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Contents

features Why Evolution Is True The “leftover” parts of human anatomy—like the tailbone, ear muscles, appendix and goose bumps—are signs of evolution. by Jerry Coyne, PhD___________________________________________

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Saving Kids with Science Clinical trials bring the most innovative cancer care to the Medical Center—and hope to pediatric patients and their families. by Jeremy Manier_____________________________________________

Designing discovery At the northeast corner of Drexel Avenue and 57th Street in Hyde Park, a behemoth of modern construction rises into the sky. Over the next few months, finishing touches will be put on the 330,760-squarefoot, 10-story building, which will house laboratories for medicine, pediatrics and the University of Chicago Cancer Research Center. The Gwen and Jules Knapp Center for Biomedical Discovery (KCBD)—an unparalleled research center in medicine and biological sciences and the tallest building on campus—will open this summer. The Center for Metastasis Research also will relocate to the new building, and researchers will work to discover the triggers for the spread of cancer. Gwen and Jules Knapp, longtime donors at the University of Chicago Medical Center, provided a $25 million contribution for the KCBD. Jules is a Medical Center trustee, and Gwen is a member of the Visiting Committee to the Division of Biological Sciences and the Pritzker School of Medicine. The Knapps are on a personal quest to find better cures and treatments for health disorders. Their daughter, Joy Faith Knapp, suffered from lupus, an autoimmune disorder, and died from complications in 2000 at age 37. Their donation is the family’s second multi-million-dollar gift for biomedical research at the University of Chicago. In 1991, they donated $10 million to create the Gwen Knapp Center for Lupus and Immunology Research. Additional funding for the $244 million building comes from the Virginia and D.K. Ludwig Fund for Cancer Research, the University of Chicago Cancer Research Foundation, university resources and ongoing philanthropic campaigns. The cluster of buildings around the KCBD will be renamed the Knapp Research Complex to honor the Knapps. The complex will include the Jules F. Knapp Medical Research Center and the Donnelley Biological Sciences Learning Center. Enclosed walkways will connect with the Gordon Center for Integrative Science and the Donnelley Biological Sciences Learning Center. —Martha O’Connell

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The “Embarrassing Disease” of the Digestive System Medical Center physicians are leaders in treating inflammatory bowel disease, which affects the large and small intestines. by Cheryl Reed_______________________________________________

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Exceptional Promise Third-year medical student Nereida Esparza is planning a career in underserved medical communities—and she’s not waiting for graduation to start her work. by Suzanne Wilder____________________________________________

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Circuit Breaker New electrophysiology equipment uses massive magnets to steer tiny catheters through the body. by John Easton_______________________________________________

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The Power of Personalized Medicine A new clinic in Chicago’s loop brings depth to the idea of medicine that caters to each patient’s life and health needs. by Suzanne Wilder____________________________________________ Photos by Dan Dry

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departments Midway News Catch up on the latest research and news in medicine and biological sciences.___________________________________________

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Medicine off the Midway Hans Larsson, an alumnus with a PhD in organismal biology and anatomy, finds lost history in places where no one else is looking. by Katie Scarlett Brandt________________________________________

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Alumni News Read up on alumni of the Pritzker School of Medicine and the Division of Biological Sciences._________________________________

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Perspective David Cohen, MD, chief of Reproductive Endocrinology and Infertility, explains the ethics behind oocyte preservation, or freezing human eggs.________________________________________________

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Midway News IN BRIEF Treating cancer with venom

Message from the Dean This past year marked a milestone at the University of Chicago Medical Center. We successfully integrated the two separate areas of our institution into one—Chicago BioMedicine—uniting all of the university’s activities in biology and medicine under a single governance and management structure. Like the rest of the nation, we cannot escape the economic downturn and its effects on health care and education. At the end of 2008, we made the decision to reorganize our resources in order to concentrate on our highest strategic priorities and maintain our ability to invest in them during this difficult time. I believe we will emerge stronger, more unified and with more clarity of mission. We continue to be guided and strengthened by our values and commitment to our missions: scientific discovery, educating tomorrow’s leaders, collaborating with our community and providing

care that only we can offer. As was our intent, we are able to strategically invest in our programs and facilities, including the Knapp Center for Biomedical Discovery, opening in June, and planning for the New Hospital Pavilion; community engagement, as evidenced by the expansion of the Urban Health Initiative to include the South Side Health and Vitality Study, and planning for the Center for Community Health; investment in science, including the Global Health Initiative, Genomics, the Office of Clinical Research, and Cores; and educational programs, including the Chicago Fellows program, which attracts internationally competitive postdoctoral scholars, and the expansion of Pritzker scholarship support. This publication, Medicine on the Midway, focuses on our alumni, faculty, students and staff, and their dedication to creating new knowledge that keeps us at the forefront of medicine. It is one of the

More zzz’s, healthier arteries

important ways that we share news about our breakthroughs and successes, and the ways the institution is changing the future of science and medicine. Sincerely, James L. Madara, MD Chief Executive Officer, University of Chicago Medical Center Dean, Division of Biological Sciences and Pritzker School of Medicine University Vice President for Medical Affairs

Robotic equipment helps rebuild bladder A 10-year-old Chicago girl has become the first child in the world to undergo a robotic-assisted bladder reconstruction. The innovative surgical method used the da Vinci robotic system to create a new bladder. The patient suffered from a very small, spasmodic bladder, a birth defect that led to gradual kidney damage and loss of urinary control. The girl always felt that she urgently had to go to the bathroom.

She stopped drinking juice or soda and cut back on water, to less than two cups a day. Medication helped, but despite two years of trying different treatments, the problem continued to get worse and began to cause kidney damage, which made surgery necessary. The typical surgery to treat the condition begins with a large incision, about 6 inches long, from above the navel down to the pubic area, followed

2 For more information, call 1-888-UCH-0200 or visit uchospitals.edu

One extra hour of sleep per night could help keep the human heart healthier. A research team led by Diane Lauderdale, PhD, found that more sleep decreased the risk of coronary artery calcification, an early step down the path to cardiovascular disease. In a study of healthy volunteers in their 40s, about 12 percent developed coronary artery calcification over five years of follow up. Calcified arteries, however, were found in 27 percent of those who slept less than five hours a night. That dropped to 11 percent for those who slept five to seven hours and fell to 6 percent for those who slept more than seven hours a night. The benefits of sleep appeared to be greater for women and did not vary according to race. “The consistency and

the magnitude of the difference came as a surprise,” said Lauderdale, associate professor of Health Studies at the University of Chicago Medical Center. “It’s also something of a mystery. We can only speculate about why those with shorter average sleep duration were more likely to develop calcification of the coronary arteries.” Previous studies have correlated decreased sleep times with established risk factors for calcification, including high blood pressure, excess weight and poor glucose regulation. But in this study, “after adjusting for age, sex, race, education, smoking and apnea risk,” the authors note, “longer measured sleep duration was associated with reduced calcification incidence.”

Dangerous drug cocktails by placement of retractors to pull the stomach muscles out of the way. With robotic-assisted surgery, the medical tools enter the abdomen through five small, dime-sized holes. “The robotic approach enabled us to avoid that entire incision, which causes significant post-operative pain, presents an infection risk and leaves a big scar,” said Mohan S. Gundeti, MD, assistant professor of Surgery and chief of Pediatric Urology at the University of Chicago Comer Children’s Hospital. In the operation, the surgeons used about 12 inches of intestine to reconstruct a larger bladder and converted the appendix into a “continent conduit,” a drain for the new, expanded bladder, with one end implanted into the wall of the bladder and the other end leading outside the body through a small outlet in the lower abdomen. “Patients prefer surgery without significant scars,” Gundeti said. “In addition to the benefit of no big wound to heal—just five small punctures—there is a quicker recovery time, less risk of infection and less pain.”

With more than half of older Americans taking five or more medications and supplements, a recent study of participants ages 57 to 85 warns that at least one in 25 older adults is at risk for a harmful drug-drug interaction. Although the number of people taking medications has remained stable for the last decade, the number of drugs taken by older people has significantly increased. This increase may be because of more intense therapies for chronic illnesses, improved access to medications due to Medicare Part D and the growth of the generic drug market. “Older adults are the largest consumers of prescription drugs,” said study author Stacy Tessler Lindau, MD, assistant professor of Obstetrics/Gynecology and Medicine at the University of Chicago Medical Center. “We find that they commonly combine these prescription

medications with over-the-counter medications and dietary supplements, which can increase their vulnerability to medication side effects and drug- drug interactions.” Ninety-one percent of all respondents regularly used at least one medication, a percentage that increased with age. Twenty-nine percent of older adults took more than five prescription medications. Sixty-eight percent of the adults who took prescription drugs also used over-the-counter medications or dietary supplements. To avoid potentially risky interactions, follow these tips from the researchers: • Carry a list of all medications. • Use the same pharmacy or chain for all medications. • Be alert for drug-safety information and ask physicians about medication safety for older adults.

Scorpion venom can be deadly to insects—and leads to pain, numbness or swelling for humans who have the misfortune to get stung by the eight-legged creatures. But the venom toxin, in synthetic form, may have another effect: eliminating brain tumors. Three Medical Center physicians, radiation oncologist Steve Chmura, MD, and neurooncologists Rimas Lukas, MD, and Kelly Nicholas, MD, are studying the treatment in a clinical trial. The synthetic venom targets glioma cancer cells in the brain, attacks them and cuts off blood supply to the tumors. “A synthetic version of a certain scorpion venom appears to have the amazing trait of homing right in on the malignant cancer cells while avoiding the healthy cells,” Chmura said. The Medical Center is the first in the nation to launch a study of the synthetic venom in patients whose brain cancer has recurred after surgery, chemotherapy and radiation. Ten patients will be treated here in the first round of the study, and each will receive up to six intravenous doses of the venom.

Hot study: Microwaves pose major burn risk Microwave ovens should be equipped with safety controls to prevent children from opening them and being burned by hot foods and drinks, according to a study published by University of Chicago Medical Center researchers in the October 2008 issue of the journal Pediatrics. Severe scalds can be devastating for children because they can leave scars and wounds that can restrict movement. The study recommends extra protections, such as locking mechanisms and stepped-up warning campaigns, to reduce accidental injuries to children when they remove food from the microwave. Study author Lawrence Gottlieb, MD, professor of Surgery and director of the Medical Center’s Complex Wound Center, added that burns have long-lasting effects on appearance and physical function. “It is far better to prevent these injuries than to treat painful burns and try to fix the resultant scars,” he said.

The most common potentially severe medication interactions Type

Medications

Prescription-prescription Lisinopril-potassium Warfarin-simvastatin

Risks Elevated blood-potassium levels (can disrupt heart rhythm) Bleeding

Prescription-non-prescription

Warfarin-aspirin

Bleeding

Atorvastatin-niacin

Muscle weakness, muscle breakdown

Simvastatin-niacin

Muscle weakness, muscle breakdown

Non-prescription-non-prescription

Ginkgo-aspirin

Bleeding

Spring 2009 3


Finding food poisoning culprits

Removing part of brain controls girl’s epilepsy Surgeons at the University of Chicago Comer Children’s Hospital told Jessica Nelson one of the scariest things she will ever hear as a parent: They wanted to treat her daughter’s epilepsy by cutting out or disconnecting half of her brain. Then something extraordinary happened. The surgery worked. Nelson’s daughter, Brooklyn Bauer, had undergone different treatments and tried different medications for more than three years with no success in controlling her seizures. Her speech and motor skills were extremely delayed. She walked on her knees and spoke in two-word phrases. When doctors at Comer Children’s Hospital looked at EEG scans, they saw that Brooklyn was experiencing nearly constant epileptic activity every one to two seconds—whether she was awake or asleep. The left hemisphere of

her brain showed significant damage with little positive brain function. Michael Kohrman, MD, a pediatric epileptologist and associate professor of Pediatrics and Neurology, along with David Frim, MD, PhD, chief of Neurosurgery, reviewed her case and concluded that Brooklyn’s brain would function better without the left hemisphere. The right hemisphere of Brooklyn’s brain was healthy.

4 University of Chicago Medicine on the Midway

“The seizing tissue in Brooklyn’s brain had lost its capability to function productively, so disconnecting or removing it paradoxically allows the remaining brain to function better,” Frim said. “Once we identified Brooklyn as a candidate for surgery, we were able to move within two months to complete all testing and perform the surgery.” Now, two years after surgery and recovery, Brooklyn is in kindergarten. “She is right on track developmentally now, and started kindergarten this fall in a regular classroom—not a special-education class. I can’t describe how far Brooklyn has come from where she was. She just shines now,” Nelson said. Brooklyn Bauer, now a healthy kindergarten student, pictured with her mom. Photo by Tarji Smedley

Doubling diabetes treatment costs National costs for diabetes drugs have risen sharply, jumping from $6.7 billion in 2001 to $12.5 billion in 2007. Researchers point to the increased number of patients, growing reliance on multiple medications and the shift toward more expensive new medicines as the causes behind the increase. “Although more patients and more medications per patient played a role, the single greatest contributor to increasing costs is the use of newer, more expensive medications,” said lead author Caleb Alexander, MD, assistant professor of Medicine at the University of Chicago. “But new drugs don’t automatically lead to better outcomes.” The researchers used two national databases, one extending back to 1994, to assess trends in diabetes treatment. They found that the number of Americans diagnosed with diabetes rose steadily from 10 million in 1994, to 14 million in 2000, to 19 million in 2007.

Studying cells and systems

This rapid growth reflects trends in American eating habits and behavior, the authors note, since the risk of developing type 2 diabetes increases with age, obesity and physical inactivity. At the same time, the average number of medications per patient has increased from 1.06 medications per patient in 1994 to 1.45 medications per patient in 2007. In 1994, 82 percent of patients were prescribed only one drug; in 2007, only 47 percent were. Meanwhile, the average price of a diabetes drug prescription increased from $56 in 2001 to $76 in 2007, due in large part to the rapid uptake of newly available oral medications, increasingly prescribed as alternatives to injectable insulin.

A new research center will bring together scientists to study how networks of genes work together to enable cells and organisms to respond to environmental and genetic change. The National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health, awarded more than $15 million over five years to the University of Chicago to support the new Chicago Center for Systems Biology. The Chicago Biomedical Consortium, with support from The Searle Funds at The Chicago Community Trust, will provide an additional $3 million over three years to the new initiative. Systems biology, an emerging field, is distinguished by its focus on connections between multiple levels of biological organization—from networks of molecules to whole organisms. It is a discipline, according to the NIGMS, “at the

intersection of biology, mathematics, engineering and the physical sciences.” One of 10 National Centers for Systems Biology and the only of its kind in Illinois, the Chicago center will combine experimental and computational tools to study the dynamic behavior of gene networks in cells, tissues and organisms. “We have brought together from around the city more than a dozen experts in genomics, developmental biology, evolutionary biology, stress and physiology, chemistry and physics, with several computational specialists who focus on network modeling, and high-performance computing,” said Center director Kevin W hite, PhD, the James and Karen Frank Family Professor in the Departments of Human Genetics and of Ecology & Evolution, and Director of the Institute for Genomics & Systems Biology.

Ginseng: New hope for colon cancer? Chicago researchers are studying the anti-tumor effects of two varieties of ginseng. American ginseng (Panax quinquefolius) and notoginseng (Panax notoginseng) are widely used but rarely studied herbal therapies for a variety of ailments, including prevention and treatment of colon cancer. This year, researchers at the University of Chicago Medical Center began studying the herbs and their possible medicinal effects. The National Center for Complementary and Alternative Medicine awarded the Medical Center $6 million over five years to create the Center for Herbal Research on Colorectal Cancer, one of four new centers funded this year. “At least one-third of adults in the United States use some sort of dietary supplement and many of them take herbal remedies, such as ginseng, to supplement or substitute for conventional pharmacotherapy,” said center director Chun-Su Yuan, MD, PhD, the Cyrus Tang Professor of Anesthesia and Critical Care at the University of Chicago, “yet we know very little about how, when or even if these products are beneficial.” Yuan, a recognized expert in herbal medicine studies and director of the University of Chicago’s Tang Center for

Herbal Medicine Research, is working with colleagues Tong-Chuan He, MD, PhD, associate professor of Surgery, and Wei Du, PhD, associate professor in the Ben May Department for Cancer Research, on three separate but interrelated projects designed to characterize the anti-tumor activities and mechanisms of the two types of ginseng.

Campylobacter jejuni causes more food poisoning around the world than E. coli, Salmonella, and Clostridium Listeria combined. And by tracing the DNA of the bacteria that sickened patients, Chicago researcher Daniel Wilson, PhD, has been able to show that the majority of those food poisoning cases can be traced to chicken and cattle. Wilson, a postdoctoral scholar in Human Genetics, studied the bacteria from more than 1,200 patients and found that in 57 percent of the cases, chicken was the likely source. Another 35 percent of cases could be traced to cattle. Sheep and pigs accounted for about 5 percent. Wild animals and environmental sources were the likely source of the bacteria in only 3 percent of the patients. “The dual observations that livestock are a frequent source of human disease isolates and that wild animals and the environment are not, strongly support the notion that preparation or consumption of infected meat and poultry is the dominant transmission route,” Wilson said.

More Access for local patients Grand Boulevard Family Health Center, a community collaborator in the Medical Center’s Urban Health Initiative, opened its doors last fall after a sizeable expansion. The clinic, part of Access Community Health Network, has upgraded its facilities and almost doubled in size, creating the additional capacity necessary to provide specialty care. Thirteen Medical Center specialty care physicians currently serve patients at the Access Grand Boulevard site. A $350,000 grant from the Medical Center’s Urban Health Initiative (UHI) helped fund the expansion. “Our collaboration with the Access clinics, such as Grand Boulevard, helps solidify an expanding, cooperative system of independent health care providers in our community,” said James L. Madara, MD, chief executive officer of the University of Chicago Medical Center and dean of the Division of Biological Sciences and Pritzker School of Medicine. “These deep, partnering relationships with many South Side health care providers help us serve a vulnerable population.”

Spring 2009 5


Fossils and Fisheyes Sharing news on ecology, evolution, organismal biology and anatomy

Pediatrics chair brings sleep expertise

Finding proof of the green Sahara

Comer Children’s Hospital has added one of the nation’s foremost leaders in pediatric sleep medicine to its faculty. David Gozal, MD, has been appointed professor and chair of the Department of Pediatrics. Gozal comes from the University of Louisville where, since 1999, he served as vice-chair for research and director of the Kosair Children’s Hospital Research Institute. He was also chief of pediatric sleep medicine and the sleep medicine fellowship program at Louisville. “David Gozal has been a pioneer in the study of childhood sleep problems and the relationship between sleep disorders and neurobehavioral or cardiovascular diseases,” said James L. Madara, MD,

The largest Stone Age graveyard found in the Sahara, which provides an unparalleled record of life when the region was green, has been discovered in Niger by National Geographic Explorerin-Residence and University of Chicago professor Paul Sereno, whose team first happened on the site during a dinosaurhunting expedition. The remarkable archaeological site, dating back 10,000 years, was brimming with skeletons of humans and animals — including large fish and crocodiles.

chief executive officer of the University of Chicago Medical Center and dean of the Division of Biological Sciences and the Pritzker School of Medicine. “He also built substantial training and clinical programs in these areas, with an impressive track record for innovative medical education and first-rate patient care.” The University of Chicago is a pioneer in sleep research and continues to lead the nation for innovative studies on the importance of sleep and consequences of sleep deprivation. Gozal called the university “the perfect place for my life-long interest in pediatric sleep research and for impressing on physicians and on the community at large just how important sleep is.”

David Gozal, MD Chairman, Department of Pediatrics

The site was pristine, apparently never visited. Two seasons of excavation supported by the National Geographic Society eventually revealed some 200 graves clearly belonging to two successive lakeside populations. “Everywhere you turned, there were bones belonging to animals that don’t live in the desert,” said Sereno, PhD, professor of Organismal Biology & Anatomy. “I realized we were in the green Sahara.”

A remarkable triple burial—containing a woman and two children—was discovered in the Sahara desert. Photo by Mike Hettwer, courtesy Project Exploration

Dinosaur teeth tell transition to omnivorous beasts A tiny skull has shown how planteating dinosaurs branched off from their carnivorous counterparts. The skull, from a young Heterodontosaurus, shows sharp canine teeth for biting and tearing, as well as flat teeth, for grinding and chewing. The discovery suggests that the creature was evolving from a diet of meat to one of plants. Laura Porro, PhD, a postdoctoral student in Organismal Biology

and Anatomy, discovered the skull in a drawer in a South African museum. “It’s likely that all dinosaurs evolved from carnivorous ancestors,” said Porro, who co-authored the study on the find. “Since heterodontosaurs are among the earliest dinosaurs adapted to eating plants, they may represent a transition phase between meat-eating ancestors and more sophisticated, fully herbivorous descendants.”

Flatfish fossils show evolution of eyes

Joseph Lodato (above left), MD, director of Cardiac Computed Tomography, looks at images of a human heart. Michael Vannier (far right), MD, professor of radiology, works with a CT technician. Photos by Dan Dry

“Breathtaking” pictures of the human body The first 256-slice computed tomography scanner in Illinois is bringing radically improved images and diagnostic abilities to patients at the University of Chicago Medical Center. With four times the capacity of the previous generation of multi-slice scanners, the new machine has been installed and is in clinical use at the University of Chicago Medical Center. “The pictures are breathtaking,” said Michael Vannier, MD, professor of

Radiology at the University of Chicago, “cleaner and crisper than anything we had seen before. We can perform detailed analysis of very complex anatomy within seconds.” Called the “Brilliance iCT” and manufactured by Philips Medical Systems, Inc., the scanner combines power, speed and coverage to produce extremely highresolution images with reduced radiation exposure. It produces three-dimensional

6 For more information, call 1-888-UCH-0200 or visit uchospitals.edu

images of blood vessels within an organ, including the arteries that supply the heart, which have always been difficult to study because of the heart’s motion. The sophisticated machine can take pictures fast enough to follow an injected dye that can be seen by x-ray as it travels through the blood vessels.

A graduate student has used fossils archived in museums for more than 100 years to solve an evolutionary riddle that stumped even Charles Darwin. All adult flatfishes—including the gastronomically familiar flounder, plaice, sole, turbot and halibut—have asymmetrical skulls, with both eyes located on one side of the head. Because these fish lay on their sides at the ocean bottom, this arrangement keeps both eyes constantly in play, peering up into the water. This remarkable arrangement occurs during the youth of every flatfish, when one eye “migrates” up and over the top of the head before coming to rest in the adult position on the opposite side of the skull. Until last year, no fish—fossil or living—had ever been discovered with such an intermediate condition. But by

searching through collections of fish fossils at several museums, Matt Friedman, a graduate student in the Committee on Evolutionary Biology at the University of Chicago and a member of the Department of Geology at the Field Museum, found examples of such transitional forms. “We owe this discovery, in part, to the European fondness for limestone,” said Friedman. The fossils—which he found in museums in England, France, Italy and Austria, and came from limestone quarries in Northern Italy and underneath modern-day Paris—were stored in collections of underwater fossilized creatures from the Eocene epoch, about 50 million years ago.

Spring 2009 7


We humans

Why Evolution Is True

Jerry Coyne, PhD, professor of ecology and evolution. Photo by Paul Merideth

By Jerry Coyne, PhD

For scientists, there is little doubt that evolution is more than a theory. It’s taken as a fact for anyone researching biology, medicine and almost any other scientific pursuit. But for those who haven’t been versed in human genetics, evolutionary biology or the fossil history of the world, Jerry Coyne lays out a clear case for evolution in his new book, Why Evolution Is True. Coyne, a professor of ecology and evolution at the University of Chicago, is known internationally for defending evolution against intelligent design. In this excerpt, he explains how weird bits of human anatomy—the appendix, goose bumps, tailbone and ears—are signs that we have evolved as a species. Appendix

Vestigial tail on human baby

Chicken

Archaeopteryx

have many vestigial features proving that we evolved. The most famous is the appendix. Known medically as the vermiform (“worm-shaped”) appendix, it’s a thin, pencil-sized cylinder of tissue that forms the end of the pouch, or caecum, that sits at the junction of our large and small intestines. Like many vestigial features, its size and degree of development are highly variable: In humans, its length ranges from about an inch to over a foot. A few people are even born without one. In herbivorous animals like koalas, rabbits and kangaroos, the caecum and its appendix tip are much larger than ours. This also is true of leaf-eating primates like lemurs, lorises and spider monkeys. The enlarged pouch serves as a fermenting vessel that helps the animal break down cellulose into usable sugars. In primates whose diet includes fewer leaves, like orangutans and macaques, the caecum and appendix are reduced. In humans, who don’t eat leaves and can’t digest cellulose, the appendix is nearly gone. The less herbivorous the animal, the smaller the caecum and appendix. Our appendix is simply the remnant of an organ that was critically important to our leaf-eating ancestors, but of no real value to us. Does an appendix do us any good at all? If so, it’s not obvious. Removing it doesn’t produce any bad side effects or increase mortality (in fact, removal seems to reduce the incidence of colitis). Discussing the appendix in his famous textbook The Vertebrate Body, paleontologist Alfred Romer remarked dryly, “It’s major importance would appear to be financial support of the surgical profession.” To be fair, it may be of some small use. The appendix contains patches of tissue that may function as part of the immune system. It also has been suggested that it provides a refuge for useful gut bacteria when an infection removes them from the rest of our digestive system. But these minor benefits are surely outweighed by the severe problems that come with the human appendix. Its narrowness makes it easily clogged, which can lead to its infection and inflammation, otherwise known as appendicitis. If not treated, a ruptured appendix can kill you. You have about one chance in 15 of getting appendicitis in your lifetime. Fortunately, thanks to the evolutionarily recent practice of surgery, the chance of dying when you get appendicitis is only 1 percent. But before doctors began to remove inflamed appendixes in the late nineteenth century, mortality may have exceeded 20 percent. In other words, before the days of surgical removal, more than one person in a hundred died of appendicitis. That’s pretty strong natural selection. Over the vast period of human evolution— more than 99 percent of it—there were no surgeons, and we lived with a ticking time bomb in our gut. When you weigh the advantages of an appendix against its huge disadvantages, it’s

Compsognathus

clear that on the whole it is simply a bad thing to have. But apart from where it’s good or bad, the appendix is still vestigial, for it no longer performs the function for which it evolved. So why do we still have one? We don’t yet know the answer. It may in fact have been on its way out, but surgery has almost eliminated natural selection against people with appendixes. Another possibility is that selection simply can’t shrink the appendix any more without it becoming even more harmful: A smaller appendix may run an even higher risk of being blocked. That might be an evolutionary roadblock to its complete disappearance. Our bodies teem with remnants of primate ancestry. We have a vestigial tail: the coccyx, or the triangular end of our spine that’s made of several fused vertebrae hanging below our pelvis. It’s what remains of the long, useful tail of our ancestors. Tellingly, some humans have a rudimentary tail muscle (the “extensor coccyges”), identical to the one that moves the tails of monkeys and other mammals. It still attaches to our coccyx, but since the bones can’t move, the muscle is useless. You may have one and not even know it. Other vestigial muscles become apparent in winter, or at horror movies. These are the arrector pili, the tiny muscles that attach to the base of each body hair. When they contract, the hairs stand up, giving us “goose bumps”—so called because of their resemblance to the skin of a plucked goose. Goose bumps and the muscles that make them serve no useful function, at least in humans. In other mammals, however, they raise the fur for insulation when it’s cold, and cause the animal to look larger when it’s making or receiving threats. Think of a cat, whose fur bushes out when it’s cold or angry. Our vestigial goose bumps are produced by exactly the same stimuli—cold or a rush of adrenaline. And here’s a final example: If you can wiggle your ears, you’re demonstrating evolution. We have three muscles under our scalp that attach to our ears. In most individuals they’re useless, but some people can use them to wiggle their ears. (I am one of the lucky ones, and every year demonstrate this prowess to my evolution class, much to the students’ amusement.) These are the same muscles used by other animals, like cats and horses, to move their ears around, helping them localize sounds. In those species, moving the ears helps them detect predators, locate their young and so on. But in humans the muscles are good only for entertainment. Vestigial traits make sense only in the light of evolution. Sometimes useful, but often not, they’re exactly what we’d expect to find if natural selection gradually eliminated useless features or refashioned them into new, more adaptive ones. A dangerous appendix and silly ear muscles simply don’t make sense if you think that species were specially created.

Reprinted by arrangement with Viking, a member of Penguin Group (USA) Inc., from WHY EVOLUTION IS TRUE by Jerry A. Coyne. Copyright © 2009 by Viking.

8 University of Chicago Medicine on the Midway

Spring 2009 9


M

oments after Desiree Thomas learned that her young daughter’s life was in danger from an advanced form of cancer, she began weighing whether to enroll the child in a clinical trial.

Saving kids with science:

How clinical trials are

changing pediatric

cancer care

by Jeremy Manier

The neuroblastoma afflicting her daughter, 3-year-old Madison Booker, had already spread far within the left side of the girl’s body by the time it was detected in 2007. It was a Stage 4 tumor, the most difficult to treat. The cancer specialists at the University of Chicago Medical Center told Thomas her daughter had less than a 40 percent chance of being cured, but aggressive treatment could help her lead a reasonably normal life. Like many parents of pediatric cancer patients, Thomas agreed to let her child take part in a clinical trial. She knew some parents who felt uneasy about putting their children in any kind of experiment, but Thomas said she decided the study could enhance her daughter’s care and pave the way for children in the future. “I felt that somebody else had (been) willing to put their kids in a study in order for Madison to get the treatment she got,” said Thomas, who works at a preschool on Chicago’s South Side. “I needed to do my part.”

Spring 2009 11


Nationwide, about three-fourths of children with cancer are treated in clinical trials, compared with less than 5 percent of adult patients.

John Cunningham (above), MD, chief of Pediatric Hematology and Oncology; Susan Cohn (below left), MD, director of clinical research for Pediatric Hematology and Oncology. Photos by Bart Harris

Although Thomas had no way of knowing how the trial would turn out, her choice may have improved Madison’s outcome. The antibody treatment she received has proven superior to previously available therapies–information that researchers could never have obtained without young patients such as Madison. It might seem like a gut-wrenching decision for parents, but putting kids in clinical trials is the norm at most pediatric oncology centers. In fact, far more children take part in cancer trials than adults. Nationwide, about three-fourths of children with cancer are treated in clinical trials, compared with less than 5 percent of adult patients. That difference may help explain the high survival rates in recent years for children with cancer, experts believe. All patients in clinical trials must adhere to precise treatment protocols, with routine monitoring from outside medical experts. The nationwide trend of putting kids with cancer in such trials may help children get high quality care. “We really feel that clinical trials provide state-of-the-art therapy for children with cancer,” said Susan Cohn, MD, who treated Madison and is director of clinical research in the Section of Pediatric Hematology and Oncology at the University of Chicago Comer Children’s Hospital. Kids with cancer represent a unique group of patients—they are vulnerable, yet strikingly resilient. Their good physical condition can make them ideal patients for clinical trials, but their young age means that doctors and parents must navigate medical and ethical concerns that seldom arise with older patients. The first challenge is obtaining informed consent for a child to take part in a trial. Minors must have a parent or guardian go through the consent process, which often begins virtually as soon as a child is diagnosed. 12 University of Chicago Medicine on the Midway

In the case of complex procedures that require prolonged courses of therapy, doctors and nurses may spend hours talking about the clinical trial with parents over the course of several visits, said John Cunningham, MD, chief of the section of Hematology and Oncology at Comer. “We usually spend up to three hours discussing the clinical trial before we ask the parents to decide whether to participate,” said Cunningham, who also runs the pediatric stem cell transplant program at the Medical Center. Such investments of time contribute to the high participation rates at the Medical Center and other hospitals. More than 90 percent of parents accept the offer to put their children in clinical trials here, which can contribute to the quality of care that patients receive, Cohn said. “When you’re on a clinical trial, if the protocol says you’re supposed to get chemotherapy on Monday, you get the chemo on Monday,” Cohn said. “There are a lot more people who are watching your back.” Trials are closely monitored, she said, and studies will end early if doctors observe problems—or if a new treatment is much better than previous treatments. For Desiree Thomas, any concerns about her daughter’s clinical trial were far outweighed by the frightful progression of the girl’s tumor. She said the growth on the left side of Madison’s body felt like a small lemon from the outside, but tests determined that it was “about the size of a 4-pound turkey breast.” “What worried me was that she’s such a tiny thing,” Thomas said. That observation drew an instant objection from Madison, now 4 years old. “I’m a big girl,” Madison said. “Who you telling I’m a baby?” Thomas responded gently, “Well, you know, you’re tiny.” “I’m not tiny!” Madison said. “Just Madison.” Madison’s bravado about her toughness may be justified. Despite their seemingly vulnerable age, children like Madison can tolerate and survive difficult courses of chemotherapy and radiation, experts say—often in more intense doses than adult patients could withstand. A major reason is that children usually have the benefit of fit and healthy organs, unlike older patients whose bodies already have sustained a lifetime of wear and tear.

“Right now, with the types of therapies we have available, we actually see kids tolerate chemotherapy and other cancer treatments much better than adults,” Cohn said. “If you’re dealing with someone who’s elderly and has cancer, it’s much more difficult to give them the kinds of aggressive treatment that we often use. Elderly patients often have organ dysfunction, and many can’t tolerate the side effects of these therapies.” Cancer trials for children have helped drive advances in the care of adults with cancer, experts say. The chances of surviving acute lymphoblastic leukemia, the most common form of pediatric leukemia, have improved dramatically since the 1970s—from a survival rate of about 30 percent to more than 80 percent today. The advances in chemotherapy techniques that led to that improvement have affected how adults with leukemia get treated as well, Cunningham said. Controlled studies are the only way to discover which treatments work best, but the logistical challenges in putting together

a pediatric trial can be daunting. About 12,500 kids get diagnosed with cancer each year, which means no single medical center can amass a sufficient number of patients to conduct rigorous studies comparing treatments. If the number of children in a study is too small, researchers can’t use statistical methods to determine the significance of a drug’s effect or the difference between two treatments. One solution is the Children’s Oncology Group, a cooperative organization that allows centers across the country to pool their scholarly resources and collaborate on large studies of children with cancer. Virtually all of the pediatric oncology clinical trials in the U.S. are coordinated through the group, which allows a much faster pace of discovery than would be possible for medical centers working in isolation. The relatively small number of pediatric cancer cases also increases the motivation for doctors to recruit families for trials. Each child represents a precious chance to increase a trial’s size

Madison Booker participated in a clinical trial to treat her neuroblastoma and is now in remission. Photo by Dan Dry


to the point where researchers can learn something useful about the disease or treatment. And unlike some clinical trials, no patients receive placebo treatments. Results from the new cancer treatments are measured against treatments that were found to be the best in previous clinical trials. “The emphasis on conducting clinical trials and doing collaborative research really is ingrained now in the training of pediatric oncologists,” said Stephen Skapek, MD, an associate professor of Pediatric Oncology at the Medical Center. “And a lot of it has to do with the parents. A lot of parents come in with the mindset that they really want a clinical trial for their child, because they want to get the most up-to-date therapy.” Desiree Thomas said her daughter’s diagnosis with neuroblastoma launched her into a long process of education about the disease and the trials that were available. Cohn described the stages of chemotherapy that Madison would be going through and said she believed there would be a trial available for the girl after the initial rounds of chemo were finished. Cohn said she would have placed Madison on a trial immediately, but by chance there was no study open to new patients at that time, so the girl received chemotherapy according to protocols used in the most recently completed trial. Madison, who was diagnosed in September 2007, lost most of her hair to the chemotherapy within weeks, Thomas said. “I was braiding her hair, and it started coming out in big clumps,” Thomas said. That was the start of many rounds of therapy for Madison’s advanced cancer. Next came surgery, followed by high-dose chemotherapy, stem cell transplant and radiation. Doctors also gave Madison retinoic acid, which previous clinical trials had shown to help cancer patients recovering from transplant therapy. But even after those successful rounds of treatment, her oncologists knew Madison was not out of danger. Kids with highrisk neuroblastoma have about a 60 percent chance of relapsing after treatment, so researchers are always looking for ways of attacking any remaining cancer cells. Cohn recommended that Madison be enrolled in a clinical trial of an experimental antibody. She would receive an infusion of antibodies designed to target any lingering cancer cells and train Madison’s immune system to attack those cells on its own. “The hope is that this antibody will stimulate the immune system to destroy the neuroblastoma cells, similar to the way the body attacks viruses and bacteria that cause infection,” Cohn said. That was a reasonable hope based on early phase clinical studies, though before the trial no one knew if the antibody would be effective for patients like Madison. But in March, an outside monitoring board concluded that adding the antibody treatment significantly raised the chance of survival for neurblastoma patients who already have received the standard therapy. Of course, no one knows ahead of time which trials will be successful. The uncertain outcome of such treatments can add to the anxiety for parents and medical professionals alike. Skapek said some doctors choose not to specialize in pediatric oncology because of the emotional toll of striving to save vulnerable children who may not survive.

14 For more information, call 1-888-UCH-0200 or visit uchospitals.edu

“It’s not for everybody,” Skapek said. Yet Skapek said some of his most rewarding experiences as a physician have happened while caring for children who ultimately died from their disease. He said those young patients and their families have taught him more than he can describe about why his work is so important. “I treasure the opportunity to help people, even in that setting,” Skapek said. Sometimes young children with serious illnesses take comfort in the idea that, by taking part in a clinical trial, they could help other kids in the future, experts say. Rosa Fuentes, a Comer nurse in Pediatric Oncology, said the chance to help others can sustain families in difficult times. “We hear over and over again from families that their children are doing well because other children participated in trials, and this is their way to give back,” Fuentes said. Although the news from Madison’s trial is encouraging, it’s not a guarantee of a good outcome for individual patients. No one knows yet how Madison Booker’s experimental treatment will turn out, though she’s in remission and so far the signs are good. The girl spent so much time in the hospital that now she misses the doctors and nurses at the Medical Center, said Thomas, Madison’s mother. Thomas said it helps to know that Madison also left a lasting impression at Comer through the research she helped advance, and the friendships she made. “There’s not a person Madison meets that she does not touch. She touches you in places you didn’t think existed.” Madison, pictured here with Cohn, lost her hair during early rounds of treatments but now has a full head of curly brown hair. Photo by Bart Harris

Silent health problems By Jeremy Manier It often takes a long battle for a child to beat cancer, but many adult survivors of childhood cancer are finding that curing their disease is just the first part of a lifelong struggle to stay healthy. The steady rise in survival rates for childhood cancer has brought with it a growing awareness that such patients have unique health risks and long-term side effects from intensive radiation treatment and chemotherapy. Researchers are just beginning to understand how cancer therapy can increase a child’s chances of developing secondary cancers, in addition to wreaking havoc with growth and brain development, fertility, heart performance and a range of other vital functions. “For pretty much any organ system you can think of, cancer treatment can cause

Childhood cancer survivors find new risks as adults that young survivors of cancer were up to 10 times more likely than their healthy siblings to develop serious heart problems. In addition, girls who get radiation treatment to their chests are at increased risk of getting breast cancer as young adults, a risk surpassing that for women who carry the genetic variants for breast cancer, called BRCA genes. People with such high risks need rigorous screening to detect potential emerging health problems. For example, women who had chest radiation in childhood are recommended to get screening mammograms and breast MRIs starting at age 25. Yet Henderson said some young cancer patients experience a drop-off in care when they leave the pediatric oncologists who helped guide them through their illnesses.

Researchers are just beginning to understand how cancer therapy can increase a child’s chances of developing secondary cancers. long-term problems,” said Tara Henderson, MD, medical director of the Childhood Cancer Survivors Center at the University of Chicago Medical Center. Henderson presented a study last year at the American Society of Clinical Oncology meeting, showing that patients who got intense radiation therapy as children had a greatly increased risk of developing sarcoma years later. The risk for survivors was nine times greater than the rate in the general population. A separate study last year by University of Minnesota researchers found

And even some of those specialists do not recognize the dangers their patients could face in later years. Those realities mean much of the responsibility for following up falls to the patients themselves. The task is complicated because adults who had cancer as children often do not remember what type of treatment they received decades earlier, and records of their care may no longer exist. The lack of good information about what those patients were exposed to makes it difficult to assess their future risks.

“This survival population presents a new paradigm,” Henderson said. “With other chronic conditions, like sickle-cell anemia or diabetes, the children know they have it and that it doesn’t go away, and they make the transition to adult care with this known illness. “But when we cure children of cancer, they go off and they feel fine,” Henderson added. “The late effects from their treatment might not show up for decades. That’s why we need to be screening for these silent health problems.” Henderson is one of many specialists working on developing new screening recommendations for survivors of childhood cancer. She also is collaborating with Olufunmilayo Olopade, MD, director of the Cancer Risk Clinic at the Medical Center, to study the merits of MRI versus mammograms for women who received radiation therapy. But the best kind of success would be learning to adjust cancer treatments so they attack the disease without leaving patients at increased risk of problems later on, said Susan Cohn, MD, professor of Pediatrics at Comer Children’s Hospital. “I’m hoping now that because some drugs seem to be better at targeting specific pathways, we will end up with therapy that’s even more successful and less toxic to patients,” Cohn said. “The next generation of studies will be particularly interesting, because we’ll be incorporating some of these novel targeted therapies into our clinical trials.”

Spring 2009 15


You probably won’t hear inflammatory bowel disease—or IBD, as it’s frequently called—talked about in social settings, and you’re not likely to read of celebrities discussing their treatments in magazines, as they often do with cancer. Jerry Lewis isn’t calling. There’s no IBD telethon.

By Cheryl L. Reed 16 University of Chicago Medicine on the Midway

“It’s an embarrassing disease. We usually do not discuss our bowel functions with family or friends,” said Stephen Hanauer, MD, chief of Gastroenterology, Hepatology and Nutrition at the University of Chicago Medical Center, which has one of the preeminent IBD centers in the world. IBD is a disease of the digestive tract, extending from the mouth, esophagus and stomach to that series of sausage-like organs below the stomach that extends to the rectum. The disease—actually, a family of diseases that primarily consists of Crohn’s disease and ulcerative colitis—is the result of an abnormal immune response in the digestive tract that results in ulcers, erosions and obstructions in the bowel. The most common symptoms are abdominal cramps, loss of appetite, fever, nausea, vomiting, rectal bleeding and diarrhea. Severe cases can cause massive weight loss or anemia and may lead to bone loss and colon cancer. Doctors don’t know exactly what causes IBD, but they believe something in the environment triggers a reaction in the body, which results in the inflammation of the digestive system. Somehow the body can’t turn off its fight response, and so the body continually attacks its own organs. Inflammation of the skin, eyes, joints and liver occasionally accompanies the disease. There appears to be a genetic predisposition and about 10 to 30 percent of patients have someone in their family who also has IBD, though the majority who develop this chronic condition have no family history. In the past, IBD was considered a disease of affluence and most commonly affected middle- and upper-class people, those who lived in northern climates, city dwellers or residents of wealthy suburbs. Caucasians, especially Ashkenazi Jews, were most susceptible. However, IBD is now seen in virtually all ethnic groups and ages as populations assimilate western diets and lifestyles. Symptoms most frequently appear in patients between the ages of 15 and 35. The average age of diagnosis is 22. About 1.4 million Americans have been diagnosed with IBD — nearly the same rate as lupus — and the disease is on the rise. Doctors at the Medical Center believe that as many as 2 million people have the disease, but, because they may have a milder form, haven’t sought treatment or are misdiagnosed as the more common irritable bowel syndrome. IBD is most prevalent in North America and Europe but rare in developing nations. It is less common in southern climates in the U.S. and Europe, areas that are more rural and agricultural. Theories abound about what causes the disease, from super-cleanliness to infections to genetics to bacteria in our guts. Crohn’s disease can attack any organ between the mouth and the anus, while ulcerative colitis is limited to the large intestine, also known as the colon and rectum. The biggest difference between the two diseases is that Crohn’s disease is a deep tissue inflammation while ulcerative colitis attacks only the superficial lining of the bowel.

“Ulcerative colitis almost looks like you skinned your knee or if you took sandpaper to the bowel and rubbed and it got red,” explained David Rubin, MD ’94, co-director of the Medical Center’s IBD center. “So if you do need surgery, and we remove the entire large intestine, you are cured from the condition.” Ulcerative colitis usually involves the rectum (called proctitis) but can affect other parts of the colon. Patients often have bloody bowel movements and diarrhea and live in fear of not getting to the bathroom in time. Crohn’s disease patients can have various symptoms depending on what part of the gastrointestinal tract it attacks. Most commonly, it occurs in the last part of the small intestine and the first part of the colon, often mimicking the pain someone might have with appendicitis. Sometimes, if the disease is only detected in the colon, doctors may have a hard time differentiating between Crohn’s and ulcerative colitis. Crohn’s disease in the small intestine often causes the patient to have a hard time absorbing nutrients, causing weight loss, anemia and bone loss. The patient may have an obstruction that results in cramping, nausea and vomiting. Patients can get what’s called a fistula, or tract, that connects one part of the bowel to another or to surrounding organs or the areas near the anus, and there can be a lot of draining and pain. In children, the only sign of the disease may be when the child can’t gain weight or doesn’t go through puberty. Treatment for Crohn’s may involve a variety of medications; many patients require surgical resection of the inflamed parts of the intestines and sewing back together the healthy parts. Crohn’s disease often recurs after surgery, so doctors advise continued medical treatments. “We cut out the part that is inflamed, but the disease comes back and it comes back right where we sewed things together. So it’s very predictable,” Rubin said.

From left: Some team members that treat IBD include: Roger Hurst, MD, associate professor of Surgery; David Rubin, MD, co-director of the Inflammatory Bowel Disease Center; Stephen Hanauer, MD, chief of Gastroenterology and Nutrition; Russell Cohen, MD, co-director of the Inflammatory Bowel Disease Center. Photo by Dan Dry

Spring 2009 17


From left: The IBD nursing team includes Jan Colwell, Mary Ayers, Michele Rubin, Debbie James, Anca Bulgariu and Maria De Ocampo. Photo by Dan Dry

Bacteria, like the one pictured here, may play a role in IBD.

About one in five ulcerative colitis patients will need to have his colon removed because of how severe the condition is or because of pre-cancerous signs. That procedure previously required patients to have an ileostomy—where the end of the small intestine is attached to an opening in the abdominal wall, allowing waste to drain outside the body into a pouch. Now, specialized surgeons at the Medical Center’s IBD center can reconstruct a functional rectum from the small intestine so that most patients can eliminate normally. Treatment for Crohn’s or ulcerative colitis usually involves medicines that keep the disease quiet. Most IBD patients have mild or moderately active disease, meaning that they periodically suffer flare-ups interspersed with times when their disease is quiet. About 20 percent of IBD patients have severe cases. Getting the correct diagnosis is one of the biggest problems for people with IBD. It is not uncommon for patients to suffer for years before doctors are able to identify the disease. The symptoms mirror those of more common ailments, such as hemorrhoids, lactose intolerance or irritable bowel syndrome. Symptoms of irritable bowel, formerly called spastic colon, are similar to IBD in that patients report abdominal pain, diarrhea and an urgency to go to the bathroom. The difference is that with irritable bowel there are no ulcers or bleeding and no intestinal narrowings or obstructions. Sometimes IBD can remain dormant in a person’s body until a stressful event triggers an outbreak.

Konstantin Umanskiy, MD, performs minimally invasive colon surgery. Colorectal surgery is a routine part of treatment for IBD patients. Photo by Bart Harris

“It’s very common to have had a major life stressor right before the attack,” explained Russell Cohen, MD, the other co-director of the Medical Center’s IBD center. “Often it’s a divorce, death in the family or loss of a job. They’ve been healthy all their lives and then, bam! Something happens and they have a major event and they have an attack.” There are a number of tests used to diagnose IBD, ranging from stool and blood samples to MRIs and X-rays. The diagnosis must be confirmed by a colonoscopy, in which biopsies are taken. IBD, like other immune-related diseases such as multiple sclerosis, asthma, lupus and rheumatoid arthritis, is on the rise and has spurred a number of medical studies to find the causes. The more interesting breakthroughs have been in identifying several genes associated with IBD. Doctors have known for years that there is some genetic component. There’s a greater risk for someone whose parents or siblings have the disease. “The problem is that we still don’t know what most of the genes do,” said Rubin. “And none of them are predictive in the sense of, ‘Let’s test you for the gene and then we’ll know if you’re going to get the disease or what’s going to happen to you.’” Less than 15 percent of the IBD patients have one of the known genes for IBD. (The first IBD gene, NOD2, was discovered by researchers at the Medical Center and reported in 2001.) Doctors believe there are probably a number of other genes that actually protect people from getting IBD, but those have yet to be identified.

IBD Discoveries and Firsts at the University of Chicago The University of Chicago was the first institution to establish a full-time department of gastroenterology in 1927. Longtime professor Joseph Kirsner, MD, PhD ’42, established the first gastrointestinal research lab at the University of Chicago shortly after he was hired in 1935. Since 1983, researchers at the University of Chicago have been leading clinical trials for new medications.

18 For more information, call 1-888-UCH-0200 or visit uchospitals.edu

In 2001, researchers at the University of Chicago discovered a genetic mutation, called NOD2, that is linked to Crohn’s disease. Now, the Medical Center treats more than 5,000 IBD patients a year. An interdisciplinary clinical team, including gastroenterologists and surgeons that specialize in colorectal cases, treats patients, while researchers study what causes IBD. Clinical trials are merging research and patient care, with a current study investigating a pill to ease the inflammation of ulcerative colitis.

Since Burrill Crohn and his colleagues first described the disease in 1932, doctors have had a number of theories about what causes it. Among the more fascinating studies are those that suggest exposure to bacteria and parasites in the environment are necessary for the development of a healthy immune system. Children who grow up in rural areas are less likely to develop IBD, allergies and other autoimmune diseases. Scientists are studying this theory by testing exposure to a parasite, the eggs of pig whipworms, as a treatment for IBD. “These are diseases of cleanliness and hygiene,” explained Hanauer. “What’s happened over the past 50 years, in the countries where IBD and other autoimmune disease have become more prevalent, is that we’ve cleaned up the environment. We don’t have pinworms any more. We’ve chlorinated the water. Our environment is sterile compared to the environment of Africa or Asia.”

!

The human body is made up of trillions of bacteria, most of which live in our colon. “There are more bacteria in our guts than there are cells in our bodies, by 10 times,” Hanauer said. “So we are 10 times more bacterial than human. When we evolved, we evolved from bacteria. We learned to live with bacteria.” America’s fascination with using antibiotics and antibacterial soaps and even health crazes that promote colonics are actually doing more damage than good, he said. “Our colon is a sewer. It is meant to be a sewer. It is not meant to be sterile. And when you sterilize things, you allow bad stuff to grow.” Cohen believes the disease is largely genetic, particularly Crohn’s disease, but is triggered by something in the environment. “I feel pretty confident in saying that we’re never going to say it’s one single thing that causes it,” he said. “There’s so much evidence that suggests it’s a variety of things.”

Alessandro Fichera, MD, an associate professor of Surgery who works with the IBD team, examines a patient. Photo by Bart Harris

Warning Signs: * Blood in the toilet * Persisting diarrhea * Waking up in the middle of the night for a bowel movement * Unexplained weight loss * Unexplained anemia * Not making it to the toilet in time Russell Cohen, MD (left) and David Rubin, MD discuss a patient case. Photo by Dan Dry

?

X

Preventive Measures:

* Do not smoke cigarettes. * Avoid exposure to secondhand smoke, particularly if there’s a family history of IBD. * Avoid excess use of aspirin or ibuprofen; use acetaminophen instead. * Avoid antibiotics unless absolutely necessary.

Differences between Crohn’s Disease and Ulcerative Colitis: Crohn’s Disease...

Ulcerative Colitis...

can attack anywhere in the GI tract, from the mouth to the anus.

is limited to the colon.

is a deep tissue attacks the superficial inflammation that moves lining of the colon. through the entire wall of the organs it attacks. is associated with smoking and the most severe cases are in those who are smokers.

is prevented by not smoking.

is associated with abdominal pain.

is associated with abdominal pain.

often returns to the same areas that were resected.

is cured once the large intestine is removed.

* Breastfeed children.

Spring 2009 19


Medicine off the Midway At 80 degrees north latitude, well within the Arctic Circle, there is ice and wind and more dark than light. There also are polar bears. And, sometimes, there is Hans Larsson.

Hans Larsson, PhD, a fossil hunter and graduate of the University of Chicago, is curator of vertebrate paleontology at McGill University’s Redpath Museum in Canada. Photo courtesy of McGill University

A paleontologist and professor at McGill University in Quebec, Canada, Larsson, PhD, says he prefers to research places where “people haven’t gone before, rather than refining what’s already known. I really want to make it a challenge.” Part of the challenge at 80 degrees north is fending off polar bears. The unpredictable creatures differ greatly from bandits or military men running around in, say, the Sahara, Larsson said, mainly because “polar bears want to eat you.” Five members of Larsson’s laboratory typically join him on his trips north—a “magic number” that is large enough to deter the bears from wandering over and small enough to fit into a helicopter. Because Larsson prefers to travel to less explored territories, he discovers fossils that no one else has seen yet. University of Chicago paleontologist Paul Sereno, one of Larsson’s mentors from his years as a graduate student here, says that’s the way to do it. On his web site, Sereno writes, “The trick to big fossil finds? You’ve got to be able to go where no one has gone before.” On a recent trip to the Arctic, Larsson and his team did just that. They uncovered a new species of marine reptile, which Larsson referred to as a “Loch Ness monster type.” The species is so new in fact, it’s not even named yet. All that Larsson and his team know so far is that the reptiles are part of the Plesiosaur family. While digging in the fossil-fertile but remote land of Niger with Sereno’s team, they discovered eight previously unknown dinosaurs and five new crocodile species. The fossils Larsson finds, however, only tell one tiny piece of the world’s expansive history. He hopes to discover the rest of the story through his research in the flourishing experimental field of evolutionary developmental biology, or evo-devo. Paleontology, Larsson said, is “essentially a collectionbased science. That can be dissatisfying for some people, including me.” Because paleontology typically doesn’t involve experimentation, many scientists consider it a “soft science,” according to Larsson. But Larsson thinks otherwise. He points to how creatures moved from water to land and the dinosaur-to-bird transition as proof of the central role of fossils in evolutionary science. Over millennia, species across the globe underwent anatomical changes that turned fins into limbs and scales into feathers. “These are two very well-resolved, major evolutionary events filled with fossils,” Larsson said.

SCIENCE AT 80º NORTH: Hans Larsson pushes the boundaries of paleontology By Katie Scarlett Brandt

Contributing to that fossil collection is only one side of his research. The experimental side involves testing the developmental mechanisms responsible for those changes— genes and proteins that still exist in embryonic development, but that turn on and off in different ways, garnering modern results. In his lab, Larsson runs experiments on embryos of modern animals such as chickens. He has found that birds, for example, have five fingers and long tails in early development. Only as their development progresses do they lose those fingers and tails and gain more bird-specific characteristics.

Youth’s passion At 5 years old, growing up in Alberta and Ontario, Canada, Larsson likely never imagined he would one day be running experiments in which he injected chicken embryos with various proteins to see if he could make the embryo inside grow a dinosaur-like tail or sequencing modern DNA to discover the genetic evolution of long-dead fossil lineages. However, he did know from a young age that he wanted to collect fossils. Like many children, Larsson was fascinated by dinosaurs. When that fascination kept growing, his parents and teachers supported him. He made regular trips to the Badlands in Alberta, wondering what other creatures could have walked over that land. He explored miles of hauntingly arid tan and brown rock formations that were once covered in wetlands. And at age 17, he worked his first of seven seasons at Alberta’s Royal Tyrrell Museum of Paleontology, then the largest in the world. After finishing his bachelor’s degree at McGill, Larsson enrolled at the University of Chicago to earn his PhD in organismal biology and anatomy in 2000. His work at the Tyrrell Museum brought Larsson’s attention to the University of Chicago’s Sereno. “His flair for doing paleontology is so different. He does it in a very public-oriented and still very critical way,” Larsson said. However, Larsson treads carefully in the public arena. “I have argued with (Sereno) about this. Sometimes you can go overboard, and the downside is that your peers might think you’re not doing your job,” Larsson said. And some scientists have criticized Sereno for his showmanship, including a 1997 ranking as one of People magazine’s 50 most beautiful people. But Larsson said he sees Sereno’s approach as a good thing. “Science needs more people

like Sereno. Our duty is to respond to and educate the public with what we do.” It was with Sereno that Larsson went on his first major expedition to Africa, while still finishing his undergraduate degree. “To get there, we traveled all through Europe and Algeria, and then entered this completely different culture, at the tail end of a civil war,” he said. Dumped in the middle of the Sahara, he and his peers began to jackhammer and pickaxe the hot, sandy earth below them. The land around them was vast but sparse, and rarely did camels or military caravans cross their path. “Just to be out there was spectacular,” Larsson said. He eventually returned to Canada, after a short postdoctorate position at Yale, to take a position at McGill University, where he currently serves as curator of vertebrate paleontology at McGill’s Redpath Museum and as the Canada Research Chair in Macroevolution. Larsson took over for Robert Carroll, PhD, who had been one of the last students of another of Larsson’s inspirations, paleontologist and evolutionary biologist Alfred Romer. “He was so integrative. He went from paleontology to muscle physiology to evolution and all the way to public interpretation,” Larsson said, mentioning text books to which Romer contributed and TV shows on which he appeared. “My own work is trying to be as integrative as possible without falling apart.” Larsson cites Romer as “the most influential paleontologist in my mind” and said that by joining McGill’s faculty, he was coming full circle. “(Romer) was really trying to bridge different sciences together, which is exactly what I’m trying to do, too.” With a lab team of eight graduate students, a handful of undergraduates and post-docs, Larsson pushes every one of his students to research something different than the next, but they work together using one another’s specialized knowledge. He considers the approach a more productive way of thrusting paleontology forward and making it a “very rigorous and testing level of science.” As a fossil hunter at heart, Larsson can’t stay in the lab forever. He likens himself to explorers of old as he treks to far corners of the globe in search of things he’s not even sure exist. He’s investigating not just physical locations but history, too. “Almost everywhere in the world has been seen by at least someone,” he said. “The next step is to explore the natural history of the world. It’s exploring with a real scientific purpose.”

“Almost everywhere in the world has been seen by at least someone. The next step is to explore the natural history of the world. It’s exploring with a real scientific purpose.”

Larsson, currently a professor at McGill University, and Chantal Montreuil, a paleontology technician, work on the cast of a teenage Triceratops. Larsson and his team discovered the original fossils in Eastend, Saskatchewan. Photo courtesy of McGill University

20 University of Chicago Medicine on the Midway

Spring 2009 21


Exceptional

promise

for Academic Advancement in Medicine. She also reached out to minority high school students to introduce them to health professions as a coordinator in the Health Professions Recruitment and Exposure Program. Monica Vela, MD, was one of the faculty members who selected Esparza to receive the Exceptional Promise scholarship, started by former Department of Medicine Chairman Joe G.N. “Skip” Garcia, MD. Vela has been one of Esparza’s champions during medical school. “She’s one of my personal mentors and one of the people who pushes me a lot,” Esparza said. Vela, assistant professor of Medicine and associate vice chair for diversity for the Department of Medicine, wrote one of Esparza’s recommendations for the AAMC award. “Through her own initiative, Nereida and another student have provided health education to a Chicago community in great need of medical services,” Vela wrote. “She presented health facts pertaining to diabetes to the employees of Casa Central, a community in the Humboldt Park neighborhood, which has rates of diabetes approaching 40 percent among its adults.”

hiring full-time employee interpreters. The Medical Center did hire two interpreters, and Esparza has been looking at how satisfied faculty, staff and guests are with the services. In her observations so far, Esparza has seen that the full-time interpreters stay busy—but that many staff members aren’t aware of the service. Esparza’s main research project in 2007 took her into the world of local community health clinics, where she interviewed physicians about their experiences. “They thought they were providing the best care they could,” she said. But she also heard about the problems they faced: the lack of equipment or staff, trouble getting their patients to specialty care and a dearth of financial resources. That research fell under the Medical Center’s Urban Health Initiative, which brings community clinics into closer contact with the hospital to gauge patient needs, connect local health care practices with specialists and encourage neighborhood residents to seek primary care physicians to maintain better overall health.

By Suzanne Wilder

Growing up in Pilsen, a predominantly Mexican neighborhood in Chicago, Nereida Esparza rarely visited doctors. Her family had no health insurance, and immunizations came from community health fairs. The family, with first-generation American children born to Mexican immigrants, turned to emergency rooms for care when they had health problems. When Esparza was 15 years old, her grandfather became seriously ill and she became a de facto interpreter in the hospital, translating medical information as best she could. The experience changed her perspective on health care. Esparza, who was the valedictorian of her high school class, decided to pursue medicine as a career. Nine years later, she is analyzing the effectiveness of medical interpreters at the University of Chicago Medical Center. As a third-year student in the Pritzker School of Medicine, Esparza has become a leader in her class, particularly on issues related to health disparities and minority health care. She was one of five medical students nationwide recently honored by the Association of American Medical Colleges (AAMC) for “leadership in efforts to eliminate inequities in medical education and health care” and “addressing educational, societal and health care needs of minorities in the United States.” Esparza attended the University of Chicago as an undergraduate in biology—and a commuter student. She lived with her mom, who had by then moved to Berwyn. In addition to the heavy academic workload in the college, she worked 10 to 20 hours a week as a research assistant at Hines Veterans Affairs 22 For more information, call 1-888-UCH-0200 or visit uchospitals.edu

Hospital, about 12 miles southwest of Chicago. As an assistant in a urology lab, she learned about the biology of stress urinary incontinence in women. The research led to several publications in medical journals—an unusual accomplishment for an undergraduate student—but Esparza also was thinking about the effects of the condition on patients’ quality of life. With a commute to and from school, Esparza struggled to fit into campus life. As graduation grew near, she reconsidered the university for medical school. “When I came to Pritzker, the attitude was different,” Esparza said. By the time she was accepted to Pritzker, she said, “I wanted to become part of my school community and my bigger community.” The faculty members who met Esparza also saw great potential in her: She was one of the first students to receive the Department of Medicine’s Exceptional Promise scholarship, which provides $10,000 in support for four years, along with mentorship and guidance from several faculty members. At the beginning of medical school, Esparza moved to Hyde Park, joined the National Network of Latin American Medical Students and got involved with the Multicultural Community

Nereida Esparza (far left) examines x-rays with faculty mentor Monica Vela, MD, and fellow third-year students Shannon Carpenter and Richmond Darko. Photo by Eileen Ryan

Vela added that the experience was “especially meaningful to Nereida, who felt that in those moments, she was having a conversation with family members. She has had a meaningful and significant impact on this community.” Esparza has tried to help other students understand common difficulties that Hispanics in the United States may face with health care. She notes that her mom, a longtime U.S. resident, doesn’t have health insurance. In fact, many Hispanics, Esparza said, don’t know how to access health care available in federally qualified health centers, community clinics or through slidingscale payment plans at some medical practices. Her life as the daughter of immigrants has driven some of her research as well. She shadowed the Medical Center’s two Spanish-language interpreters and collected surveys from doctors, nurses and patients about the interpretation services. The Medical Center’s onsite interpreters are the direct result of the research of former medical student, Pilar Ortega—now MD and a resident in Emergency Medicine. Ortega studied the hospital’s use of interpreters from outside agencies and recommended

Esparza, a native of Chicago’s Pilsen neighborhood, plans to work in primary care once she completes medical school. Photo by Dan Dry

Meeting with doctors practicing medicine in community clinics reinforced Esparza’s drive to work in underserved communities. “It just really solidified where I want to go,” she said. “I’ve always wanted to do primary care.” Esparza is immersed in clinical rotations this year. She’s worked through surgery, pediatrics and family medicine shifts. “I am trying to keep an open mind during my third-year clerkships,” she said. But she is anxious for her internal medicine rotation. Associate professor of Anesthesia and Critical Care William McDade, MD, PhD, is one of the faculty members who has overseen Esparza’s research. McDade also serves as the Pritzker School of Medicine’s associate dean for Multicultural Affairs. He and Vela recommended Esparza for the AAMC award, which includes a $5,000 scholarship. “Nereida is driven to help communities in which English is not the primary language gain equitable, compassionate and safe care in U.S. hospitals,” McDade wrote in his recommendation letter. “When she was admitted to the Pritzker School of Medicine, we knew we had a strong mind to accompany a young woman passionate to help her community.”

Spring 2009 23


Circuit breaker by John Easton

The cardiologists were coming to McCormick Place and they needed electricity and phones. But first, William Mitchell, an electrician and telephone foreman at McCormick Place, needed a cardiologist. Mitchell, 38, was a key player in preparing the vast convention center for the April 2008 meeting of the American College of Cardiology in Chicago. But his heart was all aflutter—and not because he was nervous about the phone lines. It was simply beating too fast. Mitchell’s resting heart rate doubled the average person’s heart rate, reaching 135 beats per minute even as he slept. “It felt like it would just bounce out of my chest,” he said. When he walked, his heart rate leapt up to 170. At work, he sometimes felt lightheaded and short of breath. He had to take frequent breaks. From left: Bradley Knight, MD; Martin Burke, DO; John Beshai, MD; and Albert Lin, MD, are part of the cardiac electrophysiology team that treats patients at the Medical Center. Photo by Dan Dry

24 University of Chicago Medicine on the Midway

Bradley Knight, MD, looks at electrophysiology images of a heart. He uses high-powered magnetic fields to steer catheters that can correct arrhythmias. Photo by Dan Dry

Color-coded images of the patient’s heart help physicians map the flow of current and the effects of treatment. Photo by Dan Dry

If the condition weren’t so familiar to him, Mitchell would have worried more. His father had a rapid heart beat, and his grandfather before that. Both went untreated. A “stubborn Irishman,” Mitchell also resisted seeing a doctor about it for “maybe six months.” His wife, a nurse, was nervous. She made an appointment and made sure Mitchell kept it. Cardiologists at a south suburban hospital diagnosed him with atrial fibrillation. They tried to shock his heart back into a normal rhythm, to no effect. They gave him drugs to restore a normal rhythm, but no change. “They couldn’t do it,” Mitchell recalled. “So they sent me to Dr. Knight.” Bradley P. Knight, MD, professor of Medicine and director of Cardiac Electrophysiology at the University of Chicago Medical Center, sees a lot of atrial fibrillation, a common heart-rhythm abnormality. But Mitchell was a tough case. Usually the accelerated heart rate comes and goes, and sometimes it responds to medications. Mitchell’s unrelenting fibrillation had persisted for months, overpowered the defibrillator and raced on through various medications, placing it in the realm of “permanent” atrial fibrillation, which was untreatable in his father’s and grandfather’s generations. The six-month delay in treatment didn’t help.

normal heart, electricity flows in a regular, measured pattern that coordinates heart muscle contractions. This electrical flow begins in the heart’s natural “pacemaker”—the sinoatrial node in the upper right heart chamber, the right atrium. The electricity flows through the upper chambers, crosses the atrioventricular node— a bridge between upper and lower chambers. Then, the electricity courses through the lower chambers—the ventricles—where it culminates in a carefully coordinated contraction of heart muscle that pushes blood out of the heart to the rest of the body. A detour anywhere along this electrical highway can disrupt the entire system. And a disruption may result in several different types of cardiac arrhythmias, including atrial fibrillation, atrial flutter, atrioventricular nodal reentry, WPW syndrome and atrial tachycardia—all relegated to the upper chambers of the heart, Knight’s specialty. To find the arrhythmia’s source, electrophysiologists insert the catheter—a narrow, flexible tube with current-monitoring electrodes at the tip—through a small incision in the groin or neck and snake it up a vein and into the right atrium. Once inside, they place the tip against dozens of points on the inner surface of the heart and measure the intensity and timing of the nearby electrical current that precedes each heart beat. With this data, a computer, sometimes pre-loaded with CT images of the patient’s heart, superimposes the electrical activity onto the known geography of the inner cardiac surface. Once the physicians have a suspect—some trouble-making tissue that serves as the aberrant electrical pathway—they use radio-frequency energy to damage that tissue and thus disconnect the abnormal circuit. After creating a small lesion, they try to stimulate the heart to beat rapidly again, to make certain they have “ablated” the faulty tissue, silencing the arrhythmia at its source. For many arrhythmias, such as WPW, the target is as small as a hair and can be successfully ablated with a single application of energy. For other rhythms such as atrial fibrillation, the arrhythmia that Mitchell suffered from, the target is a large amount of tissue and requires the delivery of multiple small lesions. In Mitchell’s case, it required almost 60 burns before physicians felt they had eliminated the source of the arrhythmia. The entire procedure took five hours. Mitchell has been fine since.

New technology for an old condition The current generation of heart-rhythm experts has radically sped up the growth and power of this emerging specialty. A relatively new and technology-driven field, cardiac electrophysiology began in the 1930s with the description of Wolff-ParkinsonWhite (WPW) syndrome, a racing heart caused by an extra electrical pathway that delivers duplicate signals telling the heart muscle to contract. When the heart rate multiplies, the chambers don’t have time to refill between contractions and the amount of blood pumped to the lungs and through the body decreases, leading to symptoms such as Mitchell’s. As there were no cardiac catheters in those days, heart surgeons pioneered various mechanical repairs for arrhythmias that were resistant to drugs, isolating and shutting down the aberrant pathway in the operating room. Physicians reported the first successful surgical procedure for WPW syndrome in 1968. By 1982, cardiac electrophysiologists had begun to experiment with less invasive approaches, using a catheter inserted through a vein to disrupt the trouble spot. By the late 1980s, ablation with radio-frequency energy administered via a catheter had become the standard way to eradicate an aberrant electrical pathway without surgery. “When the tip of this catheter is placed against cardiac tissue and radiofrequency current is applied, a 3 to 5 mm circular area of localized cardiac necrosis is created,” one recent review article described. Knight explained the process more succinctly: “We find the source of the problem, and we zap it.” Finding the source of an arrhythmia is typically the initial challenge. “It can be a painstaking process,” Knight said. In a

Ever onward The heartbeats may have slowed but the technology races ahead. “Our tools, the equipment and the software, keep getting more and more sophisticated,” Knight said. Better cardiac imaging and increased computing power brings new precision to the anatomical and electrical maps of the heart, which cuts down on the time required for each case and makes it safer for the patient. And the new tools can extend treatment to patients who may not have had access before. Last summer, Knight was the first physician in the world to use a new device designed to make it safer for cardiologists to burn a small hole through the atrial septum,

Spring 2009 25


The clinic includes workout facilities, which are used for fitness tests as well as to help patients meet personal health goals. Photo by Dan Dry

“Our tools, the equipment and the software keep getting more and more sophisticated.”

the thin membrane that separates the two upper chambers of the heart, allowing the catheter to pass safely from the right side of the heart to the left. “Having the right tools to control each step,” Knight said, “enhances our confidence and extends the number of patients we can help.” Barbara Ganschow, 80, suffered from atrial fibrillation. An avid traveler who was remarkably healthy for the first 75 years of her life, she noticed the irregular heart rhythm during a 23-hour flight back to Chicago from South Africa. “I just felt awful,” she recalled. “It was a miserable flight.” Cardiac ablation at another hospital worked for her—but only for three years. Then the abnormal rhythm returned, this time even worse. Because of scar tissue that formed after the first procedure, however, her doctors could not repeat the initial treatment, which required passing the catheter across the atrial septum to the left atrium, where the problem was centered. So, like Mitchell, Ganschow’s doctors referred her to Knight. Using the new device, he burned a small hole in her atrial septum, passed the catheter smoothly from the right to the left atrium and eradicated the problem. Ganschow went home the next day.

Patients at 150 East Huron will benefit from a multidisciplinary team that collaborates to create health plans to improve quality of life. Photo by Dan Dry

Bradley P. Knight, MD

“I feel fantastic,” she reported one week after treatment. “I have my life back, and I’m so glad.” And sometimes the technology makes life easier for the physicians. Last fall, the University’s electrophysiology and interventional labs installed new high-tech catheterization systems that rely on giant computer-controlled magnets to guide the catheter into place. Instead of the doctor manually manipulating the catheter to multiple locations within the heart, a magnetic field gently steers the catheter tip through a predetermined path within the heart. “This system appears to be a very safe, gentle approach,” said Knight. The technology benefits the physicians, too. Instead of wearing 20 pounds of lead to shield themselves from radiation produced by a fluoroscope as they maneuver the catheter, doctors can sit comfortably in the control room watching computer screens while the new system puts the treatment tools in place, like a GPS that can drive itself. Those full metal jackets “took a toll on me, on all of us,” said Knight. Now, like the lead shields, his persistent foot pain has gone away.

Martin Burke, DO, analyzes a patient’s heart rhythms based on recent test results. Photo by Dan Dry

The Power of Personalized Medicine Benjamin Franklin famously noted that an ounce of prevention is worth a pound of cure. Now, more than 200 years after Franklin uttered the thought, the University of Chicago Medical Center is bringing his idea to life through a clinic at 150 East Huron, which exists specifically for preventive, comprehensive care. Located in downtown Chicago at the corner of Michigan Avenue and Huron Street, the clinic includes specialists in cardiology, endocrinology, dermatology, sleep disorders, rheumatology, pulmonary medicine and internal medicine. So many experts in one place can better tailor care to each specific patient’s needs, saving the patient from scheduling appointments with physicians at multiple locations and times. Keith Perryea is one of those patients. A development officer for the McDonald’s Corporation, he visited Ari Levy, MD, lead physician for the Program for Personalized Health & Prevention and clinical associate at the Medical Center and 150 East Huron. Perryea’s physical exam and lab results showed he was overweight and had diabetes, high blood pressure and high cholesterol. He was at risk for the multitude of complications that diabetics face, including heart attack and stroke. But with Levy and a team of nutrition and fitness experts, Perryea began a simple lifestyle change by exercising daily. After developing his fitness routine, he improved his diet and started e-mailing Levy on his progress every day. “This is working for me because I know that someone is watching everything I do, and I am the kind of person who needs structure,” he said. Because of the changes he’s made, Perryea has lowered his cholesterol, blood sugar levels and weight—by 26 pounds. “In this clinic, we want to provide the time, the setting and the information in a very, very individualized manner,” said Martin Burke, DO, associate professor of Medicine and Medical Director at the clinic, who specializes in heart rhythm disorders. “I think the Huron practice model is how we take University of Chicago’s reputation for exceptional patient care, education, research and clinical expertise and integrate it in a different location.” The medical team includes authorities on heart diseases, advanced lung and sleep disorders, skin diseases, women’s health issues, immune disorders such as sarcoidosis, and genetic

Physicians and staff at the practice are available around the clock to answer questions about general health and specific concerns and to guide patients’ health goals. Photo by Dan Dry

diseases such as cardiomyopathy and Long QT syndrome. They also focus on cardio-metabolic treatment, risk-factor reduction and lifestyle modification. “We’re providing the patient with what they need in one setting—triaging medical risks, consolidating the three- to four-month process of scheduling, following up and coordinating into one day,” Levy said. Patient education on diet, exercise and lifestyle is available, too. The medical team creates personalized care plans to improve health, which allows patients to manage and reduce risk. On-site genetic counselors, certified dietitians and exercise physiologists help monitor and implement sustainable lifestyle changes while providing the tools and support needed to reach an individual’s pinnacle of health, as Perryea can attest. The Program for Personalized Health & Prevention (formerly known as the Executive Health Program) also accepts patients at the downtown location. “Huron’s mission is to provide comprehensive personalized care to individuals, control their risks and deliver better outcomes,” Levy said. “Better outcomes meaning healthier people living longer.” Spring 2009 27


Alumni News

1930s Bernard G. Sarnat, SB ’33, MD ’37, is featured in Pete E. Lestrel’s book Bernard G. Sarnat: 20th Century Plastic Surgeon and Biological Scientist. Sarnat was a practitioner in the formative years of modern plastic surgery as well as an internationally known biological researcher in the area of craniofacial biology. He was among the first bone researchers to apply the stain alizarin red S to document the pattern of dental and bone growth, and he published over 220 research papers dealing with bone and teeth biology. The biography tells the story not only of a successful physician-scientist, but also Sarnat’s dedication to his family.

1940s Albert Sjoerdsma, PhB ’45, SB ’46, PhD ’48, MD ’49, is the subject of a new biography, Starting with Serotonin: How a High-Rolling Father of Drug Discovery Repeatedly Beat the Odds, written by his daughter, Ann G. Sjoerdsma, a professional journalist. Called the father of modern clinical pharmacology for his research at the National Institutes of Health in the 1950s and 1960s, Sjoerdsma conducted groundbreaking serotonin studies that led to diagnosis of the carcinoid syndrome and discovery of the antihypertensive, methyldopa, among many other accomplishments. Later, as president of the Merrell Dow Research Institute, Sjoerdsma oversaw development of a breakthrough antiepileptic, the first-ever nonsedating antihistamine, and a cure for African sleeping sickness. Sjoerdsma, now 84, received the 1967 University of Chicago Distinguished Service Award.

1950s James A. Roberts, SB ’56, MD ’59, reports that he is enjoying retirement in the mountains of North Carolina.

1960s “Medicine has changed markedly since our graduation, but academic medicine continues to be intellectually stimulating, challenging and lots of fun.” Abdollah Sadeghi-Nejad, SM ’64, MD ’64, writes, “It has been a wonderful journey. Medicine has changed markedly since our graduation, but academic medicine continues to be intellectually stimulating, challenging and lots of fun. Professionally, I continue to work full time and enjoy my life as a triple-threat dinosaur. After 35 years of marriage, Marion and I still love holding hands, traveling, sharing a glass of wine and challenging one another to a game of Scrabble on the beach. A fabulous journey indeed. See you all at the Reunion.” Samuel Jacobson, MD ’68, is sorry to have missed the Reunion but is still alive and well and surfing in southern California. Jeffrey P. Froehlich, MD ’69, was a commissioned officer in the U.S. Public Health Service Commissioned Corps from 1972 to 2000, stationed at the National Institute on Aging (NIA). He became the chief of the Membrane Biology Section at the NIA in 1985. In 2005, he was appointed professor in the Department of Biochemistry and Molecular Biology at the University of Maryland School of 28 University of Chicago Medicine on the Midway

Medicine, and in 2007, joined the faculty in the Department of Medicine, Division of Cardiology at Johns Hopkins University. His current research focuses are congestive heart failure and the development of novel drugs for treating prostate, breast and pancreatic cancer. He is married to Sandra Rose and has one son, Paul. Richard M. Gottlieb, AB ’65, MD ’69, is in clinical practice in New York City and Sharon, Conn. He also recently became a sheep farmer. In addition, he teaches, writes and edits literature in his field. He has two sons, one about to graduate from law school and the other a college sophomore who ran the Grand Canyon in his whitewater kayak in December. Karen L. Kaplan, PhD ’67, MD ’69, is enjoying retirement in New York City and thinking about a non-science master’s degree. She also enjoys her grandchildren, who live nearby.

1970s Robert A. Kaufman, MD ’74, has been the radiologist-in-chief at St. Jude Children’s Research Hospital since 2003. His wife, Elaine, is now retired from “Facing History and Ourselves” but has become a board member of that organization and two others. Their daughter, Jenny, is a pediatric hospitalist living in Philadelphia, and their son, Jay, is in the MBA program at the Chicago Booth School of Business, Class of 2010. Kaufman says, “We’re still having fun, which is a good thing, since we’ll be working for a long time to come.” Nathan Szajnberg, AB ’74, MD ’74, was appointed to the Sigmund Freud Chair of Psychoanalysis at the Hebrew University, which was established at the urging of Anna Freud. Previous recipients have included Al Solnit, Joseph Sandler, Sidney Blatt and Bennett Simon. Szajnberg’s study of Israeli soldiers, Reluctant Warriors, was reissued in 2008. Alan R. Rushton, PhD ’75, MD ’77, has published Royal Maladies: Inherited Illnesses in the Ruling Houses of Europe. The work presents the effects of the hereditary diseases hemophilia and porphyria on the personal and political lives of the Royal Families of England, France, Russia, Spain, the German states and Scandinavia from the ninth century to modern times. Frank S. Lieberman, MD ’79, currently serves as the director of the Adult Neuro-Oncology Program at the University of Pittsburgh Cancer Centers. Paul Sternberg Jr., MD ’79, moved to Nashville in January 2003, when he joined the faculty at Vanderbilt to build its eye program. It has been a successful move, with the opening of the Vanderbilt Eye Institute in the spring of 2008. The new space includes a 50,000-square-foot clinical and educational facility with 53 exam rooms and a 15,000-square-foot vision research laboratory. There are 34 full-time faculty, 15 residents, and a number of clinical and research postdoctoral fellows. Sternberg is enjoying life in Nashville.

1980s Anne L. Peters, MD ’83, recently received the American Diabetes Association’s Distinguished Clinician Award. This award is presented to an individual who has made outstanding efforts in diabetes care and is recognized as a highly regarded clinician and educator with more than 10 years of distinguished service. Peters currently serves as the director of the Clinical Diabetes Programs

at the University of Southern California (USC) and a professor of clinical medicine at the USC Keck School of Medicine. Ira S. Rubin, PhD ’83, MD ’84, runs a mini-medical school for high school students, in an effort to encourage them to pursue careers in medicine. The program is 16 hours long and held at Edward Hospital in Naperville, Ill. Rubin created this program with the help of his son, Zachary, who is now a Pre-Professional Scholar in Medicine at Case Western Reserve University. Maxine Barish-Wreden, MD ’85, has co-written The Complete Idiot’s Guide to Secrets of Longevity, which includes tips for healthier living. Barish-Wreden, who completed her internship and residency at UC Davis Medical Center, has been a practicing internist in Sacramento since 1988.

1990s Gretchen L. Birbeck, MD ’94, spends six months annually in southern Africa, where she provides clinical services and conducts clinical and epidemiologic research on common neuropsychiatric conditions in Zambia, Malawi and Uganda. Gretchen L. Birbeck, MD ’94, is the director of Michigan State University’s International Neurologic & Psychiatric Epidemiology Program. She spends six months annually in southern Africa, where she provides clinical services and conducts clinical and epidemiologic research on common neuropsychiatric conditions in Zambia, Malawi and Uganda. Loren Schechter, MD ’94, has been appointed division chief of plastic and reconstructive surgery at Chicago Medical School, Rosalind Franklin University of Medicine and Science. With almost 10 years of experience in plastic surgery, Schechter will mentor Chicago Medical School students and will be responsible for proposing appointment, promotion and retention of faculty members, developing an annual divisional report and evaluating faculty status on an annual basis. Ithaar H. Derweesh, MD ’95, joined the University of California at San Diego Division of Urology faculty in July 2008 as associate professor of surgery. His practice and research will be centered at the Moores UCSD Comprehensive Cancer Center. William Dale, AM ’94, PhD ’97, MD ’99, returned to the University of Chicago following his residency (Internal Medicine – Primary Care) and fellowship (Geriatrics) at the University of Pittsburgh. He cares for older geriatric-oncology patients in his Specialized Oncology Care & Research in the Elderly (SOCARE) Clinic. He recently accepted the position of section chief of Geriatrics & Palliative Medicine. He is married to Tamra Dale, and they have three boys (twin 2-year-olds and a 5-year-old). Anjali Karen Fedson Hack, LAB ’85, AB ’88, AM ’90, MD ’99, PhD ’99, writes that after completing her anesthesiology residency and obstetric anesthesiology fellowship at Brigham, she and her husband (Andrew Hack, AB ’95, PhD ’00, MD ’02) moved to New York where she took a faculty position at Columbia University. She currently practices high-risk obstetric anesthesia and does research in the social anthropology of medicine. They live in New York City and have two healthy, lovely children.

2000s Sean A. McKay, AB ’96, MD ’01, graduated from his Pulmonary & Critical Care Fellowship at the National Naval Medical Center in June 2008. He has been assigned to Naval Hospital Camp Lejeune in North Carolina as a staff Pulmonary & Critical Care physician. Elizabeth Sailhamer, MD ’03, a general surgery resident at the Massachusetts General Hospital (MGH), was honored by the New England Surgical Society for research presented at its annual meeting. Sailhamer earned second place in the Resident Essay Prize competition based on a paper and oral presentation of research she conducted as part of the MGH residency program. Her study identified predictors of mortality and the need for colectomy among patients with fulminant Clostridium difficile colitis (FCDC). She found that reliable predictors of mortality exist and should be used to prompt aggressive surgical intervention, and that survival is higher in patients cared for with surgical instead of non-surgical services, perhaps because of more frequent and earlier operations. Rekha Vij, MD ’04, married Sujit V. Janardhan, PhD ’07, MD ’08, on September 27, 2008, in Chicago, Ill. Andrew Stan Flotten, MD ’07, was recognized by his program leader as the Transitional Intern of the year, out of 25 interns. He also held the position of class leader for the 77 interns at the Naval Medical Center, Portsmouth, Va. He will be spending two years as a Navy flight surgeon before pursuing a residency in radiology.

Former Faculty Richard M. Bergenstal, MD ’76, a former endocrinology fellow at the University of Chicago Pritzker School of Medicine, has become President-Elect, Medicine & Science, for the American Diabetes Association. Bergenstal works as the executive director of the International Diabetes Center at Park Nicollet in Minneapolis, Minn., and clinical professor for the Department of Medicine at the University of Minnesota. Samir Hajj, MD, a longtime faculty member and recently retired chief of Gynecology, has been recognized with an honorary lectureship in his name. The first Professor Samir Hajj Honorary Lecture will take place May 15 at the University of Chicago Medical Center. Arthur L. Herbst, MD, former chairman of the Department of Obstetrics and Gynecology, will present the inaugural lecture. Alumni are welcome to attend; for more information, contact Gail Isenberg at gisenber@babies.bsd.uchicago.edu. Peter A. Ubel, MD, a fellow in clinical ethics from 1991 to 1992, is the author of Free Market Madness: Why Human Nature is at Odds With Economics—and Why It Matters (Harvard Business Press, January 2009). In his book, Ubel exposes the limits of human rationality and shows what happens when capitalism meets human nature. He shows what markets could look like if they were designed to consider human nature and reminds policymakers that when freedom and well-being collide, carefully calibrated restrictions on freedom are a small price to pay for a healthier, happier populace.

Correction The e-mail for alumnus Richard Neudorfer, MD ’51, was misspelled in the previous issue. His correct e-mail address is neudorfr@bellsouth.net.

Spring 2009 29


In Memoriam 1940s John E. “Jack” Charles, MD ’49, died December 9, 2008, in Fond du Lac, Wis., at the age of 86. Charles, a veteran of the US Army and Navy during World War II, worked as a radiologist at St. Agnes Hospital in Fond du Lac from 1957 until 1989. He is survived by his wife of 63 years, Dorothy; four daughters; three sons; two grandchildren and two step-grandchildren.

1950s John B. Aycrigg, MD ’57, passed away on August 11, 2008. Aycrigg was a leader in the field of psychiatric hospital care in both the public and private sectors. He was a Distinguished Life Fellow of the American Psychiatric Association and a member of the Colorado Psychiatric Society. Aycrigg was recently preceded in death by his wife, Marilyn J. Aycrigg, whom he met while they were both students at the University of Chicago. He is survived by his five children: Charlotte, Benjamin, Jocelyn, Maria and Victoria.

1980s Ronald M. Davis, AM ’81, MD ’83, lost his battle with cancer on November 6, 2008. Davis, a preventive medicine physician, served as the President of the American Medical Association in 2007. His distinguished career included positions as medical director for the Michigan Department of Public Health and director of the Centers for Disease Control and Prevention’s Office on Smoking and Health. Davis recently served as the director of the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit. He was also a longtime public health and anti-tobacco advocate. He is survived by his wife, Nadine, and sons Jared, Evan and Connor.

Former Faculty Together with Paul Harper, Katherine Lathrop and Don Charleston, Beck was a key member of a University of Chicago research team that was one of the first to investigate several of the tools of modern nuclear medicine. A pioneer in the diagnostic uses of radiation and the development and testing of radiotracers in the early days of nuclear medicine, Robert N. Beck, professor emeritus in the Department of Radiology at the University of Chicago, died on August 6, 2008, from myelodysplasia, a form of leukemia. He was 80. Together with Paul Harper, Katherine Lathrop and Don Charleston, Beck was a key member of a University of Chicago research team that was one of the first to investigate several of the tools of modern nuclear medicine. They are perhaps best known for introducing technetium-99m into clinical practice in the early 1960s as a radiotracer agent. This substance is now used about 35,000 times

a day in the United States and 20 million times a year worldwide in nuclear medicine scans designed to identify tumors or abnormal physiologic processes. Beck was also known for his fundamental role in developing the theoretical framework at the core of much of nuclear medicine and for bringing mathematical rigor to imaging systems, such as SPECT and PET scans, which rely on injection of radioactive agents that can be detected within the body by external sensors. Beck, born and raised in San Angelo, Texas, earned two bachelor’s degrees from the University of Chicago. He worked as a technician in various university labs before moving to the newly created Argonne Cancer Research Hospital, where he became chief scientist in 1957. In 1964, he joined the faculty as an assistant professor of medicine, and by 1976 he was appointed professor of radiology and section chief of radiological sciences. Beck taught the physics of nuclear medicine course at the University of Chicago for 30 years and helped to establish the graduate program in medical physics. Beck is survived by his wife, Ariadne, of Indian Head Park, Ill., and two sisters, Mary Ann Beck and Dorothy Corbell of San Angelo, Texas.

Beutler enrolled at the University of Chicago when he was 15. By age 21, he had earned his medical degree. Ernest Beutler, PHB ’46, SB ’48, MD ’50, a leading hematologist whose studies opened an important new window for the treatment of leukemia, died on October 5, 2008, in San Diego from lymphoma. Born in Berlin, Germany, and raised in Milwaukee, Beutler enrolled at the University of Chicago when he was 15. By age 21, he had earned his medical degree. He completed an internship and junior residency at the University of Chicago before serving in the medical corps during the Korean War. After discharge from the Army, Beutler returned to the University of Chicago, finished his residency and worked as an assistant professor. Leon Jacobson, a pioneer in the use of radiation in medicine and on diseases of the blood, encouraged his work in hematological research. Beutler left Chicago to become chairman of the division of medicine at the City of Hope Medical Center in Duarte, Calif., in 1959. He then moved to Scripps Research Institute in La Jolla, Calif., as head of the division of hematology and later as chairman of the department of molecular and experimental medicine. Among his many professional highlights, Beutler performed wide-ranging research in biochemistry and medical genetics, especially inherited blood-borne disease. That work included the development of a drug used to treat hairy cell leukemia, as well as major investigation into the role of iron in the blood. Beutler is survived by his wife of 58 years, Brondelle, AB ’49; three sons (including Bruce, MD ’81, and Steven, MD ’77); a daughter; and eight grandchildren. Seymour Glagov, MD, professor emeritus in the departments of Pathology and Surgery at the University of Chicago Medical Center, died at a Chicago nursing home on October 29, 2008, from complications of neurovascular disease. He was 83.

Glagov was best known for his studies on the early response of blood vessels to partial blockage, a phenomenon now known as “Glagov remodeling” or the “Glagov phenomenon.” In 1987, he showed that as atherosclerotic plaque began to build up within an artery, the arterial wall would expand enough to maintain normal blood flow. Only after the blockage reached about 40 percent was the artery unable to keep pace and blood flow began to decrease. He also, with colleague Donald Rowley, MD, professor emeritus of pathology at the University of Chicago, helped invent the gel electrode, now used universally to monitor the heart by electrocardiogram. In 1959, in order to study the relationship between heart rate measured over the course of a day and atherosclerosis, the two pathologists serendipitously discovered that a bare copper wire, embedded in a gel but not contacting the skin and held in place by a small rubber container glued to a ring of adhesive gauze, could transmit an electrical signal without “electrical noise.”

Glagov was best known for his studies on the early response of blood vessels to partial blockage, a phenomenon now known as “Glagov remodeling” or the “Glagov phenomenon.” The native of Brooklyn, New York, earned a bachelor’s degree in physics from Brooklyn College and later completed medical school at the University of Geneva, Switzerland. He moved to Chicago in 1956 as a junior pathologist at Cook County Hospital and came to the University of Chicago as a pathology resident in 1957 for additional training in vascular disease. Except for two visiting professorships at Oxford, he never left. He became a full professor in 1970, directed the autopsy service at the Medical Center for more than 20 years and taught the clinical pathophysiology course for all second-year medical students from 1971 to 1975 and again from 1978 to 1993. His wife of nearly 55 years, Sylvia Glagov, died from ovarian cancer in 2001. Glagov is survived by his brother, Lester, of Orlando, Fla.; son, Hersh, of Oak Park, Ill.; Hersh’s wife Jennifer; and one grandson, Benjamin.

Medicine on the Midway A publication of the University of Chicago Medical Center Spring 2009, Volume 1, No. 1 Editor Suzanne Wilder Contributing editors Denise Alamad, John Easton and Pat Kampert

Moscona showed that the individual cells from an organ can find each other and reassemble properly, “like parts,” he said, “of an animated jigsaw puzzle.” Aron A. Moscona, PhD, the Louis Block Professor Emeritus of Molecular Genetics and Cell Biology and of Pathology at the University of Chicago and a member of the U.S. National Academy of Science, died from heart failure January 14 in Manhattan. He was 87. Moscona was best known for a series of experiments that revealed how cells arrange themselves to form tissues or organs in the body. He developed techniques to separate cells at early stages of development, suspend them in fluid and allow them to grow back together. He showed that the individual cells from an organ can find each other and reassemble properly, “like parts,” he said, “of an animated jigsaw puzzle,” and that specific molecules on cell surfaces govern these interactions during development. Moscona’s work, beginning at Strangeways Research Laboratory in Cambridge, England, in 1952, and continuing at the University of Chicago from 1958 to 1992, influenced a generation of scientists. Aron Arthur Moscona was born July 4, 1921, in Haifa, Israel. He graduated from the Reali High School in Haifa then attended Hebrew University, in Jerusalem, where he earned his PhD in endocrinology-biochemistry in 1950. He spent two years as a post-doctoral fellow at the Strangeways Research Laboratory at Cambridge, before joining the faculty at the University of Jerusalem as an associate professor of physiology in 1953. He then spent two years as an investigator at Rockefeller University in New York City, before joining the faculty at the University of Chicago as an associate professor of zoology in 1958. He rose quickly through the ranks at the University, becoming a professor in 1960. He co-founded the committee on developmental biology in 1969 and was named the Louis Block Professor of Biology in 1974. Moscona, who retired in 1992, is survived by his wife of 53 years and scientific collaborator, Malka; his daughter Anne; and two grandchildren, Jacob and Ari, all of Manhattan.

Medicine on the Midway is published for friends, alumni and faculty of the University of Chicago Medical Center, the University of Chicago Biological Sciences Division and the Pritzker School of Medicine. Articles may be reprinted in full or part with permission of the editor. We welcome your comments and letters to the editor.

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Perspective

Preserving Future Possibilities THE ETHICS OF EGG FREE ZING By David Cohen, MD

Imagine finding out you have cancer, but you haven’t yet completed school or found your life partner. Doctors tell you the tumor is treatable and that chances of surviving are higher now than in the past—75 percent compared to older figures of less than 10 percent. Imagine you are then told that the treatment has a high probability of leaving you infertile. Your plans for life are changed in an instant. If you’re a man, you have the option of freezing sperm before initiating cancer treatment. This pro-

The American Society for Reproductive Medicine, the professional organization to which nearly all physicians offering these services to women in the United States belong, makes it clear that oocyte cryopreservation for any purpose is considered experimental, that patients should be aware of this fact and should be required to sign a consent form approved by an institutional review board. At every step of these complex procedures, doctors and patients ask serious ethical questions. Consider the hypothetical case above. Should a procedure with such a low chance of success even be offered to this patient? Is it fair to offer what might be false hope to a woman at such a vulnerable moment? Who, if anyone, should have legal control of the frozen oocytes if she dies? Who should be involved in making these decisions? There are dozens of questions and no easy answers. Should this technology be available to anyone? Should these procedures be offered to the younger woman who has chosen to delay having children while pursuing an education or a career, aware of her diminishing fertility with advancing age? Understanding several fundamental reproductive principles is crucial to the consideration of freezing eggs. A woman of reproductive age with normal ovarian function most frequently produces only one mature egg, or oocyte, per month. In a healthy patient having unprotected intercourse, this oocyte has only a 10–20 percent chance of being fertilized and leading to a viable fetus. By comparison, the typical ejaculate contains more than 50 million sperm, of which at least half are typically viable.

In order to overcome the small number of oocytes available, the ovary can be stimulated with medications that provoke the production of as many as 50 oocytes, but more frequently 10 to 20. This process is expensive and cumbersome. It requires that the woman receive multiple injections, takes at least 10 days to complete and demands expert monitoring to avoid dangerous side effects. Finally, in order for doctors to obtain the oocytes, patients must undergo an invasive surgical procedure. Once harvested, oocytes traditionally are fertilized immediately, and the resulting embryos used right away or frozen. Recently, however, the technology has been developed to freeze unfertilized eggs. The technology to successfully “defrost” sperm has been around for decades, but while frozen sperm has essentially the same success rate as sperm that has not been frozen, success rates using frozen eggs are much lower than with fresh. The discrepancy between success rates using sperm and oocytes after thawing results from differences in how the cells are constructed. Sperm are small compared to oocytes (4 microns versus 100 microns), and the water content of an oocyte is much greater, making the egg much more vulnerable to damage during the freezing process. The water crystallizes when frozen, and the crystals act as shards inside the cell, tearing the machinery needed to permit normal cell division after fertilization. The crystallization phenomenon can be diminished using specific cryoprotectant compounds, but these may be toxic to the cell. Finding the right balance between protecting against damaging crystals and poisonous chemicals is the focus of many laboratory efforts. Each oocyte, once obtained, must be isolated and prepared for fertilization in the laboratory and incubated with sperm for several days before the resulting embryo is ready to be transferred into the uterus. With “fresh” eggs, each embryo has an approximately 15 percent chance of successfully implanting. Therefore, more than one embryo is frequently transferred with the hope that at least one normal embryo successfully attaches. If oocytes are frozen before fertilization, the chance of successfully conceiving after the oocyte is thawed, fertilized

and transferred is 5 percent. And importantly, the woman’s age at the time the oocytes are obtained will predict the chances of an ultimately successful outcome, with the likelihood of success decreasing with advancing age. At the Center for Reproductive Medicine and Fertility at the University of Chicago, we do not have a specific protocol to resolve all questions for all patients. Instead, we have adopted a practice of presenting complicated ethical questions to the University Ethics Committee to discuss all angles of each case, in a forum composed of individuals from many different backgrounds. Currently, we do not have any specific restrictions, and we have, thus far, resisted the urge to produce written criteria, preferring to consider each case separately. We have recently vigorously debated how to offer a procedure to a healthy woman without misguiding her to a false expectation of success. Just explaining the process and the success rates, even if she clearly understands how poor they may be at the time, seems insufficient. We require each patient to accept in writing the institutional review board consent statement, as well as the standard surgical consent, before proceeding. Additionally, we make it clear that the current cryotechnology is more likely to be successful with standard in vitro fertilization—that is, if harvested eggs are directly fertilized and the embryos frozen—than if the unfertilized eggs are frozen to be fertilized after thawing. Reproduction has always been considered a fundamental right, and each new technology demands that medical experts reassess how we address the issues of the individual and society. As doctors, we are harnessed between our desire to give patients autonomy and our own need to respect our instincts of what we consider appropriate and safe interventions. At what point does a patient’s autonomy to make decisions about her reproductive options conflict with our duty to do no harm? As we answer these questions, each patient must be considered individually. Reproductive technologies are changing at an amazing rate, and ethics committees that comprise physicians and nonphysicians must be prepared to face new and unforeseen challenges as patients face life-changing decisions.

cedure is relatively simple and inexpensive. If you’re a woman, however, the opportunity to try to preserve fertility is much less simple. Freezing eggs, a process called oocyte cryopreservation, involves not only complex reproductive issues, but also intense ethical debates. 32 University of Chicago Medicine on the Midway

David Cohen is associate professor and chief of Reproductive Endocrinology & Infertility in the Department of Obstetrics & Gynecology. He leads the In Vitro Fertilization Program at the University of Chicago Center for Reproductive Medicine and Fertility. Photo by Dan Dry Spring 2009 33


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