy Carter Work Project in Los Angeles, Ward Rice served as crew leader for the siding crew that included Garth Brooks and Miss World. Alan I. Faden, MD ’71, professor of neuroscience, neurology and pharmacology at Georgetown University Medical Center, serves as president for the American Society for Experimental NeuroTherapeutics and as editor in chief of the journal Neurotherapeutics. William W. McIntyre, MD ’72, is chief of medicine at the Cheyenne VA Medical Center in Wyoming, where he also serves as director of the gastroenterology, hepatology and chemotherapy clinic. William W. Jacobs Jr., SM ’71, PhD ’73, reports that he works as a biologist for the Environmental Protection Agency Office of Pesticide Programs in Arlington, Va.
Ralph W. Kuncl, PhD ’75, MD ’77, a neuroscientist, was named provost of the University of Rochester this past August. Richard M. Bergenstal, MD ’76, serves as executive director of the International Diabetes Center in Park Nicollet, Minn., where he is the principal investigator on the organization’s National Institutes of Health-funded trials. The American Diabetes Association recently awarded Bergenstal the Outstanding Physician Clinician in Diabetes Award. Art Reingold, AB ’70, MD ’76, joined the School of Public Health at the University of California-Berkeley, as professor and chairman of the epidemiology division, with concurrent appointments in medicine and epidemiology at the University of California-San Francisco School of Medicine.
“The advantages of being my own boss in private practice have been quite liberating.” —Janet Hill Prystowsky, MD ’83
Walter J. Scott, MD ’81, became chief of thoracic surgery for the Fox Chase Cancer Center in Philadelphia this past October. Since joining Fox Chase in 2001, Scott has developed a minimally invasive thoracic surgery program that performs procedures such as robotic pulmonary resections and video-assisted thoracoscopic surgery. Bennett Shatkin, MD ’81, and his wife, Anne, recently downsized “now that the kids are out of the house.” They live on a golf course in Moorestown, N.J., though Bennett notes, “I still cannot golf.” Louis Philipson, PhD ’82, MD ’86, professor of endocrinology at the University of Chicago, received the 2007 Outstanding Scientist Award from the National Disease Research Interchange. Ronald M. Davis, MD ’83, became the 162nd president of the American Medical Association this past year. He works as the director of the Center for Health Promotion and Disease Prevention at Detroit’s Henry Ford Health System. Mary G. Cormier, MD ’83, lives in Virginia with her husband, Gregory Love, and their six children (three biological, three adopted). When not immersed in their family routine of dinners, music and exercise, Cormier swims and says she has “rediscovered my college bicycle.” In her professional life, Cormier works at Georgetown University Hospital and gives a monthly lecture on chest radiology. “I am not in touch with any of our classmates,” she writes, “but would love to hear from any of you.” Janet Hill Prystowsky, MD ’83, taught at the College of Physicians and Surgeons at Columbia University for 14 years before starting her private practice in 2002. While she enjoyed researching cultured keratinocytes and clinical studies of psoriasis and artificial skin, Prystowsky writes, “the advantages of being my own boss in private practice have been quite liberating.” Two of her four children will graduate from law school in May of this year. As for the other two, one is a college junior and the other is a high school sophomore. Her husband chairs the pathology department at the Albert Einstein College of Medicine, which keeps Prystowsky “associated, albeit at arms length, with academia.” Nicholas P. Sauter, MD ’83, switched from academic medicine to industry two years ago and now works in clinical development for the Novartis oncology business unit.
Ward R. Rice, PhD ’76, MD ’78, volunteers with Habitat for Humanity at the Jimmy Carter Work Project in Los Angeles. During one volunteer stint with the organization, he served as crew leader for the siding crew that included Garth Brooks and Miss World.
R. Lawrence Hatchett, MD ’85, was inducted into the West Aurora (Ill.) High School Distinguished Alumni Hall of Honor. An accomplished urologist, he founded Incontinence Center Consultants Inc. in 1996.
Debra E. Weese-Mayer, MD ’78, has announced the opening of the first Center for Autonomic Medicine in Pediatrics, located at
Neil Hersh, AB ’81, MD ’85, recently joined a multispecialty group and does neck and back rehabilitation. He and his wife, Jean, enjoy Spring 2008 41
Match Day Results living in Bakersfield, Calif., with their 8-year-old daughter, Anna, but they miss Chicago pizza. Joseph Geradts, MD ’87, returned to North Carolina in 2005 after a seven-year hiatus. Now a pathology professor at Duke University, he combines teaching, research and surgical pathology with an emphasis on breast cancer. David Toub, AB ’83, MD ’87, serves as vice president and medical director for SciFluent, a continuing medical education company, and will represent the organization at this year’s Continuing Medical Education Congress in Vancouver. Toub’s alter ego composes music, available for free at homepage.mac.com/dtoub/dbtmusic.html. Michele M. A. David, MD ’88, recently was promoted to associate professor of medicine at the Boston University School of Medicine. She also serves as director of community health programs for the Boston University Center of Excellence in Women’s Health, second vice president of the Association of Haitian Physicians Abroad and co-director for the Boston Medical Center Haitian Health Institute. David’s artwork has been exhibited at the Fort Smith (Ark.) Art Center, the Mennonite Heritage Center in Harleysville, Pa., the Museum of Biblical Arts in New York City and the Cincinnati Museum Center, among others. Andrew Satinsky, AB ’85, MD ’89, moved with his wife, Marla, and their two sons to Chevy Chase, Md., after 14 years living in Milwaukee, Wis. Satinsky works as a radiation oncologist at Georgetown University Hospital.
1990s John Alroy received the Schuchert Award of the Paleontological Society from the Geological Society of America. Rajiv Jauhar, MD ’91, completed his interventional cardiology training at Cornell Medical Center and is now the director of interventional cardiology at Long Island Jewish Medical Center in New York. Hossein Jadvar, MD’93, PhD, MPH, MBA, works as a tenured associate professor in radiology and biomedical engineering at the University of Southern California, where he also is director of radiology research. Jadvar is a charter member of the National Institutes of Health-National Cancer Institute Medical Imaging study section, and the Los Angeles Radiological Society appointed him president of its nuclear medicine section. Russell Khater, SB ’90, MD/MBA ’94, was named president-elect of Provena St. Joseph Medical Center in Joliet, Ill. John Alroy, SM ’93, PhD ’94, received the Schuchert Award of the Paleontological Society from the Geological Society of America. An associate researcher at the Santa Barbara, Calif., National Center for Ecological Analysis and Synthesis, he is the only person to win both the Schuchert and the Society of Vertebrate Paleontology’s Romer Prize. Petar Igic, MD ’99, writes that he and his wife, Jennifer Penzotti, MD ’99, moved to Madison, Wis., after completing their training. Their children are ages 5, 3 and 1, and the family stays “plenty busy on all fronts,” but, Igic writes, he looks forward to seeing everyone soon.
42 University of Chicago Medicine on the Midway
Road to White House begins at Pritzker
What Chicago recruits will do:
Internal Medicine 24 Pediatrics 8 Family Practice 6 Emergency Medicine 5 General Surgery 5 Medicine, Preliminary 5 Obstetrics and Gynecology 5 Medicine, Primary Care 4 Orthopaedic Surgery 4 Pathology 4 Transitional 4 Medicine, Pediatrics 3 Anesthesiology 2 Neurology 2 Neurological Surgery 2 Physical Medicine & Rehab 2 Psychiatry 2 Surgery, Preliminary 2 Urology 2 Radiology, Diagnostic 1 Medicine, Psychiatry 1 Plastic Surgery 1 Otolaryngology 1
hile preparing for a career path in health care at the University of Chicago Pritzker School of Medicine, Jaewon Ryu, JD ’01, MD ’04, didn’t know his journey would lead him to Bob Costas, Colin Powell and President George W. Bush. But meeting policymakers and decision leaders is now routine for the 33-year-old Pritzker grad, who is serving this year as a White House Fellow in the Department of Veterans Affairs. “We have a speaker series where we meet with three to four people each week for a brown bag lunch,” Ryu said. “We get to have off-the-record, frank discussions to learn about how leadership and decision-making happen at the highest levels of business and government.” The White House Fellowship is a non-partisan program in which participants are placed in various government agencies and report to Cabinet-level leaders. In addition to the speaker series, the fellows attend four policy trips to learn about issues ranging from labor and management to global competitiveness. During one such trip to Detroit, the fellows met Ford Motor Company Chairman Bill Ford and United Auto Workers President Ron Gettelfinger. The meetings became especially timely: They coincided with the October 2007 strike of the United Auto Workers. “We talked to them to learn their perspective on what was happening,” Ryu said. Ryu’s Washington office works on issues such as meeting the complex demands for health care among the aging veterans’ population and the influx of soldiers returning from Iraq and Afghanistan. “It was a nice placement exposure to health care,” Ryu said, noting the opportunity to use his medical knowledge in a policymaking setting. “It’s been great just learning about the VA’s health system.” He didn’t exactly take a straight road from medical school to working for the largest integrated health care provider in the United States. Ryu enrolled in Pritzker in 1996, then took a leave of absence in 1998 to earn a degree from the University of Chicago Law School. He then worked as a corporate health care attorney for the firm McDermott, Will and Emery. “I wanted to understand the regulatory overlay that permeates the whole health care system,” Ryu said. “Health care is a business. It’s a highly-regulated industry, and it’s a hot-button topic in the political world.” Then in 2002, he returned to Pritzker. He completed his residency in June 2007 at Harbor-UCLA Medical Center, where he worked in emergency medicine. Now at the headquarters of the Department of Veterans Affairs on Vermont Avenue, Ryu puts all his varied academic and work experience to use. “There are people who can approach the subject of medicine from a variety of backgrounds. It’s increasingly interdisciplinary,” he said. “I think the U of C really fostered my understanding of that.” —Megan Seery
From top right: Audrey Brewer (center) is heading to Advocate Christ Medical Center, and Jocelyn Slaughter (left) to Morehouse School of Medicine; Troy Leo, Stanford; Pritzker spirit; Danielle Kiggins (left) and Bahareh Khatibi, UC-San Diego; and (from left) Alan Thong, Stanford, David Sisul, UC-San Diego, Caroline Cottrell, University of Pennsylvania, Danielle Kiggins, UC-San Diego, David Konczal, UC-Davis, and Michael Luc, Georgetown. Photos by David Christopher
Where Chicago recruits will go: University of Chicago Medical Center 18 Northwestern University Hospitals, IL 7 Columbia University Medical Center, NY 5 University of California-San Francisco Medical Center 4 University of California-San Diego Medical Center 4 University of Washington Affiliated Hospitals 3 Stanford University Programs, CA 3 Children’s Hospital Boston, MA 2 Einstein/Montefiore Medical Center, NY 2 Georgetown University Hospital, DC 2 Hospital of the University of Pennsylvania 2 Johns Hopkins Hospital, MD 2 Oregon Health and Science University 2 Brigham and Womens Hospital, MA 2 SAUSHEC-Lackland Air Force Base, TX 2 Yale-New Have Hospital, CT 2 University of Wisconsin Hospital and Clinics 2 Advocate Christ Medical Center, IL 1 Beth Israel Deaconess Medical Center, MA 1 Barnes-Jewish Hospital, MO 1 Baylor College of Medicine-Houston, TX 1 Children’s Hospital of Philadelphia, PA 1 Denver Health Medical Center, CO 1 George Washington University, DC 1 Indiana University School of Medicine 1 Kaiser Permanente Oakland Medical Center, CA 1 MacNeal Memorial Hospital, IL 1 Massachusetts General Hospital 1 Mayo School of Graduate Medical Education, MN 1 Morehouse School of Medicine, GA 1 Mt. Sinai Hospital, NY 1 Presbyterian Hospital of Dallas, TX 1 Brown University Rhode Island Hospital 1 St. Joseph’s Hospital, AZ 1 University of Alabama-Birmingham Medical Center 1 University of Illinois-Chicago COM 1 University of Iowa Hospitals and Clinics 1 University of Michigan-Ann Arbor Hospitals 1 University of North Carolina Hospitals 1 University of Southern California 1 University of Tennessee-Chattanooga COM 1 University of Wisconsin School of Medicine and Public Health 1 University of California-Davis Medical Center 1 University of Illinois-Chicago/Advocate Illinois Masonic Medical Center FMR 1 University Hospitals Case Medical Center, OH 1 University of Pittsburgh Medical Center MEP, PA 1 Ventura County Medical Center, CA 1 Spring 2008 43
William O. Ogle, SM ’93, PhD ’98, teaches in the J. Crayton Pruitt Family Department of Biomedical Engineering at the University of Florida. In 2006, the Ellison Medical Foundation awarded him a New Scholar in Aging Award to research hormonal control of plasticity, memory and neurogenesis. Michael Allen Gertz, MD ’97, had a son, Brandon Isaiah Gertz, in November 2007.
2000s Stephen Keefe sends good wishes to all. He says he’d love to hear from classmates at stephen.keefe@uphs. upenn.edu. Rachel Jones-Stringfellow, AB ’96, MD ’00, enjoys sweet tea in Clinton, Miss., where she works in a private practice group. She practiced in a community health center in Jackson, Miss., after completing her family-practice residency at West Suburban Hospital in Oak Park, Ill. In Jackson, she met and married Eric Stringfellow, a journalist and professor.
In Memoriam 1930s
After retiring in 1984, Benjamin Libet continued his research on the physical origins of consciousness and free will. Alan P. Freedberg, MD ’35, a dermatologist, practiced at Massachusetts General Hospital for more than 50 years. He died in January 2007 and is survived by his wife, Charlotte, two sons and two grandchildren. Benjamin Libet, SB ’36, PhD ’39, died at the age of 91 in July 2007. After serving in the Air Force materials-engineering lab during World War II, Libet, a physiologist, joined the University of California-San Francisco. After retiring in 1984, he continued his research on the physical origins of consciousness and free will. He is survived by his wife, Fannie E. Libet, AB ’40, two sons and two daughters.
school’s Albert Einstein Medical College from 1955 to 1992. A groundbreaking hematologist, he helped uncover the functions of a hereditary disorder that impairs the ability of red blood cells to transport oxygen. Survivors include his wife of 58 years, Jane; a son, Richard; a daughter, Stephanie Green; and four grandchildren. Daniel E. Koshland Jr., PhD ’49, was a biochemist who worked on the Manhattan Project. He died in mid-July in Walnut Creek, Calif., at the age of 87. Koshland reorganized the biology department and had a research building named for him at the University of California-Berkeley after joining the school’s faculty in 1965. He received the National Medal of Science in 1990 and edited the journal Science from 1985 to 1995. The University of Chicago awarded him an honorary Doctor of Science degree in 1992. Koshland’s first wife, Marian “Bunny” Koshland, to whom he was married 52 years, died in 1997. His survivors include his second wife, Yvonne, two sons, three daughters, three stepchildren, two sisters, nine grandchildren, 12 step-grandchildren, one great-granddaughter and 17 step-great-grandchildren.
Jeremy Mayes, SB ’98, SM ’01, lives on the north side of Chicago with his wife, Angira Patel, AB ’97, MD, who completed her pediatric residency at the University of Chicago Medical Center, and their two children, Sofia and Kieran.
Marguerite Faerber Riddick, SB ’36, SM ’39, died in mid-April in Santa Fe, N.M. A dietician, Riddick worked at Yale’s New Haven Hospital in Connecticut, and for the federal government. For some 20 years, she also served as a docent for the National Gallery of Art. Survivors include a son, a daughter, seven grandchildren and three great-grandchildren.
Ekaterina Korobkova, SM ’02, PhD ’04, joined the John Jay College of Law as assistant professor in the sciences.
Michael Rubin, MD ’02, serves as a vitreoretinal surgery fellow at the Massachusetts Eye and Ear Infirmary. Last year, his wife gave birth to their son.
A groundbreaking hematologist, Ernst Richard Jaffe helped uncover the functions of a hereditary disorder that impairs the ability of red blood cells to transport oxygen.
Irving S. Bengelsdorf, SM ’48, PhD ’51, worked as a research chemist with U.S. Borax before becoming a science editor for the Los Angeles Times in 1961. He died in Oceanside, Calif., at the age of 84. Bengelsdorf later taught at the University of California-Los Angeles and the University of Southern California. He also directed science communications at the Jet Propulsion Laboratory. He leaves behind his wife, Beverly, three daughters and a grandchild.
Albino J. Marchello, SB ’41, MD ’44, of Billings, Mont., died in June 2007.
Jane Overton, PhD ’50, see “Former Faculty/Housestaff” entry.
George Krakowka, SB ’43, MD ’45, died this past July in Wenatchee, Wash., where he retired after serving in the Helena (Mont.) Veterans Hospital and as a fellow at the Mayo Clinic. He leaves behind his wife, Patti, a son, two daughters and six grandchildren.
Stanley L. Miller, PhD ’54, died at the age of 77 in National City, Calif. A biochemistry and chemistry professor emeritus, Miller belonged to the National Academy of Sciences and the American Chemical Society. He joined the University of California-San Diego in the early 1960s and served as president of the International Society of the Study of the Origin of Life. He is survived by a brother.
Stephen Keefe, MD ’03, writes that he and his wife, Gillian Gottlieb, are doing well in Philadelphia with Eliza, 6, Tessa, 4, and Max, 2. Keefe has another year and a half of training left in hematology and oncology at the University of Pennsylvania and sends good wishes to all. He says he’d love to hear from classmates at stephen.keefe@ uphs.upenn.edu. Elizabeth Kieff, MD ’03, writes that she and her husband, Tom Levinson, JD ’05, still live in Hyde Park with their son, Asher, and would love to see everyone this spring. Daniel Aaron Pollyea, MD ’03, married Jessica Joy Gadeken this past May at the University of Chicago’s Newberry Library. He served as a chief resident at Cook County Hospital and now works as a hematology and oncology fellow at Stanford University. The couple lives in Menlo Park, Calif. Luba Romantseva, AB ’00, MD ’04, gave birth to Alexander Benjamin Blander on Nov. 26. She and her husband, Benjamin Blander, SB/ SM ’98, PhD ’03, live and work in Chicago. Jaewon Ryu, JD ’01, MD ’04, was chosen for the 2007–2008 class of White House Fellows. He serves as a special assistant in the Department of Veterans Affairs. Joseph Sorg, PhD ’06, married his wife, Jaime, in October 2006. The couple now lives in Boston, where Joseph researches as a fellow for Tufts University. Paula Williams, MD ’06, and her husband, Jason, had a baby girl, Ainsley Evelyn Williams, in August. The newborn weighed in at 6 pounds, 7 ounces. 44 University of Chicago Medicine on the Midway
Raymond E. Robertson, SB ’43, MD ’45, operated a private practice as a psychiatrist for 53 years before his death in October. He served in the Army Medical Corps before directing the University of Illinois at Chicago’s Institute for Juvenile Research and later the Illinois Department of Mental Health. Robertson also served as a clinical professor at Loyola University Chicago Stritch School of Medicine and worked as clinical director for the adolescent unit at Riveredge Hospital in Forest Park, Ill. He is survived by his wife, Mary B. Robertson, SB ’45, his son, his daughter and four grandchildren. John Hogness, U-High ’39, SB ’43, MD ’46, died in Seattle this past July. Hogness served as dean of the University of Washington School of Medicine beginning in 1964, then became the university’s president in 1974. The National Academy of Science named him the first president of its Institute on Medicine. Survivors include his wife, Margaret, two sons, three daughters and four stepchildren. Ernst Richard Jaffe, SB ’45, MD/SM ’48, died at the age of 83 on Feb. 16, 2008. After graduating from and teaching at the University of Chicago, Jaffe went on to complete post-doctoral work at Yeshiva University. There, he served as a teacher and administrator at the
Duncan E. Govan received a Rotary Foundation fellowship for his help establishing a free health care clinic and an Alwin C. Rambar Award for patient care.
Duncan E. Govan, PhD ’57, a two-time winner of the Henry Kaiser Foundation Award, died in September in Portola Valley, Calif. A member of Stanford University’s urology department since 1961, Govan received a Rotary Foundation fellowship for his help establishing a free health care clinic and an Alwin C. Rambar Award for patient care. Govan leaves behind his wife, Paddy, two daughters, four sons and 15 grandchildren.
1960s Pediatric cardiologist Charles L. Cooper founded a camp for pediatric heart disease patients. Robert E. DeMar, SM ’60, PhD ’61, a vertebrate paleontologist and research associate at the Field Museum, died in Chicago in April. An expert in the teeth and jaws of Paleozoic and Mesozoic reptiles, he joined the University of Illinois at Chicago in 1956 and helped found the school’s geology department.
Sherwin Harold Rubenstein, SB ’59, SM ’61, died earlier this year at the age of 70. Survivors include his wife, Judith; a daughter, Jennifer; two sons, Jason and Robert; three grandchildren; and two nieces. Lewis S. Seiden, AB ’56, SB ’58, PhD ’62, see “Former Faculty/ Housestaff” entry. Charles L. Cooper, MD ’64, died in Tulsa, Okla., in November 2000. A pediatric cardiologist, he founded a camp for pediatric heart disease patients and served as a faculty member at the University of Oklahoma Medical School for more than 30 years.
Former Faculty/Housestaff Lewis S. Seiden, a pioneer of psychopharmacology, published more than 220 scientific papers and 40 book chapters on neurochemistry, the brain and behavior, drug effects and neurotoxicity. Jane Overton, PhD, professor emerita in molecular genetics and cell biology at the University of Chicago, died in June 2007 at the age of 88. The granddaughter of William Rainey Harper, the first president of the University of Chicago, Jane Harper grew up in Hyde Park and went on to earn a bachelor’s degree from Bryn Mawr College in 1941. She married George Overton, a prominent Chicago lawyer and political activist, and completed a PhD at Chicago before joining the faculty as a research assistant in zoology in 1950. Among the first to use the electron microscope for research, Overton rose through the ranks and became a professor of biology in 1972 before joining the newly created Department of Molecular Genetics and Cell Biology in 1985. Widely published in the areas of genetics and cell biology, Overton belonged to the American Society for Cell Biology and the American Association for the Advancement of Science. Later in her life, Overton further explored her visual talent and studied at the School of the Art Institute of Chicago. In the 1990s, several Chicago and New York art galleries exhibited her artwork, which also was featured in two solo shows at the Artemisia Gallery in Chicago. Overton leaves behind a daughter, two sons and two grandchildren. Lewis S. Seiden, PhD, a pioneer of psychopharmacology and professor emeritus at the University of Chicago, died in July 2007 after a 50-year battle with dystonia, a neurological movement disorder. Seiden grew up in Chicago’s South Shore neighborhood and went to a rural high school close to the newly created suburb of Park Forest before receiving early admission and a full-tuition scholarship to the University of Chicago. Diagnosed with the disease at age 20, he had originally planned to attend medical school but the illness tilted his interests toward neurobiology. Seiden graduated from Chicago with his AB in 1956, his SB in 1958 and his PhD in 1962. An expert on how drugs, especially amphetamines, can selectively damage certain neurons, Seiden published more than 220 scientific papers and 40 book chapters on neurochemistry, the brain and behavior, drug effects and neurotoxicity. In addition to rising through the academic ranks and becoming a full professor in 1977, he served on various national committees, including the President’s Advisory Committee on Mental Health, the board of scientific counselors for the National Institute of Environmental Health Services, and the Life Sciences Working Group for the National Aeronautics and Space Administration. He leaves behind his wife, Anne (Maxwell) Seiden, AB ’59, MD ’64, three children and a grandson.
Spring 2008 45
Perspective Rudi Schmid, MD, PhD, an expert in diseases of the liver and a former University of Chicago faculty member, died in Kentfield, Calif., this past October. In 1966, the University of California-San Francisco recruited him to establish a division of gastroenterology at the medical school, where he went on to establish a strong basic research program. He is survived by his wife of 58 years, Sonja, a son, a daughter and one grandchild.
Fred Winsberg, MD, retired professor of radiology at the University of Chicago, died this past November. Survivors include his wife, Katherine Davison-York, a daughter, a son, two step-children and three grandchildren.
Endowment fund honors pathologist
Excerpted from Your Inner Fish by Neil Shubin © 2008 by Neil Shubin. Reprinted with permission by Pantheon Books, a division of Random House, Inc.
FINDING FISH FINGERS AND WRISTS
“He was a pathologist’s pathologist. A terrific guy, a punster par excellence, an active participant in the academic and social life of the University and a valued, outgoing colleague who was concerned about and enormously helpful to those who worked or studied with him.” —Godfrey Getz, MD, Distinguished Service Professor of Pathology and of Biochemistry and Molecular Biology
R esearch training for
pathology residents will receive a boost from a new fund created in Robert W. Wissler, SM ’43, PhD ’46, MD ’48 honor of Robert W. (1917-2006) Wissler, SM ’43, PhD ’46, MD ’48. Wissler, who died in November 2006, was the Donald N. Pritzker Distinguished Service Professor emeritus in pathology. Wissler “trained hundreds of pathologists, was a mentor to many and a friend to all,” said Seth Haber, SM/MD ’58, retired chief of pathology at Kaiser Permanente Medical Center in Santa Clara, Calif. Now, former students and colleagues have created the Robert W. Wissler Fund, which aims to raise $150,000 to create an endowment that will support research training in pathology. After earning his doctorate, Wissler became an associate professor of pathology at the University of Chicago, where he remained the rest of his career. He served as chairman of pathology from 1957 to 1972, and then became director of the Specialized Center of Research in Atherosclerosis at the university, one of the first centers to focus on atherosclerosis—the buildup of fatty deposits on arterial walls that is a major cause of clogged arteries.
Known for documenting the effects of elevated cholesterol and smoking on atherosclerosis in teenagers and young adults, Wissler tirelessly advocated for understanding how heart disease develops. He pioneered studies of the immune system and connecting the arterial disease with the role of smooth muscle cells that line vessels. After developing some of the first non-human primate animal models for studying arterial disease, he showed that drastically reducing dietary fat decreases artery-clogging plaques. “He was a pathologist’s pathologist,” said colleague Godfrey Getz, MD, distinguished service professor of pathology and of biochemistry and molecular biology at Chicago. “He was at the top of preventive pathology. He played a role in all of the major societies in the field and received leading awards and honors from most of them.” More than $80,000 has been collected for the fund so far. The Wissler family will match gifts up to $50,000. Gifts can be made online at https://alumniservices.uchicago.edu/Giving/ or by calling (888) 303-0030. Getz, who made a personal donation to the fund, added that the fund is a way to perpetually honor “a terrific guy, a punster par excellence, an active participant in the academic and social life of the University and a valued, outgoing colleague who was concerned about and enormously helpful to those who worked or studied with him.” —Megan Seery
by Neil Shubin, PhD
In 1995, Ted Daeschler and I had just returned to his house in Philadelphia after driving all through central Pennsylvania in an effort to find new roadcuts. We had found a lovely cut on Route 15 north of Williamsport, where PennDOT had created a giant cliff in sandstones about 365 million years old. The agency had dynamited the cliff and left piles of boulders alongside the highway. This was perfect fossil-hunting ground for us, and we stopped to crawl over the boulders, many of them roughly the size of a small microwave oven. Some had fish scales scattered throughout, so we decided to bring a few back home to Philadelphia. Upon our return to Ted’s house, his four-year-old daughter, Daisy, came running out to see her dad and asked what we had found.
Medicine on the Midway Bulletin of the Medical and Biological Sciences Alumni Association Spring 2008, Volume 61, No. 2 Editor Catherine Gianaro Contributing editors John Easton, Tom Hallman Editorial contributors Katie Scarlett Brandt, John Easton, Catherine Gianaro, Scot Roskelley, Megan Seery, Neil Shubin, PhD, Susan Soric and Suzanne Wilder Design firm Words&Pictures, Inc. Editorial committee Chairman Coleman Seskind, AB ’55, SB ’56, SM/MD ’59; 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 46 University of Chicago Medicine on the Midway
Medicine on the Midway is published for alumni, faculty and friends of the University of Chicago Biological Sciences Division and 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) 702-6241 Facsimile (773) 702-3171 E-mail editor email@example.com E-mail class news firstname.lastname@example.org Find us on the Web www.uchospitals.edu/midway
In showing Daisy one of the boulders, we suddenly realized that sticking out of it was a sliver of fin belonging to a large fish. We had completely missed it in the field. And, as we were to learn, this was no ordinary fish fin: it clearly had lots of bones inside. People in the lab spent about a month removing the fin from the boulder—and there, exposed for the first time, was a fish with [anatomist Sir Richard] Owen’s pattern. Closest to the body was one bone. This one bone attached to two bones. Extending away from the fin were about eight rods. This looked for all the world like a fish with fingers. Our fin had a full set of webbing, scales, and even a fish-like shoulder, but deep inside were bones that corresponded to much of the “standard” limb. Unfortunately, we had only an isolated fin. What we needed was to find a place where whole bodies of creatures could be
recovered intact. A single isolated fin could never help us answer the real questions: What did the creature use its fins for, and did the fish fins have bones and joints that worked like ours? The answer would come only from whole skeletons. For that find, we had to search almost ten years. And I wasn’t the first to recognize what we were looking at. The first were two professional fossil preparators, Fred Mullison and Bob Masek. Preparators use dental tools to scratch at the rocks we find in the field and thereby expose the fossils inside. It can take months, if not years, for a preparator to turn a big fossil-filled boulder like ours into a beautiful, research-quality specimen. During the 2004 expedition, we had collected three chunks of rock, each about the size of a piece of carry-on luggage, from the Devonian Spring 2008 47
of Ellesmere Island. Each contained a flatheaded animal: the one I found in ice at the bottom of the quarry, Steve [Gatesy]’s specimen, and a third specimen we discovered in the final week of the expedition. In the field we had removed each head, leaving enough rock intact around it to explore in the lab for the rest of the body. Then the rocks were wrapped in plaster for the trip home. Opening these kinds of plaster coverings in the lab is much like encountering a time capsule. Bits and pieces of our life on the Arctic tundra are there, as are the field notes and
scribbles we make on the specimen. Even the smell of the tundra comes wafting out of these packages as we crack the plaster open. Fred in Philadelphia and Bob in Chicago were scratching on different boulders at the same general time. From one of these Arctic blocks, Bob had pulled out a particular small bone in a big fin of the Fish (we hadn’t named it Tiktaalik yet). What made this cube-shaped blob of bone different from any other fin bone was a joint at the end that had spaces for four other bones. That is, the blob looked scarily like a wrist bone—but the fins in the block that Bob was preparing were too jumbled to tell for sure. The next piece of evidence came from Philadelphia a week later. Fred, a magician with his dental tools, uncovered a whole fin in his block. At the right place, just at the end of the forearm bones, the fin had that bone. And that bone attached to four more beyond. We were staring at the origin of a piece of our own bodies inside this 375-million-year-old fish. We had a fish with a wrist.
48 University of Chicago Medicine on the Midway
Over the next months, we were able to see much of the rest of the appendage. It was part fin, part limb. Our fish had fin webbing, but inside was a primitive version of Owen’s one bone–two bones–lotsa blobs–digits arrangement. Just as Darwin’s theory predicted: at the right time, at the right place, we had found intermediates between two apparently different kinds of animals. Finding the fin was only the beginning of the discovery. The real fun for Ted, Farish [Jenkins], and me came from understanding what the fin did and how it worked, and in guessing why a wrist joint arose in the first place. Solutions to these puzzles are found in the structure of the bones and joints themselves. When we took the fin of Tiktaalik apart, we found something truly remarkable: all the joint surfaces were extremely well preserved. Tiktaalik has a shoulder, elbow, and wrist composed of the same bones as an upper arm, forearm, and wrist in a human. When we study the structure of these joints to assess how one bone moves against another, we see that Tiktaalik was specialized for a rather extraordinary function: it was capable of doing push-ups. When we do push-ups, our hands lie flush against the ground, our elbows are bent, and we use our chest muscles to move up and down. Tiktaalik’s body was capable of all of this. The elbow was capable of bending like ours, and the wrist was able to bend to make the fish’s “palm” lie flat against the ground. As for chest muscles, Tiktaalik likely had them in abundance. When we look at the shoulder and the underside of the arm bone at the point where they would have connected, we find massive crests and scars where the large pectoral muscles would have attached. Tiktaalik was able to “drop and give us twenty.” Why would a fish ever want to do a pushup? It helps to consider the rest of the animal. With a flat head, eyes on top, and ribs, Tiktaalik was likely built to navigate the bottom and shallows of streams or ponds, and even to flop around on the mudflats along the banks. Fins capable of supporting the body would have been very helpful indeed for a fish that needed to maneuver in all these environments. This
interpretation also fits with the geology of the site where we found the fossils of Tiktaalik. The structure of the rock layers and the pattern of the grains in the rocks themselves have the characteristic signature of a deposit that was originally formed by a shallow stream surrounded by large seasonal mudflats. But why live in these environments at all? What possessed fish to get out of the water or live in the margins? Think of this: virtually every fish swimming in these 375-millionyear-old streams was a predator of some kind. Some were up to sixteen feet long, almost twice the size of the largest Tiktaalik. The most common fish species we find alongside Tiktaalik is seven feet long and has a head as wide as a basketball. The teeth are barbs the size of railroad spikes. Would you want to swim in these ancient streams? It is no exaggeration to say that this was a fish-eat-fish world. The strategies to succeed in this setting were pretty obvious: get big, get armor, or get out of the water. It looks as if our distant ancestors avoided the fight. But this conflict avoidance meant something much deeper to us. We can trace many of the structures of our own limbs to the fins of these fish. Bend your wrist back and forth. Open and close your hand. When you do this, you are using joints that first appeared in the fins of fish like Tiktaalik. Earlier, these joints did not exist. Later, we find them in limbs. Proceed from Tiktaalik to amphibians all the way to mammals, and one thing becomes abundantly clear: the earliest creature to have the bones of our upper arm, our forearm, even our wrist and palm, also had scales and fin webbing. That creature was a fish. What do we make of the one bone–two bones–lotsa blobs–digits plan that [Richard] Owen attributed to a Creator? Some fish, for example the lungfish, have the one bone at the base. Other fish, for example Eusthenopteron, have the one bone–two bones arrangement. Then there are creatures like Tiktaalik, with one bone–two bones–lotsa blobs. There isn’t just a single fish inside of our limbs; there is a whole aquarium. Owen’s blueprint was assembled in fish. Tiktaalik might be able to do a push-up, but it could never throw a baseball, play the piano, or walk on two legs. It is a long way from Tiktaalik to humanity. The important, and often surprising, fact is that most of the major bones humans use to walk, throw, or grasp first appear in animals tens to hundreds of millions of years before. The first bits of our upper arm and leg are in 380-million-
year-old fish like Eusthenopteron. Tiktaalik reveals the early stages in the evolution of our wrist, palm, and finger area. The first true fingers and toes are seen in 365-million-year-old amphibians like Acanthostega. Finally, the full complement of wrist and ankle bones found in a human hand or foot is seen in reptiles more than 250 million years old. The basic skeleton of our hands and feet emerged over hundreds of millions of years, first in fish and later in amphibians and reptiles. But what are the major changes that enable us to use our hands or walk on two legs? How do these shifts come about? Let’s look at two simple examples from limbs for some answers. We humans, like many other mammals, can rotate our thumb relative to our elbow. This simple function is very important for the use of our hands in everyday life. Imagine trying to eat, write, or throw a ball without being able to rotate your hand relative to your elbow. We can do this because one forearmbone, the radius, rotates along a pivot point at the elbow joint. The structure of the joint at the elbow is wonderfully designed for this function. At the end of our upper-armbone, the humerus, lies a ball. The tip of the radius, which attaches here, forms a beautiful little socket that fits on the ball. This ball-and-socket joint allows the rotation of our hand, called pronation and supination. Where do we see the beginnings of this ability? In creatures like Tiktaalik. In Tiktaalik, the end of the humerus forms an elongated bump onto which a cup-shaped joint on the radius fits. When Tiktaalik bent its elbow, the end of its radius would rotate, or pronate, relative to the elbow. Refinements of this ability are seen in amphibians and reptiles, where the end of the humerus becomes a true ball, much like our own. Looking now at the hind limb, we find a key feature that gives us the capacity to walk, one we share with other mammals. Unlike
Shubin holds a cast of his fossil discovery Tiktaalik roseae. Photo by Dan Dry
“The earliest creature to have the bones of our upper arm, our forearm, even our wrist and palm, also had scales and fin webbing.” NEIL SHUBIN, AUTHOR
fish and amphibians, our knees and elbows face in opposite directions. This feature is critical: think of trying to walk with your kneecap facing backward. A very different situation exists in fish like Eusthenopteron, where the equivalents of the knee and elbow face largely in the same direction. We start development with little limbs oriented much like those in Eusthenopteron, with elbows and knees facing in the same direction. As we grow in the womb, our knees and elbows rotate to give us the state of affairs we see in humans today. Our bipedal pattern of walking uses the movements of our hips, knees, ankles, and foot bones to propel us forward in an upright stance unlike the sprawled posture of creatures like Tiktaalik. One big difference is the position of our hips. Our legs do not project sideways like those of a crocodile, amphibian, or fish; rather, they project underneath
our bodies. This change in posture came about by changes to the hip joint, pelvis, and upper leg: our pelvis became bowl shaped, our hip socket became deep, our femur gained its distinctive neck, the feature that enables it to project under the body rather than to the side. Do the facts of our ancient history mean that humans are not special or unique among living creatures? Of course not. In fact, knowing something about the deep origins of humanity only adds to the remarkable fact of our existence: all of our extraordinary capabilities arose from basic components that evolved in ancient fish and other creatures. From common parts came a very unique construction. We are not separate from the rest of the living world; we are part of it down to our bones and, as we will see shortly, even our genes.
ABOUT THE AUTHOR :
Neil Shubin is professor and associate dean for organismal and evolutionary biology at the University of Chicago and provost of the Field Museum of Natural History. In 2004, Shubin and his colleagues Ted Daeschler and Farish A. Jenkins Jr. lead the team that discovered Tiktaalik roseae. That discovery coupled with his experience teaching human anatomy to first year medical students at the University of Chicago prompted him to write this book. To learn more about the book, go to www.yourinnerfish.com.
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