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S P E C I A L 5 0 TH ANNIVERSARY ISSUE

SUMMER 2018

MOUNT SINAI SCIENCE & MEDICINE T H E M AG A Z I N E O F T H E M O U N T S I N A I H E A LT H S Y S T E M

50 YEARS OF INNOVATION at the Icahn School of Medicine at Mount Sinai


MOUNT SINAI SCIENCE & MEDICINE VOLUME IX, NUMBER 1

PRESIDENT AND CHIEF EXECUTIVE OFFICER MOUNT SINAI HEALTH SYSTEM

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Kenneth L. Davis, MD ANNE AND JOEL EHRENKRANZ DEAN, ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI PRESIDENT FOR ACADEMIC AFFAIRS, MOUNT SINAI HEALTH SYSTEM

Dennis S. Charney, MD CHIEF DEVELOPMENT OFFICER SENIOR VICE PRESIDENT FOR DEVELOPMENT MOUNT SINAI HEALTH SYSTEM

Mark Kostegan, FAHP EDITOR

Elizabeth Chute ASSOCIATE EDITOR

Anna Horton PRODUCTION ASSOCIATE

Vincent Lofton

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CONTRIBUTORS

Travis Adkins Joni Aveni Catherine Clarke Alison Dalton Sheena K. Fallon Don Hamerman Andrew Lichtenstein Susan McCormick Claudia Paul Sima Rabinowitz Deborah Schupack Katie Quackenbush Spiegel Ellen Stark DESIGN

Taylor Design Mount Sinai Science & Medicine is published by the Office of Development, Mount Sinai Health System, for an audience of friends and alumni. We welcome your comments; please contact us at magazine@mountsinai.org or call us at (212) 659-8500. Visit us online at giving.mountsinai.org.

The First 50 Years Fifty years is a short time in the life of an institution, and yet, for the Icahn School of Medicine at Mount Sinai, celebrating its first half century, it is enough time to make a profound impact within the world of biomedicine and science. This special 50th anniversary issue looks back at the extraordinary vision of the School’s founders, who instilled a culture of innovation that survives and thrives today, and who understood that the path to success begins with thoughtful risk-taking and the inclusion of diverse ideas and people. We also look at the brilliant alumni who are breaking barriers across science, medicine, policy, and industry; the clinician-scientists who are creating the new research and clinical platforms for the new world of biomedicine; and not least, the educators who continue to nurture and inspire the next gener-

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ABOUT THE COVER

ation of scientists and physicians to achieve the goals the founders

A full brain tractography with artistic color. This is a full brain tracking coming from a super-resolution reconstruction of 0.6 cubic mm. Front view. Image by Sherbrooke Connectivity Imaging Lab (Getty Images).

set out: to change and improve the lives of patients.

Back cover photo of Match Day by Robert Caplin. Studio portraits on pages 2, 20, 21, 22, 24, 26, 27, 29, 30, 32, 33 and 41 © Claudia Paul.


CONTENTS

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S P E C I A L 5 0 TH ANNIVERSARY ISSUE

FEATURES

Celebrating a Milestone: The Icahn School of Medicine at Mount Sinai Turns 50 03

50 Years of Innovation A look at the forces and vision behind the extraordinary rise of the medical school.

10

The Rise of a School—A Timeline

 Milestones for the Icahn School of Medicine, from 1968 to

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Dean Dennis Charney looks ahead—and the future is bright.

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The Icahn School of Medicine at 50

Transforming Medical Education How Mount Sinai’s brand of education is an agent for change.

20 Profiles in Innovation  Research at the Icahn School is transforming our under-

standing of disease and changing the lives of patients.

Medicine of the future means creating new research and clinical platforms.

Lab100: The New Model of Care

 A dazzling new lab prototype at Mount Sinai is the new model

present day.

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Reinventing Medicine for the Next Generation

for clinical care.

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Alumni Profiles

 Mount Sinai alumni are breaking barriers across science and medicine.

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50th Anniversary: A Celebration in Images A look at the special events marking the anniversary year.

Mount Sinai Leadership at a Pivotal Moment in Time

 The revolution in biology and technology paves the way for a

campaign to keep up with and inspire growth.

The Mount Sinai Health System is comprised of eight hospitals and the Icahn School of Medicine at Mount Sinai: Mount Sinai Beth Israel + Mount Sinai Brooklyn + The Mount Sinai Hospital + Mount Sinai Queens + Mount Sinai St. Luke’s + Mount Sinai West + New York Eye and Ear Infirmary of Mount Sinai + South Nassau Communities Hospital

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Mg

MESSAGE Message from

THE CEO      THE DEAN

&

At Mount Sinai, we believe that the impossible is possible, that collaboration is the path to conquering the unknown, that groundbreaking discoveries are worth the risk of failure, and that the future of biomedicine is built upon a thoroughly diverse group of students from all walks of life. In the 50 years since our visionary founders made the transformational decision to establish a medical school and attach it to a world-renowned hospital, the Icahn School of Medicine has been transforming medical education, training, and research. These forward-thinking founders recognized the clinical importance of the new insights emerging from the revolution in biology and were determined to exploit this information to enhance the understanding and treatment of human disease. The research conducted at Mount Sinai is truly exceptional. We consistently lead in National Institutes of Health funding and in rankings that measure our impact, such as the Nature Innovation Index, which measures the impact of science on new therapies—a testament to our outstanding translational research. Beyond the numbers, our scientists have invented game-changing new ways to diagnose, treat, and ultimately prevent some of the most devastating diseases of our times. What makes this engine of innovation and progress possible is the remarkable collaboration of our faculty, something that has always been integral to our insti-

While our faculty and students innovate in the lab and clinic, we as an institution must meet them with creative, forward thinking.

tution. Our scientists, educators, and clinicians share expertise, insights, and ideas across traditional lines, rendering the volume and diversity of the Health System an extraordinary asset. As educators, we are revolutionizing medical training to ensure that our students and residents are prepared to lead and thrive as biomedical science evolves to new horizons. Based on our belief that intellectual diversity is the key to scientific progress, we are the only top-tier medical school in the country to specifically recruit students from non-scientific backgrounds into medicine. As a result, we attract motivated, brilliant candidates from an incredible range of backgrounds. While our faculty and students innovate in the lab and clinic, we as an institution must meet them with creative, forward thinking. To ensure Mount Sinai’s next era

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

of excellence, we have embarked on a capital campaign that focuses on making new

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resources available to our students, trainees, and educators. As we have done for the last 50 years, we look not only to where the science is now but also where it is going, promising areas of experimentation that will become the new frontiers of discovery. Guided by the boldness of imagination that has led us to this milestone half-century mark, we are creating the research and clinical platforms that will launch the next generations of breakthroughs in biomedicine. Kenneth L. Davis, MD President and CEO, Mount Sinai Health System

Dennis S. Charney, MD Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai President for Academic Affairs, Mount Sinai Health System


50 YEARS OF INNOVATION B Y E L L E N S TA R K

The Icahn School of Medicine Celebrates a Milestone—and Looks to the Future

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Dedication of Mount Sinai School of Medicine, 1968 Right, above: Basic Sciences Building, the first MSSM building (rendering); below, left: George James, MD, MPH, first Dean of MSSM and President, Mount Sinai Medical Center, in 1965; below, right: Gustave L. Levy, Chairman, Mount Sinai Boards of Trustees (1962-1976) and a driving force behind the creation of the School, in 1971

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

F 04

orty-nine years ago, Kenneth L. Davis, MD, was an accomplished senior at Yale University in search of a medical school to attend. Now President and Chief Executive Officer of the Mount Sinai Health System, Dr. Davis recalls finding what was then called simply the Mount Sinai School of Medicine almost by chance. After the usual battery of school interviews led to long waits and a string of deferrals, an aunt who had been a nurse at Mount Sinai mentioned that the hospital had just opened a medical school.

Realizing that a Yale friend had joined the

a tradition of serving the community,

investigator. Last year the Nature Index

first class, Dr. Davis reached out, liked what

and committed to students from varied

of Innovation, a measure of high-quality

he heard about the small class size, and

backgrounds. Propelled by a spirit of

research and new commercial products,

applied. The interview process wrapped

innovation and discovery inherited from

ranked ISMMS 10th in the nation for

up with a face-to-face with the Dean of

The Mount Sinai Hospital, this young school

influential innovations.

Students, who offered him admission to the

has matured quickly, shooting into the

To understand this meteoric rise, we

School’s second class on the spot. “I thought

upper ranks of medical schools in just a

asked a half dozen longtime faculty

this was pretty good,” Dr. Davis recalls.

few decades.

members and administrators, many

“This is a different kind of place. It seems

With $306 million awarded to ISMMS

alumni among them, to speak to their

like it’s a lot more intimate and caring. So

researchers in 2017, the School ranks 14th

experiences at the School and to identify

that was my decision.”

among U.S. medical schools in research

the innovations that have made ISMMS

Fifty years after it opened, the Icahn

grants from the National Institutes of

the “different kind of place” Dr. Davis

School of Medicine at Mount Sinai (ISMMS)

Health. The Association of American

encountered as a new medical student

remains a “different kind of place,” a school

Medical Colleges (AAMC) places the School

in 1969—and so successful in the years

grounded in its hospital roots, guided by

second in research dollars per principal

that followed.


A GROUNDING IN PATIENT CARE In looking at the crucial innovations that have shaped the character, culture, and vision of ISMMS over the past 50 years, perhaps none is more significant than the story of the School’s founding in the 1960s and the transformational decision by leadership to establish a medical school and attach it to a world-renowned hospital. While most top medical schools have started within a university system, ISMMS was built on the foundation of a hospital MSSM Dean Nathan Kase, MD, circa 1985

to fulfill the expressed clinical needs of patients. “The genome of the school is unique in this respect,” says Nathan Kase, MD, Dean of the School from 1985 to 1997

Board of Trustees decided that this would

science. But it valued science for the sake

and now Dean Emeritus and Professor of

not remain an outstanding hospital if they

of facilitating patient care, understanding

Obstetrics, Gynecology, and Reproductive

didn’t train the future leaders in the field,”

diagnoses, understanding pathophysiology.

Science. “It didn’t emerge as an academic

says Janice Gabrilove, MD, James F. Holland,

It was a place that put science in the service

outgrowth of applied science but through

MD Professor of Medicine and Oncological

of solving problems of disease.”

an understanding that to remain clinically

Sciences; Associate Director, Education and

When Dr. Davis looks back at the

effective and cutting edge, a great hospital

Training, The Tisch Cancer Institute; and a

most influential leaders from the early

urgently needed to incorporate the ‘new’

member of the Class of 1977.

days, he cites great clinicians, including

science into clinical care.”

Yet even as the School built up its

Solomon Berson, MD, the first Chair of the

When the School was conceived in the

labs and institutes, that distinction of

Department of Medicine, and Hans Popper,

late 1950s, the then-100-year-old Mount Sinai

being created by a hospital rather than

MD, PhD, the Chair of Pathology and the

Hospital had a long history of top-notch

a university informed the work. “It was

first Dean for Academic Affairs. “When I

clinical research. Adding a medical school

very clear that this was not a university

was a medical student, the iconic senior

was seen as a way to boost its standing

with a medical school; this was a hospital,”

faculty were people who were clinician-

in the basic sciences and remain a leader

recalls Dr. Davis. “A hospital like this, which

scientists, great diagnosticians who also

in the world of medicine. “Uniquely, the

had a tradition of doing research, valued

were attempting to push the boundaries of medicine. Those are the role models.” Dr. Gabrilove saw much of the same when she came to Mount Sinai as a first-year med student in 1973. “The initial faculty were really master clinicians,” she says. “I think that the educational groundwork as a medical school was to encourage students to use all of their senses to understand normal human physiology and pathophysiology of disease.” Being a hospital first has left a lasting imprint on the School, she adds. “From the get-go, the hospital and the medical school were joined at the hip.” Janice Gabrilove, MD, MSSM ’77, receives the Elster Prize, with Samuel Elster, MD (left) and Thomas C. Chalmers, MD (right), Dean and President, 1973-1983

05


A BREAKDOWN OF SILOS

announced it would fund five research

scientific innovations from the outset, says Dr. Kase. In their wisdom, the founders

The School’s origin as a hospital with

a very, very young medical school,” says

understood the necessity of establishing at

a strong research reputation laid the

Dr. Davis. “No one was thinking we were

the same time a robust scientific partner,

foundation for the important scientific

going to get an Alzheimer’s center.” But

he says, a multidiscipline basic science PhD

breakthroughs to come, including the first

the group he led was awarded one, along

degree-granting entity approved by the

genetically engineered vaccine, for influ-

with powerhouses like Johns Hopkins

University of the State of New York—the

enza; the proteasome, the major regulated

and Harvard, the difference being that

Graduate School of Biological Sciences. That

mechanism for protein degradation in the

Mount Sinai’s was the only pitch focused

was especially true because the medical

cell; and identification of the first genetic

on therapeutics. “That’s the league that we

school was not part of a university system.

risk factors for neuropsychiatric disorders.

were in.”

So in 1968, 19 graduate students joined the

In the 50 years that have followed, what’s

Not only do novel approaches pay off,

36 incoming first-year medical students,

pushed ISMMS into the upper echelons of

adds Dr. Davis, but persistence does too.

as PhDs were offered in 14 subject areas.

medical schools so quickly, says Dr. Davis, is

“What has been done here in cancer with

Three years later, the first MD/PhD

that its researchers have picked important

Steve Burakoff [Dean for Cancer Innovation,

students were admitted.

problems to tackle. “What differentiates

Lillian and Henry M. Stratton Professor of

“The pairing of a great hospital, an

us is when we think about what we want

Cancer Medicine, and former Director, The

ambitious medical school, and a strong basic

to study,” he says, “we study the places

Tisch Cancer Institute at Mount Sinai] is a

science graduate school into an interactive,

where we can have a huge therapeutic

wonderful example of believing in science

interdisciplinary, translational entity

consequence.”

that others might not believe in,” he says.

unquestionably accounts for not only the

Plus, he adds, “we often have a more novel

The immune system has long been thought

meteoric success of the ISMMS but the

approach.” He points to his own experience

to be the key to understanding cancer and

sustained world class clinical reputation

with Alzheimer’s research in the early

new therapeutics, and Dr. Burakoff has been

of the hospital and its physicians,” he says.

1980s, when the National Institute on Aging

a leader in the field. “Over decades it failed

One other factor was a crucial driver of

centers around the country. “We were still

to the point that everybody had given up on

“We study the places where we can have a huge therapeutic consequence.”

it, except for Steve and the people that he surrounds himself with,” says Dr. Davis, and now immunotherapies are revolutionizing cancer treatment. The other crucial innovation has been

– Kenneth L. Davis, MD

the breaking down of traditional silos around departments to target certain Kenneth L. Davis, MD, MSSM ’73, 1985

diseases more effectively. “That’s part of the innovation,” says Dr. Gabrilove. “What are the current health problems, and how can we bring the disciplines that are needed to bear on that problem?” Today ISMMS is made up of 40 multidisciplinary research institutes, such as the Arnhold Institute for Global Health, the Institute for Personalized Medicine, and the Institute for Transformative Clinical Trials. There’s been a recognition, Dr. Davis says, that science requires multidisciplinary teams. “If the only way you had collaborators was within your own department, because those are the only people you knew, you’d never get that much done,” he notes. Dean Kase championed such a multidisciplinary approach to research back in

06


Dr. Nathan Kase with students, 1993

the 1980s, with the creation, for example,

The GPEP Report: Report of the Panel

the MCAT. That left those students, who

of a center for molecular biology and an

on the General Professional Education of

already showed aptitude in math and

institute for neuroscience. More recently,

the Physician and College Preparation for

science in high school, free to continue

Dr. Davis credits Dennis S. Charney, MD,

Medicine.”

their studies in the humanities and social

Anne and Joel Ehrenkranz Dean, ISMMS,

The report bemoaned the “pre-med

sciences; an eight-week summer program

and President for Academic Affairs, Mount

syndrome,” or the single-minded cutthroat

after junior year filled in their gaps in

Sinai Health System, with invigorating this

competition to earn high grades in college

fundamental basic science.

approach: “He said we’re going to have these

science classes at the expense of other

“The School literally, absolutely pioneered,

institutes, and the institutes are going to

studies, and recommended rethinking

through early admissions policies, a

have all kinds of different disciplines, and

entrance requirements to capture the

sea change in which students we were

they’re going to focus on the diseases that

insights, values, and sensitivities that

interested in recruiting to medical school,”

you want to solve rather than the discipline

form the foundation of an altruistic and

Dr. Kase says. Studies of graduates of

that you come from. We did that very early

empathetic profession such as medicine.

the program find that they do as well as

on, and I think that contributes to our

As Dr. Kase recalls, “It recognized—truly

students who follow a more traditional

effectiveness.”

innovatively recognized—that to be a part

science-heavy path, particularly in clinical

of the caring, humane profession, you

rotations. Attracting students with arts,

A WIDE EMBRACE OF STUDENTS

need more than a grounding in organic

music, and humanities backgrounds

chemistry.”

enriches the School in unexpected ways, Dr.

So in 1987 Dean Kase, with the

Kase adds. “I’m fond of saying that the class

enthusiastic support of both the clinical

shows have never been better.”

One of the ISMMS’s signature innovations

and basic science faculty, launched the

In 2013, The Donald and Vera Blinken

was the brainchild of Dr. Kase. When

Humanities and Medicine Early Assurance

FlexMed Program expanded on this concept,

he was Dean in the mid-1980s, Dr. Kase

Program (HuMed), which offered

offering early admission to students from

was impressed by the message of a 1984

sophomores at top liberal arts colleges early

any undergraduate field of study. And today

report from the AAMC, with the lofty title

acceptance to the School without requiring

up to half of every incoming class comes

“Physicians for the Twenty-First Century:

the traditional pre-med science classes or

from this nontraditional background.

07


MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

08

A COMMITMENT TO THE COMMUNITY

Pediatrics Kurt Hirschhorn, MD, whom Dr.

in turn, imparted to students like myself.”

Butts cites as one of his strongest advocates.

Since 2004, ISMMS students have provided

A residency led to a fellowship and then

free primary care services to uninsured

to a faculty post—and a career that exempli-

local residents at the East Harlem Health

Growing up in East New York, Brooklyn,

fies the School’s innovative commitment

Outreach Partnership’s clinic.

Gary Butts, MD, Chief Diversity and

to community outreach and social justice.

Another faculty member who has had

Inclusion Officer for the Health System

Among his many achievements, Dr. Butts

a front-row seat for these innovations is

and Dean for Diversity Programs, Policy,

developed the first wave of pediatric health

Ramon Murphy, MD, Clinical Professor in

and Community Affairs, always thought

programs in New York City schools and

Pediatrics and Environmental Medicine and

he would return to his old neighborhood

secured funding from the state to develop

Public Health. After completing a residency

after he finished his training. “Like many

Mount Sinai’s pediatric school health

in pediatrics at Columbia-Presbyterian

medical students from poor communities,

program.

Medical Center, Dr. Murphy came to ISMMS

and particularly those students of color, I

Public health was part of the vision for

in 1973 to do a residency in preventive and

wanted to become an outstanding doctor

the School from the outset. In his influential

community medicine and later went on to

and go back home to take care of people

1965 paper “The Mount Sinai Concept,”

get a master’s degree in public health.

who looked like me, who were from

Dean Popper called for the creation of a

During his long career at ISMMS,

communities like mine,” he says.

Department of Community Medicine to

he spent 19 years at the Mount Sinai

Nearly 40 years after arriving at Mount

study the health needs of the community,

Adolescent Health Center in East Harlem,

Sinai as a pediatric resident, Dr. Butts

the first such department in an urban

New York City’s largest provider of free

still hasn’t returned to East New York.

setting in the United States. “What Mount

health and wellness services for young

But through decades of work in East and

Sinai truly stands for, and what’s been a

people ages 10 to 22. And in 2005 he co-

Central Harlem, the New York City public

key part of the history of Mount Sinai, is

founded the Mount Sinai Global Health

school system, and the city as a whole, he’s

addressing the needs of the underserved,”

Program, which a decade later evolved into

been able to live out his dream of helping

says Dr. Butts.

the Arnhold Institute for Global Health.

underserved communities. “I’ve been in a

The original department eventually

“I’ve been there for many of the large efforts

position to do things that were personally

morphed into today’s Department of

in community medicine,” says Dr. Murphy.

important to me,” Dr. Butts says, “and I

Environmental Medicine and Public Health,

That included working with Kurt

found an alignment of my values with those

but its legacy lives on, notes Dr. Gabrilove.

Deuschle, MD, the first Chair of the

of the institution.”

“The Department of Community Medicine

Department of Community Medicine and

Dr. Butts’s long tenure at Mount Sinai

established a sense of social justice, a

a public health pioneer. “He lit the flame,

dates back to the summer of 1980, when he

commitment to medicine being a socially

he got a lot of us going, and many people

began his residency under then-Chief of

responsible enterprise,” she says. “That was,

came to Sinai because of Dr. Deuschle,” says

Gary Rosenberg, PhD; Enrique Riggs, DDS; Gary Butts, MD; and NYC Mayor David Dinkins at Harlem Week, 1992

Ramon Murphy, MD, circa 1979


Dr. Murphy. “Allowing the community to be involved in the planning and decision-making around some programs was unheard of up until Dr. Deuschle said that this is the way to do things,” recalls Dr. Murphy. “Now everyone says ‘listen to the patient and listen to the community,’ but it was rare then.” Dr. Murphy’s own contribution to the history of innovations was the idea of training medical

Students with the Center for Excellence in Youth Education at the annual Brain Awareness Fair

students in the care of the underserved, both here and abroad. In the mid-2000s, he and colleagues created the Division of Global Health to formalize such training and make it a mandatory requirement. “By the time we were done, we were one of the five medical schools in the country that had obligatory courses in the care of the underserved,” says Dr. Murphy. “The innovation is what we’re doing that other people aren’t.” The School’s location, on the border of Harlem, contributes to the culture of caring for all, regardless of ability to pay, and all in one place, says Dr. Murphy. “The students and the doctors always had a yearning and a desire to take care of those who were in front of us,” he says. “Students sought Sinai as an agent of change.” As a former student, Dr. Gabrilove agrees: “This sense of inclusion, of diversity, commitment to the community, valuing social justice equally is on a par with the pursuit of basic science. I think for the students, that message is very strong.”

“What Mount Sinai truly stands for, and what’s been a key part of the history of Mount Sinai, is addressing the needs of the underserved.” – Gary Butts, MD

LEADING IN DIVERSITY

A

diverse student body has long been a goal for Mount Sinai’s medical school, and to that end ISMMS has launched innovative initiatives since its early days. Since 1975, the Center for Excellence in Youth Education has run a pioneering program for minority high school students interested in STEM careers. Today, Dr. Gary Butts is at the center of the efforts to help members of groups that are underrepresented in medicine flourish. “We now have the best diversity program in the country,” says Dr. Ramon Murphy, who helped train Dr. Butts when he was a resident. “And it’s because of Gary and his colleagues.” When Dr. Butts came to ISMMS as a resident, his mentor, former Chief of Pediatrics Kurt Hirschhorn, MD, was quietly promoting diversity. “A few years ago, he let me know that I was part of his diversity plan back in 1980,” says Dr. Butts. As a faculty member nearly 20 years later, Dr. Butts was asked by then-Dean Arthur Rubenstein to design, develop, and oversee diversity programs, a seed that has blossomed into wide-reaching initiatives to train, recruit, and support minority and economically disadvantaged students. The Northeast Regional Alliance MedPrep Program, one of many of the educational pipeline programs in

his diversity portfolio, for example, prepares hundreds of college students for med school with its three-year summer enrichment program. “In our peak year, 90 percent of the graduates who applied to medical school got accepted to medical school,” says Dr. Butts. Through all his years promoting diversity, Dr. Butts has felt the full support of the School behind him. “Frankly, it’s been a privilege to lead and to garnish support and respect for this work, which is Mount Sinai’s work­—it’s not just my work,” he says. “And I must commend and acknowledge the support and tireless commitment of my leadership team and the many colleagues who have worked with us in advancing these efforts.” ISMMS has also been at the forefront of ensuring that women are well represented in its classes. In 1993, ISMMS’s graduating class was majority female for the first time, and the School was the first in New York State to achieve that milestone. Dr. Janice Gabrilove recalls the environment when she arrived as a student in 1973. “When I applied to medical school, clearly there were fewer women nationally being taken in,” she says. “But for this class, one had a sense there was a better representation of women from the get-go. I think that was one very unique aspect of the School.”

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T HE I CA H N S C H OOL OF MEDICINE AT MOUNT SINAI

THE RISE OF A SCHOOL—A TIMELINE 1968 1963

1981

First students are admitted to MSSM with 36 in first-year class, 23 in third-year class, and 19 in the Graduate School

Terry Krulwich, PhD, becomes Dean of the Graduate School and Mount Sinai’s first woman dean

The Mount Sinai School of Medicine is chartered by the New York State Board of Regents

1985 1970 MSSM is dedicated and George James, MD, is inaugurated as the first Dean and President with Nobel Laureates George W. Beadle, Francis Crick, Sir Peter Medawar, and Linus Pauling in attendance

1965

Mount Sinai launches a fundraising campaign to create the Mount Sinai School of Medicine and establish as its home the Annenberg Building, named for early supporters of the School

1967

School of Medicine affiliates with The City University of New York

MSSM graduates first class of 23 students

1971

First MD/PhD students admitted

1969

1987

The first genetically engineered vaccine, for influenza, is created by Edwin Kilbourne, MD

The Humanities and Medicine Early Assurance Program (HuMed) is created to attract liberal arts students to careers in medicine

1974

The Annenberg Building is dedicated with Vice President Gerald Ford as principal speaker

1977

Rosalyn Yalow, PhD, receives Nobel Prize for development of radioimmunoassay, for work done with Solomon Berson, MD, Chairman of Medicine, 1968-1972 The MD/PhD program at Mount Sinai receives its first NIH Medical Scientist Training Grant

10

A new campaign is launched to rebuild the hospital’s facilities, including an I. M. Pei-designed pavilion named for the Guggenheim family, supporters of the hospital from the early 1900s

1988

The first liver transplant in New York State is performed by a team led by Charles M. Miller, MD


2010

MSSM is granted initial accreditation to be a free-standing accredited body and grant its own degrees

2001

The Institute for Medical Education is established

2015

Bruce Gelb, MD, and colleagues claim the first gene discovery for the class of genetic traits, now called the RASopathies

1992

2012

1998

2013

The Leon and Norma Hess Center for Science and Medicine opens with nearly 500,000 square feet of space for research and clinical facilities

The first minimally invasive abdominal aortic aneurysm repair in the United States is performed by Michael L. Marin, MD

First White Coat Ceremony for first-year medical students is held

Benjamin Greenbaum, PhD, and Nina Bhardwaj, MD, PhD, discover a group of non-coding RNA molecules in cancer cells that sets off an immune response and influences the cancer’s growth Icahn School creates an academic partnership with Google LifeScience for medical and MD/PhD student research programs in Silicon Valley

The Donald and Vera Blinken FlexMed Program expands on HuMed and allows candidates from any undergraduate major area of study to apply

2017 2004 1999

MSSM changes academic affiliation to New York University

MSSM students create the East Harlem Health Outreach Partnership clinic to provide high-quality primary and preventive health care at no cost to uninsured residents of East Harlem

2005

MSSM creates the Center for Global Health to focus on underserved populations at home and abroad

MSSM is renamed Icahn School of Medicine at Mount Sinai in honor of Trustee Carl Icahn The Mount Sinai Health System is created with the combination of the Mount Sinai Medical Center and Continuum Health Partners, becoming New York City’s largest hospital network

In a study of early-stage lung adenocarcinoma, researchers led by Miriam Merad, MD, PhD, make discoveries in immune cells that suggest that immunotherapy can be effective much earlier

2018

Mount Sinai launches a new $1.5 billion capital fundraising campaign to support research and strengthen and redesign infrastructure that connects science and clinical care

11


THE ICAHN SCHOOL OF MEDICINE AT

50 Thriving in a Culture of Innovation

12

Photo by Don Hamerman

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

U

nder the leadership of Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs for the Mount Sinai Health System, the Icahn School of Medicine has risen to a rank of 14th among U.S. medical schools in National Institutes of Health (NIH) funding and is ranked second in funding per principal investigator by the Association of American Medical Colleges. With an innovative approach to education and strategic recruitments across the biomedical sciences and in genomics, computational biology, entrepreneurship, and information technology, Mount Sinai has cultivated a supercharged environment for faculty and students, instilling a passion for pushing boundaries. Mount Sinai Science & Medicine writer Sheena K. Fallon recently sat down with Dr. Charney to discuss this culture of innovation and its influence on the medical school’s present and future.


We are not a place that does things in an iterative, step-by-step way. We are an institution that anticipates the future and participates in the future today.

13


How do you view the mission of the Icahn School of Medicine in this milestone year? Fifty years ago, the Mount Sinai School of Medicine welcomed its first students and began on a journey to fulfill our mission of becoming one of the nation’s leaders in innovation in research, education, and clinical care. What underlies that mission

We are looking for students who want to make an impact in whatever field they choose.

that? By training the next generation of

They have the ability to conduct research

physicians and scientists.

with our scientists early in their curriculum,

We are looking for students who want

and many of the students end up taking

to make an impact in whatever field they

a scholarly year to have a more in-depth

choose. Scientists who discover new

research experience.

insights about the causes and treatments patients seek out because of their expertise.

How does innovation play a role in medical education?

Today, because of our students, scientists,

We are all about innovation—we are not

create the research and clinical platforms for the next generation of doctors and scientists to be leaders of medical and scientific progress.

How do you attract and train the next generation of physicians and scientists?

anticipates the future and participates in the future today. We want our students to have the attitude that the impossible is

building on our strengths, including diversity and commitment to social justice; and anticipating and funding new areas of research to discover novel approaches to disease diagnosis and treatment. A

in what’s not so obvious to then have a major return on that investment for our patients.

How do you identify areas for investment if they’re not obvious? It sounds a little like gambling. It is a little like gambling, but we are not risk-averse at Mount Sinai. You have to be aware of the great science that’s happening in our field and to determine what is going to require greater investment, but with a greater return.

possible; to push the envelope of science and

How does this approach influence clinical care?

medicine. That’s the environment that we

The School and the hospitals have a

create here. We are very nimble in how we

education we provide. David Muller [Dean

Our students are impatient, which is what

for Medical Education] and Marta Filizola

we want. We cannot let bureaucracy get in

[Dean of the Graduate School of Biomedical

the way.

And not just to attract the students—we

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

step-by-step way. We are an institution that

allocate our resources and make decisions.

attractive to recruiting the best students.

14

a place that does things in an iterative,

We have to be innovative in the kind of

Sciences] have created programs that are

in medical and graduate education by

what is obvious, but takes risks and invests

the world for our patients. How do we do

educators, and clinicians, we are poised to

research institutes; establishing excellence

successful strategic plan not only invests in

is the goal of nothing less than changing

of human disease, and physicians whom

education, in establishing or expanding key

What does it mean to be nimble in scientific research and discovery?

seamless relationship, and investments in clinical care are investments that the School and the hospital system make together. We must provide the resources for our physicians and other medical staff to provide the best care right now, but we are also going to make investments in what we anticipate will occur over the next five or 10

need to provide an environment in which

The pace of science is very fast. We need to

years in medicine in terms of direct patient

the only limitation is their imagination.

make investments not only in where science

care. This includes further investment in

The medical school provides a wide range

is, but in where it is going. And we have

digital medicine, telemedicine, and hospital-

of educational experiences, from social

done that: we have made major investments

in-the-home techniques to keep people out

justice, humanism, and medical ethics to

in high-performance computing, data

of the hospital. This also means investing in

the latest in scientific investigation such

science genomics, vaccine development,

sophisticated equipment that our surgeons

as gene therapy, gene editing, and novel

and experimental therapeutics across the

will need to conduct complex surgeries that

therapeutics. Students have the ability to

full range of scientific disciplines related to

will lead to greater outcomes.

follow their passions and their imaginations

medicine. We’re going to continue with those

so that when they’re done with us, they can

investments, but we realize we also need

do world-changing work.

to invest in artificial intelligence, machine

We provide students with experiences

learning, computational medicine, and

What role do students at the Icahn School of Medicine play in continuing a tradition of innovation?

with top physician-scientists and clinicians

other areas. We’re always trying to anticipate

When you recruit extraordinary students,

who can act as role models. Students get

the future.

they make you want to do better. They

early exposure to patients to excite them

Our five-year strategic plan, which we

challenge you. So it is important that we

about their potential roles as physicians.

unveiled last year, focuses on research and

attract a unique student body.


We were the first medical school in the

you in terms of resources and other things,

Innovation itself leads to the formation

country to create a progressive admissions

then I am not happy. I want faculty who are

of new companies, startups, and bigger

approach for humanities majors and other

always pushing to do great things. So that

companies that have emerged out of

students outside of a traditional premedical

pervades the atmosphere at Mount Sinai. As

scientific discovery at Mount Sinai. That

background. That program—now called

a result I’m always getting requests.

return on investment feeds our innovative

FlexMed—has grown to admit students hard sciences such as computer science,

How do you support a tradition of innovation, to make sure it continues?

physics, and chemistry. It is difficult to

You need to have resources and you need

have one of those majors and still complete

to invest in it. NIH funding is important.

premedical requirements. Given the changes

We do very well there; our scientists rank

in medicine that I have mentioned, we

second in the nation in research dollars per

want to have students who come from

scientist. The Nature Index of Innovation

that background, as well as a traditional

recently ranked the Icahn School of

premedical or humanities background.

Medicine as the 10th most influential

Our student body reflects students from

research institution in the world related

all different backgrounds: where they come

to innovation. [The index ranks 200

from, their personal lives, their ethnicities,

universities and research organizations

and their educational experiences. When

worldwide based on their contributions

you combine that with their passion,

to published research that is later cited in

commitment, and dedication, it’s a fantastic

other organizations’ patents.]

student body.

Although that funding has been

who have majors in diverse fields, including

What do faculty bring to the tradition of innovation?

culture.

When the school celebrates its 100th anniversary, and a dean sits down with Mount Sinai magazine, what do you hope he or she will say? I have deep admiration for the founders of the medical school. They had an extraordinary vision, and they built this School in a way that over time it would become a great medical school. I would hope that at the 100th anniversary, they evaluate the job that we did in a positive way—that we did a good job and set the stage for even more extraordinary discoveries for our patients.

important, we need philanthropic support to continue to provide the resources to keep moving forward powerfully. Philanthropy

We’ve been recruiting faculty who have the

gives us the flexibility to invest in areas

same attitude as their students—that the

that are not so obvious. We are now

impossible is possible. Our faculty come

embarking on a new capital campaign,

from different scientific backgrounds:

focused on making new resources available

experts in data science and computational

to our students and faculty, building new

science, physics, and chemistry, along with

laboratories, and investing in science and

the more traditional paths in science and

medicine, so that Mount Sinai is able to

medicine. I tell our faculty all the time that

continue to attract and retain the best

if you’re not pushing me to do more for

physicians and scientists in the country.

The pace of science is very fast. We need to make investments not only in where science is, but in where it is going. 15


MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

MOUNT SINAI’S BRAND OF E D U C AT I O N I S A N A G E N T F O R C H A N G E

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TRANS FORM ING

MEDICAL EDUCATION


B Y A L I S O N D A LT O N

M

oving from old-school lecture halls to high-tech simulation labs, medical education has changed greatly in the half century since the Icahn School of Medicine at Mount Sinai (ISMMS) was founded. Yet some things have remained constant at the School: academic rigor, a powerful student voice, commitment to the community, and a forward-looking philosophy.

Innovation from the Get-Go

Student activism continues unabated.

boxes that recreate minimally invasive

The Mount Sinai School of Medicine was

Recently a group of students talked frankly

surgery to full-body mannequins that can

innovative from its inception. The Mount

to the administration about the impact of

bleed, speak, and even respond physiologi-

Sinai Hospital, founded in 1852, already had

racism and bias on the student experience.

cally to injected medications.

a national reputation for clinical excellence.

School leaders heard their concerns and are

“There was a drive to bring that clinical

taking steps to address them. “We looked

excellence together with academic scholarly

through literally every PowerPoint slide of

rigor,” says David Muller, MD, Dean for

every lecture, of every course, in the entire

Medical Education and the Marietta and

curriculum, and continue to do so on a rolling

Charles C. Morchand Chair and Professor

basis, to look for evidence of bias and racism

in Medical Education.

and inaccurate science,” says Dr. Muller.

Unlike older schools with more rigid

•  Personalized pharmacogenomics testing. Students have the opportunity to get genomic testing for several loci related to drug metabolism to understand individual variability in drug disposition. •  Flipped classrooms. Students study outside of the class and then meet to apply the learning, using problem sets

hierarchies, Mount Sinai’s medical school was

Managing a Juggernaut of Knowledge

also, from the beginning, an environment

“Today there is so much innovative research

that empowered students. Born in the tumul-

going on that the fundamental things we

tuous 1960s—and with its share of student

thought were true are challenged every day,”

now taped and are accessible to students

protests—the School has long encouraged

says Reena Karani, MD, MHPE, Senior Associ-

24 hours a day, seven days a week.

student-led initiatives. These have included

ate Dean for Undergraduate Medical Educa-

the East Harlem Health Outreach Partner-

tion and Curricular Affairs and Director of

ship; a global health program, now part of the

the Institute for Medical Education.

school curriculum; and the Human Rights

To equip students, ISMMS has created

and Social Justice Scholars program.

a strong curriculum in evidence-based medicine. Students learn how to appraise the medical literature and gain practical skills in

– DAV I D M U L L E R , M D

•  Taped lectures. All classroom lectures are

•  Team-based learning. Students work as individuals and in teams, using active learning methods to complete in-class exercises followed by facilitated discussions with faculty. •  Nontraditional large-group sessions.

patient safety and quality with the goal of

In-class large-group sessions are increas-

answering key questions, like which methods

ingly interactive to include patient presen-

actually result in better patient outcomes.

tations, inter-professional faculty, and a

A half century ago, lecture classes were the

variety of multimedia resources.

standard method of imparting knowledge.

“There was a drive to bring that clinical excellence together with academic scholarly rigor.”

and discussion questions.

“But we’ve learned that the more engaged you are in a process, the more enduring the learning,” says Dr. Karani. Because individuals all learn differently, the School employs a variety of teaching formats, specifically: • Simulation and augmented/virtual reality. Simulation devices range from simple

•  InFocus weeks. Each semester through all four years of study, students are exposed to aspects of health care not typically discussed in medical school, such as the health of our community, social justice, global health, physician advocacy, human rights, business acumen, and leadership skills.

17


“Now we might maintain continuity by calling the patient or with technology that we are helping to develop.” – I. MICHAEL LEITMAN, MD

•  Online study aids. Interactive online study aids help clarify complex concepts. •  Trained actors as patients. Mount Sinai

Physician depression and burnout are

a hospital stay. “Now we might maintain

widespread problems nationally, and ISMMS

continuity by calling the patient or with

is not alone among medical schools in

technology that we are helping to develop.

experiencing their effects. “It has gone from

Attached to an iPhone, it can measure blood

‘Do we talk about those things?’ to massive

sugar, heart rate, even vocal sound waves

calls for action,” says Dr. Karani. “The School

to determine if the patient is having any

put together a large and representative

psychological problems.”

task force to identify the aspects of medical education that contribute to stress without

A Diverse Student Body

making you a better doctor,” says Dr. Muller.

ISMMS is ahead of the curve in both gender

Dr. Leitman adds that the School is now

and ethnic diversity. Women represent

working with a national leader in medical

almost exactly half of all medical students.

resident burnout to design solutions. “Our

Students who are underrepresented in

research tells us that burnout is tied to work

medicine and science make up almost

intensity; residents are asked to perform the

20 percent of the student body; nationally,

same amount of work during fewer hours

the figure is 13 percent. Still, there is room

per week, and we need to make structural

for improvement, and several programs

changes to prevent this.”

address that need.

trained actors (“standardized patients”) in

The unique Donald and Vera Blinken Flex-

medical education.

dress the challenge of student and physician

Med Program, which diversifies the student

burnout is by establishing a Center for

population, is open to students of all majors

Learning and Development to support medi-

and gives them the opportunity to apply to

Following a patient throughout the course

cal and graduate students during their time

ISMMS at the beginning of their sophomore

of their hospital stay has long been a main-

at Mount Sinai, with dedicated staff focused

year. Accepted students aren’t required to

stay of training. Today, however, admitted

on teaching student resilience, nurturing

take the usual pre-med courses or the MCAT.

patients are sicker and experience shorter

academic excellence, and maintaining the

“We give students their college education

stays in the hospital.

well-being of trainees, students, and faculty.

back,” says Dr. Muller.

To aid continuity of care, the School has MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

Taking Action to Promote Wellness

ity gap when a patient went home following

was the first medical school to use highly

Maintaining the Care Continuum

18

previously there was a medical care continu-

One way in which the School will ad-

Another program brings

shifted to spending considerable time in

in high-achieving, mature

the outpatient setting and incorporated

individuals who have made

home visits into the curriculum during

the decision to become

third-year clerkships, says Dr. Muller.

physicians. Recruited from

The Visiting Doctors Program, the largest

organizations as diverse

academic home-visit program in the nation,

as the U.S. Navy and the

was co-founded by Dr. Muller. Students are

consulting firms McKinsey

also paired with a physician who cares for

and Deloitte, those who

chronically ill patients and are with such a

are accepted are assured a

patient for their first year of school.

spot in the School without

Another innovation is the Mount Sinai

having to take the MCAT

“Outcomes are better when individuals with different skill sets work together. The physician is not sitting at the top of the food chain. That’s a big change.”

at Home program. I. Michael Leitman, MD,

or many of the traditional

– REENA KARANI, MD, MHPE

FACS, Dean for Graduate Medical Education

pre-med requirements.

(GME), describes it, explaining that


INNOVATIO N IN GR A D U AT E B IO M E DICA L E D U CAT I O N

Innovation at the Graduate Level The GME program is by far the biggest such nonmilitary program in the United States, with 2,500 residents and fellows. “Residents are great innovators,” says Dr. Leitman, and GME more than accommodates that creative energy, with numerous programs including the following: • New training programs, ranging from primary care to highly focused subspecialty care, are created at the rate of approximately one every two months. •  Health Hackathons, exciting, 48-hour competitions that bring together innovators in medicine, technology, and venture capital are creating novel solu-

“We’re expanding the master’s program in Biomedical Sciences because of the terrific research opportunities at Mount Sinai.” – M A R TA F I L I Z O L A , P H D

tions for today’s health care challenges. •  The global rotations program, open to all residents, offers the opportunity to help under-resourced populations and study health care systems in other nations. •  Robotic surgery techniques are taught in one of the very few locations in the country with a system dedicated solely to surgical instruction. •  Med Ed Tanks allow students to pitch

“Inter-professional learning—maximizing communication and collaboration—is the wave of the future,” says Dr. Karani. “Outcomes are better when individuals with different skill sets work together. The physician is not sitting at the top of the food chain. That’s a big change.” According to Dr. Leitman, the move

ideas for improving care in a stimulat-

toward population health will shift

ing, Shark Tank-like atmosphere.

the emphasis in medical education to monitoring people in their own

Future Innovation in Medical Education

environment, rather than waiting until

What does the future hold? “Across the

adds, measuring outcomes for those

country, medical schools feel much more

who have left the School is becoming

comfortable bending the boundaries, as we

vitally important. “What types of data

have with FlexMed,” says Dr. Muller. Tech-

can we get back about the individuals

nology will enable more distance learning.

that we have trained that will inform

“In the future a medical student might

us about training others in the future?”

even be able to cherry pick best-in-class

Change is always a challenge—and,

courses from different medical schools to

clearly, Mount Sinai thrives on it.

create an enhanced curriculum.”

they become ill to treat them. And, he

How does graduate education in biomedical sciences adapt to the changing demands posed by increasingly complex biological problems? With innovation intrinsic to the work of scientific discovery, Mount Sinai is taking a more interdisciplinary approach with attention to computational thinking and training in data science and advanced quantitative methods as a foundation, says Marta Filizola, PhD, Dean of the Graduate School of Biomedical Sciences. The School has expanded its advanced graduate education and professional training programs by creating a variety of PhD and master’s programs, which allow scientists and advanced medical students to develop the specialized skills that are necessary to succeed in twenty-first century biomedical and health care sciences. Public Health is the largest master’s program at Mount Sinai, with an average of more than 70 trainees per year over the past five years. “We’re expanding the master’s program in Biomedical Sciences because of the terrific research opportunities at Mount Sinai. There are also master’s programs in biostatistics, genetics counseling, clinical research, health care delivery leadership, and biomedical informatics,” she says. The School is especially active in providing education and training in entrepreneurship. Students learn how to commercialize a product, how to bring it to market, how to create a start-up. Sema4, a health information company founded last year by Eric Schadt, PhD, Dean for Precision Medicine at the Icahn School of Medicine, and Jean C. and James W. Crystal Professor of Genomics, is an excellent example of entrepreneurship at this level. The company currently offers advanced genome-based diagnostics and is building predictive models of complex disease. Mount Sinai gives students the opportunity to be involved in this sort of innovative business model, says Dr. Filizola. How is the School addressing the challenge of the increasing scarcity of academic positions for PhD holders? By breaking the conventional mold that led them only to a career in academia, for starters. “Traditionally,” she says, “someone who received a PhD or MD/PhD would go into academia, with the result that it’s extremely difficult nowadays to get such a position.” The Graduate School has diversified its training, she says, so that now graduates are prepared to enter not only academia but also industry, allied health care, consulting, finance, medical and scientific writing, government, and nonprofit organizations. “We have introduced professional degree programs and have reduced the length of PhD programs without compromising quality. “Mount Sinai is more nimble than many other institutions—and for innovation, that’s absolutely required.”

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PROFILES IN I N N O V AT I O N Research at the Icahn School of Medicine at

BY DEBORAH SCHUPACK W I T H S H E E N A K . FA L LO N

Mount Sinai is transforming our understanding of disease, leading to new treatments and therapies. Here, leading researchers tell about their work— and how it is changing the lives of patients.

Exploring Connections in the Brain Helen Mayberg, MD Mount Sinai Professor in Neurotherapeutics; Founding Director, Center for Advanced Circuit Therapeutics; Professor, Neurology, Neurosurgery, Psychiatry, and Neuroscience

Deep brain stimulation (DBS) was already improving lives for people with Parkinson’s disease when Dr. Mayberg, building on her intricate understanding of brain circuitry, wondered if the technology might also help people suffering from depression, particularly those 17 percent of patients for whom other treatments have failed. The answer, her investigation revealed, was yes. She has spent the last decadeplus advancing pioneering research to develop DBS treatment that is increasingly more precise, effective, and long-lasting for MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

treatment-resistant depression.

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As befits someone who studies the brain, her work turns on making connections—between mood and movement, neuroscience and psychiatry, research and clinical care. She came to the Icahn School of Medicine in January, from Emory University School of Medicine, to run Mount Sinai’s Center

“This kind of research platform breaks down traditional views of what is neurology and what is psychiatry. Ultimately, the diseases we treat do not respect departmental boundaries.”

for Advanced Therapeutics, a pioneering center that leverages insights and discoveries from myriad disciplines—including neurosurgery, neurology, psychiatry, rehabilitation, brain imaging, electrophysiology, neuroengineering, computation, neuroscience, and genetics—to advance an understanding of the brain’s circuits and translate those discoveries to treatments for patients.


A Novel Treatment for Depression Dennis S. Charney, MD Anne and Joel Ehrenkranz Dean, Icahn School of Medicine; President for Academic Affairs, Mount Sinai Health System

For half a century, depression medications have worked primarily via actions on serotonin and norepinephrine. With these treatments requiring regular, repeated doses before they have an effect on symptoms, Dr. Charney decided to look at another mechanism. Exploring instead the role of the neurotransmitter glutamate, he made an astonishing discovery that has been lauded as the most significant breakthrough in treating depression in 50 years. He found

Changing the Equation for Alzheimer’s Alison Goate, DPhil Willard T.C. Johnson Research Professor of Neurogenetics; Founding Director, Ronald M. Loeb Center for Alzheimer’s Disease

The devastating impact of Alzheimer’s disease is expected

that ketamine, a drug long used in anesthesia, works on glutamate to alleviate depression—often in a matter of hours and on depression that has previously resisted other treatments. The pharmaceutical company Janssen is currently conducting large clinical trials, and researchers hope the drug will be approved by the U.S. Food and Drug Administration in 2019. The drug, FDAapproved as an anesthetic, is currently being used off-label to bring relief to many Americans with treatment-resistant depression. “Mount Sinai science leads to new therapeutics for patients who need them most,” says Dr. Charney. “That’s our mission.” The institution’s success is driven by fertile connections among scientists conducting basic, translational, and clinical research.

to grow as populations age. There is currently no effective treatment. By thinking differently, Dr. Goate is changing the equation. Because Alzheimer’s disease (specifically late-onset, the most common form) is characterized by the death of neurons in the brain, many researchers have explored the neurons themselves. Dr. Goate instead focused on the environment around the neuron, finding that a network of genes linked to

“Innovation that leads to improving lives for patients starts in neuroscience laboratories; those findings are translated into new therapeutic targets, and that leads to new treatments.”

the disease is expressed in myeloid cells, immune cells that include microglia and macrophages. “That’s changed how people think about the disease,” she says. “The idea that so many risk factors are actually expressed in the non-neuronal cell population in the brain—that neurons are dying because of the action of other cells that causes the environment to become toxic to those neurons—that’s a fundamental switch in terms of thinking about neurodegenerative diseases, particularly Alzheimer’s.” Homing in on pathways implicated in Alzheimer’s disease, she is exploring how “we can target the right pathways to prevent the death of neurons”—and ultimately lead to novel treatments. A longtime trailblazer in Alzheimer’s research, Dr. Goate is the founding director of the Ronald M. Loeb Center for Alzheimer’s Disease, which is committed to translating breakthroughs in the lab to effective therapies as quickly as possible.

21


Examining the Molecular Makeup of Addiction and Depression Eric Nestler, MD, PhD Dean for Academic and Scientific Affairs; Nash Family Professor of Neuroscience; Director, The Friedman Brain Institute

Depression and disposition to drug addiction are highly—but not entirely—hereditary. There are also external environmental factors that regulate whether the complex of genes that contribute to the brain disorders get turned “on” or “off” over time, a process known

Evidence-Based Treatments for Addiction

people get sick while others, with similar genetics, do not. “It’s been difficult to crack drug addiction and depression, to understand what is at the heart of these syndromes, and to develop definitive treatments [because of] the unique complexity of the brain,” says Dr. Nestler, a prolific investigator who is a global leader in neuroscience and past president of the Society for Neuroscience.

Ward-Coleman Chair in Translational Research; Director, Addiction Institute at Mount Sinai; Professor of Psychiatry, Neuroscience, and Pharmacological Sciences

molecular level, how drugs of abuse and stress change nerve

overdoses, primarily opioids. “That’s vastly more people than die of the flu, but there isn’t anywhere near the urgency to protect and treat people for addiction,” notes Dr. Hurd. “My vision is that by shedding neurobiological insights, we can provide evidence-based treatments for addiction and help people get back their lives.” She has made two recent breakthroughs that are already leading to advances in science-based treatment for opioid addiction. In the first, she conducted a small human study that validated an insight from prior animal studies: that cannabidiol (CBD), a cannabinoid in the marijuana plant devoid of rewarding properties, reduces cravings and MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

mechanisms of addiction and depression to understand why some

Yasmin L. Hurd, PhD

Last year, more than 50,000 Americans died from drug

22

as epigenetics. Dr. Nestler’s innovative work explores the molecular

withdrawal symptoms of opioid drugs. She also is leveraging epigenetic insights from other fields, primarily cancer, to learn more about the brains of human heroin abusers, which show “profound changes in the epigenetic landscape,” or, how genes are turned on or off. This, too, is leading to promising treatments for addiction and may also have implications for treating Alzheimer’s disease. In the same way the environment turns on and off certain genes in epigenetics, Dr. Hurd says, the environment of an institution like Mount Sinai—one that fosters creativity and working across disciplines—“turns on” the innovation gene and leads to truly groundbreaking insights that benefit patients.

Dr. Nestler’s lab has pioneered studies to understand, at the cells and their brain circuits to cause behavioral abnormalities. In depression, he has examined mice that succumb to stress (susceptibility) and those that avoid deleterious outcomes (resilience), suggesting the novel approach of developing medications that promote resilience. In studies of addiction, his lab’s insights into the brain’s reward circuitry can be mined to develop improved diagnostic tests and treatments for addictive disorders.


Making Discoveries to Stop Cancer Cells Julio Aguirre-Ghiso, PhD Professor, Medicine, Hematology, and Medical Oncology; Otolaryngology; Oncological Sciences

Cancer, as commonly understood, is a fast-moving, fast-growing disease that does its damage as it proliferates in vital organs,

Better Predictions for Bone Marrow Transplantation James L. M. Ferrara, MD, DSc Ward-Coleman Chair in Cancer Medicine; Professor and Director, Hematologic Malignancies Translational Research Center; The Tisch Cancer Institute and Division of Hematology/Medical Oncology

forming lethal metastases. While most cancer researchers focus on stopping the disease in its tracks once it is growing actively in these vital organs, Dr. Aguirre-Ghiso focused elsewhere: the dormant, or sleeping, cancer cells in treated patients who have gone into remission. These cancer cells are the seeds of metastasis that can awaken and subsequently form those lethal tumors in the future. By using mouse and avian models and human tissues for validation, Dr. Aguirre-Ghiso’s lab made key discoveries about how the body signals those cancer cells to stop proliferating and remain dormant. The insight and implications are profound: scientists can now work on predicting metastases

Bone marrow transplantation can be a highly effective treatment for

before they become life-threatening, discovering them earlier,

certain cancers, particularly blood-borne cancers like leukemia and

and either prevent them or treat them more effectively. Two

lymphoma. But the treatment comes with significant risk: about half

drugs approved by the U.S. Food and Drug Administration

of bone marrow transplant (BMT) patients suffer from acute graft-

for other cancers show promise for treating residual disease

versus-host disease (GVHD), in which the donor’s immune cells attack

in prostate cancer patients; clinical trials are expected to

the patient’s tissue. About 20 to 25 percent of patients die from the

start at Mount Sinai later this year. “That is the Holy Grail of

complication.

translational research—to discover a mechanism in the lab,

What if doctors could predict who is at risk of developing GVHD, then

translate the biology to detect these cells in patients, then

treat at-risk patients early, even before GVHD begins? That question

bring it to fruition by designing a therapy for patients, all

drives the lab of Dr. Ferrara, who has discovered that a certain protein

within the span of a decade,” says Dr. Aguirre-Ghiso.

signature in the blood can indeed yield such a prediction. “This is the future for bone marrow transplantation, the precision medicine of tomorrow, telling us who’s at high risk and who’s at low risk—and allowing us to adjust our therapies appropriately.” With a $10 million grant from the National Cancer Institute, Dr. Ferrara’s lab is leading a global consortium of 23 medical centers sharing data to improve the standard of care for BMT patients. Clinical trials are currently underway. Dr. Ferrara hopes the findings will allow doctors to target the right treatment at the right time, and reduce the mortality of GVHD by 50 percent over the next 10 years. If the lethal risk of GVHD can be lowered, the benefits of BMT can also extend to patients with other serious diseases, such as sickle cell anemia, for which the procedure can be curative but is currently considered too risky.

“By making bone marrow transplant safer, we make it more attractive to patients with other diseases, even non-malignant diseases, and the impact becomes exponential.” 23


New Therapies for Blood Cancers

Translating Findings: Cancer Genetics

Ronald Hoffman, MD Albert A. and Vera G. List Professor of Medicine (Hematology); Director, Myeloproliferative Disorders Research Program

A leading researcher in myeloproliferative disorders, a family of blood cancers, Dr. Hoffman has a singular motivation. “My raison d’être is to make patients better,” he says. “Since I am a researcher who also treats patients clinically, I see the pain and suffering they go through. Everything we do in the lab is focused on making a real, tangible difference in the quality and quantity of patients’ lives.” Working with blood stem cells, his lab is investigating therapies for a particularly intractable blood cancer, myelofibrosis, developing drugs that both target malignant stem cells for destruction and disarm an abnormal microenvironment that favors the malignant cells. With a recent grant from the National Cancer Institute, he aims to advance drug combinations into clinical trials. Dr. Hoffman is also developing a unique method of increasing the number of cord blood stem cells that can be used to treat patients with blood disorders. In clinical trials, expected later this year, investigators will transplant an expanded stem cell product in patients with incurable forms of blood cancers. Mount Sinai, he says, is the ideal place to drive translational research because of the investigative and clinical talent, resources, and infrastructure, and the large base of patients whose cells contribute to research and who benefit from advances in the lab.

“This is what translational research means. If we can demonstrate that there’s a reduction in the progeny of these malignant stem cells, then we’re taking that into the clinic.”

Ramon Parsons, MD, PhD Ward-Coleman Chair in Cancer Research; Director of The Tisch Cancer Institute

After witnessing his own father’s early death from colon cancer, Dr. Parsons has dedicated his medical career to advancing the early detection, treatment, and ultimately prevention of cancer. He made a giant step toward that goal two decades ago with the discovery of PTEN, a tumor suppressor gene that is often mutated in cancer, which provides critical therapeutic targets in breast, brain, prostate, and endometrial cancer. Building on that knowledge, he has made other key discoveries that advance scientists’ understanding of how PTEN works and how to begin translating those findings into potential therapies.

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

His lab has recently discovered that a drug FDA-approved for

24

rheumatoid arthritis shows promise in killing PTEN-deficient tumor cell lines in mice, and is currently working with colleagues to establish a clinical trial to test the drug in breast cancer patients. A recent Outstanding Investigator Award from the National Cancer Institute will support his lab to explore how PTEN and its longer isoform PTEN-L are regulated, study tumor development and metabolism when the gene is inactivated, and develop small molecule therapies that target tumor cells with cancer-causing mutations in PTEN. “Understanding PTEN could hold a key to helping patients with some of the most aggressive and the most treatment-resistant cancers, such as triple-negative breast cancer and advanced prostate cancer,” he says.


Pioneering Mitral Valve Repair David H. Adams, MD Cardiac Surgeon-in-Chief, Mount Sinai Health System; Marie-Josée and Henry R. Kravis Professor of Cardiothoracic Surgery; Chairman, Cardiovascular Surgery

Dr. Adams is a recognized leader in cardiac surgery and is the President-Elect of the American Association for Thoracic Surgery. He has long been at the forefront of innovating new approaches to mitral valve repair, having co-invented many of the most popular repair rings used throughout the world. He is currently exploring novel strategies that can treat mitral valve

Finding the Roots of Heart Health

disease without opening the chest and placing the patient on a heart-lung machine. He was recently appointed the National Co-Principal Investigator of the Medtronic FDA pivotal APOLLO Trial, the first study in the United States to explore closed chest, beating heart mitral valve replacement in patients who are at increased risk for conventional biological valve replacement. The trial began in 2017 and will involve more than 40 clinical sites, including The Mount Sinai Hospital. “This is the beginning of an important journey to establish a truly less invasive approach to treat severe mitral valve regurgitation in patients who are appropriate candidates for mitral valve replacement with a transcatheter technology that eliminates the need for open-heart surgery,” he says. Dr. Adams is also the National Co-Principal Investigator of the NeoChord FDA pivotal trial, which is exploring the efficacy of closed chest, beating heart mitral valve repair compared with open surgery.

Valentín Fuster, MD, PhD Director of Mount Sinai Heart, The Zena and Michael A. Wiener Cardiovascular Institute, and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Richard Gorlin, MD/Heart Research Foundation Professor of Cardiology

Dr. Fuster began his career looking through a microscope to research a disease that was fast becoming the world’s greatest killer. The questions he was investigating—What causes a heart attack? What causes a blood clot? What causes atherosclerosis?—eventually led him to an answer as bold as it was inevitable: human behavior. “You follow a pattern of trying to go the roots,” he says. “The roots are where we are today in health.” Dr. Fuster has been a global leader in cardiology for four decades in research, clinical practice, global health, education, and stewardship of major world bodies. Landmark research contributions include demonstrating the role of platelets in coronary artery bypass occlusion and the pioneering preventive trial of aspirin in human atherothrombotic disease; demonstrating that acute coronary events arise from small plaques and developing diagnostic MRI to characterize vulnerable plaques; the significant protective contribution of Rapamycin in the field of angioplasty; and the FREEDOM trial, establishing the superiority of coronary artery bypass graft over angioplasty in diabetic patients with multivessel coronary disease. Most recently, he has been breaking new ground on improving therapeutic adherence, developing the first fixed-dose polypill approved for secondary prevention in 45 countries; establishing the genetic and risk factor predictive value of atherosclerotic burden; and introducing health promotion to children around the world. He has published more than 1,000 research studies on prevention and treatment of cardiovascular disease, and is past President of the American Heart Association and the World Heart Federation.

“Everything we learn from science should be applicable as an educational tool to make people healthier.” 25


New Approaches to Treating Type 1 Diabetes Andrew F. Stewart, MD Irene and Dr. Arthur M. Fishberg Professor of Medicine Director of the Diabetes, Obesity, and Metabolism Institute

One of the most important goals in type 1 diabetes research today is to generate insulin-producing beta cells in the pancreas, since these are the cells that the autoimmune system attacks in patients with the disease. Without the insulin that beta cells produce, the body cannot regulate blood sugar levels, which can lead to outcomes such as heart attack, kidney failure, blindness, stroke, and death. Three years ago, when many researchers thought human beta cells were

New Therapies for Advanced Heart Disease

impossible to reproduce, Dr. Stewart’s laboratory discovered harmine, the first drug to regenerate beta cells. Since then, he and his team have patented even more effective beta cell regenerative drugs. Now, the Stewart laboratory has completed the largest study of insulinomas to date. By researching these usually benign beta-cell tumors, Dr. Stewart and his team have made significant inroads into understanding how beta cells reproduce. “Insulinomas are benign

Roger Hajjar, MD

growths in the pancreas that overproduce insulin. We hoped—and

The Arthur and Janet C. Ross Professor of Medicine Director, Cardiovascular Research Center

diagram’ that reveals even more drug targets that make human beta

“I come from a family ravaged by cardiovascular disease,” says Dr. Hajjar. “This is a personal crusade of mine: to bring new therapies to the forefront that will help as many patients as possible.” This is precisely what Dr. Hajjar is doing as head of the Cardiovascular Research Center and a renowned pioneer in understanding the molecular mechanisms of heart failure and developing novel gene therapy methodology. Dr. Hajjar’s lab developed and first tested the platform for gene therapy vector for the treatment of heart failure known as AAV1.SERCA2a. This vector-based therapy enables the precise delivery of therapeutics to damaged heart tissue, and introduces MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

a new realm of treatment modalities for advanced heart

26

failure patients. He is currently leading “the second generation” of discovery, developing novel vectors that better target the heart and can better escape the body’s immunity. The impact is potentially huge—heart failure affects about 5.7 million American adults. Dr. Hajjar credits Mount Sinai’s vision, collaborative structure, and resources, including the Drug Discovery Institute, for helping his lab drive basic science in gene therapy and in small molecule research to patients. “We have an engine for discovering novel mechanisms for heart failure,” he says, “and we have an engine that develops therapeutics based on these new findings.”

indeed have found—that they hold the ‘genomic recipe’ or ‘wiring cells regenerate even more quickly for people with diabetes.” With this step, together with a closer understanding of why our own immune system attacks beta cells, Dr. Stewart’s work could one day illustrate how to reverse the effects of—or cure—type 1 diabetes.


Innovations in Palliative Care Diane E. Meier, MD, FACP

R. Sean Morrison, MD

Catherine Gaisman Professor of Medical Ethics; Director of the Center to Advance Palliative Care; Co-Director, The Patty and Jay Baker National Palliative Care Center; Professor of Geriatrics and Palliative Medicine, Brookdale Department of Geriatrics and Palliative Medicine

Ellen and Howard C. Katz Professor and Chair, Brookdale Department of Geriatrics and Palliative Medicine; Director of the Hertzberg Palliative Care Institute and the National Palliative Care Research Center; Co-Director, The Patty and Jay Baker National Palliative Care Center

In the 20 years since Mount Sinai became one of the first academic medical centers to recognize a need for palliative care, the number of hospitals offering palliative care services has grown from 5 percent to more than

Understanding HPV in Sexually Active Urban Youth

70 percent. The Center to Advance Palliative Care (CAPC), under the direction of Dr. Meier, and the National Palliative Care Research Center (NPCRC), directed by Dr. Morrison, continue to spur growth and development of high-quality palliative care in the United States through their innovative research and diffusion efforts toward a goal of making palliative care available to all people living with serious illness in the U.S. CAPC and NPCRC collect and analyze data on the effectiveness and availability of palliative care, showing that palliative care teams help reduce the pain, symptoms, and stresses of serious illness for both the patient and the family, thereby improving quality of life and ability to function. As a

Angela Diaz, MD, PhD, MPH

result, preventable crises are avoided, leading to reduced need for 911 calls,

Jean C. and James W. Crystal Professor in Adolescent Health and Director, Mount Sinai Adolescent Health Center

successfully advocated for an increase in research funding for palliative care

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is associated with cervical cancer and other cancers. Under the leadership of Dr. Angela Diaz, researchers at the Mount Sinai Adolescent Health Center are investigating the burden of HPV in inner-city adolescents and young adults. The first of the two flagship research studies has been following a cohort of nearly 1,400 urban adolescent females for close to 10 years to understand the prevalence, incidence, and risk factors for different types of HPV

emergency room visits, and urgent hospitalizations. The centers have also from the National Institutes of Health. “Our research shows that palliative care improves quality of life for the patient, outcomes for the family, and survival—patients both live well and live longer and, as a result, incur fewer health care costs,” says Dr. Morrison. CAPC and NPCRC create resources to help both clinicians and patients and their families with serious illness to find palliative care services in their communities. This includes getpalliativecare.org, a website that connects patients and families with palliative care information and clinical programs. “Our work centers on providing the best possible quality of life for people living with serious illness,” says Dr. Meier. “Palliative care puts control and choice back in the hands of the patient and family.”

infection, including social, environmental, and behavioral factors. A parallel but linked study examines similar topics in a cohort of adolescent and young adult males. The studies also examine the prevalence and transmission of specific types of HPV between heterosexual partners by recruiting the male partners of the adolescent women in the initial flagship study. This study is one of the few to research adolescent and young adult males and to explore multiple infection sites. “By giving young people knowledge, identifying HPV infection early, and providing interventions, we have a better chance of protecting these teens and young adults from cancer,” says Dr. Diaz.

27


Reinventing Medicine

FOR THE NEXT

GENERATION

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

BY SIMA RABINOWITZ

28

DEEP SCIENCE AND BIG DATA.

These critical connections and distinctions, seemingly contradictory,

Biological tools and computational

scientists across the Icahn School of Medicine, driving the innovative

tools. Academic research teams and

are being embraced as synergies by investigators, clinicians, and data research and clinical platforms that will shape the future of medicine. Physician-scientists are addressing the most pressing and provocative

industry partners. Precise targets and

questions around disparate diseases such as cancer and influenza,

universal applications. Unexpected

creating new approaches for engaging with patients. “We’re going to

findings and predictable outcomes.

Precision Medicine and Ward Coleman Chair in Translational Genetics.

evolving novel methods for collecting and interpreting data, and reinvent medicine,” says Judy Cho, MD, PhD, Senior Associate Dean for


“ SOMETHING WE’RE EXCITED ABOUT IS THE POTENTIAL FOR DEVELOPING THERAPEUTIC APPROACHES THAT CAN BE EFFECTIVE FOR TREATING MORE THAN ONE DISEASE.” – Judy Cho, MD, PhD

GENOMICS AND PRECISION MEDICINE

that lead to certain products or changes

“Something we’re excited about is the

in a cell) has resulted in the discovery of

potential for developing therapeutic

effective therapies for a number of diseases,

approaches that can be effective for

Harnessing the Digital Universe to Alter the Course of Disease

including certain cancers, skin diseases, and

treating more than one disease, like some

cardiovascular disease.

of the new immunotherapies that have

Taking advantage of the power of high-

proven successful for more than one type

speed genomic sequencing, integrated with

of cancer,” says Dr. Cho. She and Genetics

Genetic sequencing has evolved more

many other tools and technologies—from

and Genomics Sciences colleague Inga

rapidly than any other technology in the

immune cell profiling, gene editing, and one

Peter, PhD, recently discovered that distinct

history of the world. It took scientists 13

of the country’s largest and most diverse

and common protective variants in the

years to fully sequence the first human

patient biobanks, BioMe, to biomedical data

LRRK2 gene raise or lower risk for both

genome; today it takes just a few hours. And

warehousing—Icahn School of Medicine

Crohn’s disease and Parkinson’s—the first,

over the last 10 to 15 years, large genome-

investigators have their sights set on

a gastrointestinal disease that typically

wide association studies, many led by

predicting the future. More specifically,

affects younger people, and the latter, a

Mount Sinai researchers, have provided an

they’re focused on two distinct, equally

neurological disease that primarily affects

enormous amount of information, allowing

critical questions: Can we determine

older adults—or “a disease of the gut and

scientists to identify both common gene

precisely who will be at risk for developing

a disease of the brain,” Dr. Cho says. This

mutations across different populations

a particular disease or disorder? And

finding of risk and protective factors for

and rare variations in select populations.

can we predict how a patient with breast

two entirely different conditions can have

Targeting specific mutations and the

cancer, ulcerative colitis, or multiple

major implications for the prevention, or

pathways that enable their contribution

sclerosis, for example, will be likely to

early treatment, of both.

to disease (the actions among molecules

respond to a specific treatment?

29


CANCER IMMUNOLOGY

“I have spent the last several years thinking

release Natalis™, a simple cheek swab to

about how we can integrate the great

obtain DNA that can detect 193 childhood-

diversity of data we have—and the vast

onset diseases in children up to the age

amount of data we must still collect—to

of 10. “All of the diseases the product tests

create predictive models that will help

for the risk of developing, even the most

people be well over the trajectory of their

serious and potentially devastating ones,

Immunotherapy has revolutionized the

lives,” says Eric Schadt, PhD, Dean for

are treatable, some with only changes

treatment of cancer. There is now an

Precision Medicine and founder and CEO

to diet or with vitamin supplements,”

abundance of immunotherapeutic agents,

of Sema4, Mount Sinai’s spin-out next-

Dr. Schadt explains.

with more being discovered every day.

generation health information company

The future, Dr. Schadt predicts, will

But while there is a subset of patients

merging big data analytics with clinical

be about enabling big health systems

that responds dramatically to the new

diagnostics. “The future of medicine will

like Mount Sinai to benefit from the

treatments, immunotherapies are not

depend on how we engage not thousands,

exceptional science being done in genomics,

successful for many patients. “We’re

but millions of patients along their life

immunology, and other fields by collecting

faced with two major questions,” says

course to acquire the data to guide both

massive quantities of data not only about

Steven Burakoff, MD, Dean for Cancer

clinical decision-making and personal

diverse patients’ disease history, but their

Innovation and former Director of The

decision-making about health.”

daily habits and activities, and subsequently

Tisch Cancer Institute at Mount Sinai.

Sema4 geneticists, genetic counselors,

employing big data analytics and machine

“First, why do some patients respond to

and data scientists are working closely

learning, or artificial intelligence, to

a particular therapy while other patients

with colleagues at the Icahn School and

interpret this data. “The technology is

with the same cancer do not? And second,

at other institutions to develop, and bring

advancing at a furious pace and it’s going

how can we increase the effectiveness of

to a national audience, methods and

to drive new ways of thinking about drug

immunotherapy by combining it with other

tools for predicting risk for the onset

safety, childhood disorders, cancer, obesity,

types of cancer treatments?”

or development of disease. One of these

and so much more over the next decade,”

What will be required, says Miriam

is a comprehensive cancer panel that

he says. “We must harness the digital

Merad, MD, PhD, Mount Sinai Professor

detects actionable (treatable) variants in

information in a way that is clinically

in Cancer Immunology and Director of

advanced solid tumors, and the newest

relevant and impactful.”

the Precision Immunology Institute, is a

Discovering the Mechanisms of Resistance and Response

Miriam Merad, MD, PhD

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

Eric Schadt, PhD

30


“ I THINK THERE WILL CONTINUE TO BE OUTSTANDING NEW DISCOVERIES AND TREATMENT MODALITIES, INCLUDING NOVEL COMBINATIONS OF THERAPEUTICS.” – Nina Bhardwaj, MD, PhD

Steven Burakoff, MD

deep understanding of the physiological

of Texas MD Anderson Cancer Center,

with other therapies, such as checkpoint

processes implicated in the disease.

and 11 biopharmaceutical firms to profile

inhibitors, is cancer vaccines. Vaccines

“The only path to cure,” she insists, “is to

the tumor lesions of patients who have

work much the same way for cancer as

understand the mechanisms of resistance

been treated with the immunotherapies

they do for the prevention of infectious

and response. The development of

known as checkpoint inhibitors, such as

disease, teaching the immune system to

immunotherapies is the result of years and

therapies that target the protein PD-1.

recognize an antigen that is present on

years of basic research, which is why it is

“This will provide us with a completely new

the surface of cancer cells. Nina Bhardwaj,

so solid. We must continue this work.” In

understanding of disease mechanisms,

MD, PhD, Ward-Coleman Chair in Cancer

the Institute’s Human Immune Monitoring

which will enable us to pilot more effective

Research and Director of Immunotherapy

Center, a team of researchers led by

clinical trials,” Dr. Merad explains. The

at The Tisch Cancer Institute, is leading a

Dr. Merad is working with sophisticated

combinations of new therapies are virtually

number of studies and trials with vaccines

molecular tools to analyze tissues at

endless, and trials with high-priority

administered at the tumor site, as well

the cellular level and create tumor cell

combinations may offer the best chance

as “personalized” therapeutics including

atlases—catalogues of all the characteristics

of success. The project is led by Human

dendritic cell vaccines. Dendritic cells are

of a single cell—in order to discover new

Immune Monitoring Center Co-Director

components of the immune system that

pathways that play a role in the response

Sacha Gnjatic, MD, who believes that

are uniquely powerful in their ability

to specific treatments.

“immune monitoring will be the most

to mount an attack against a pathogen.

A particularly exciting new project

effective way to quickly make progress”

“This is an incredibly important time in

is the Partnership for Accelerating

to better understand why some patients

immunology,” she says. “We have seen that

Cancer Therapies (PACT), a National

respond to checkpoint blockade therapies

our immune system is very robust and

Cancer Institute-funded collaboration

and others do not.

that our bodies have the ability to respond

with Stanford Cancer Center, Dana-

One promising immunotherapy that

to cancer. I think there will continue to be

Farber Cancer Institute, the University

may prove effective in combination

outstanding new discoveries and treatment

31


INFLUENZA

Palese, one of the world’s leading virologists,

The Quest for a Universal Vaccine

microbiologists Adolfo García-Sastre, PhD,

tools and technologies to discover “druggable

Developing a universal influenza vaccine—

Health and Emerging Pathogens Institute,

targets” for cancer. Brian Brown, PhD,

a vaccine that would be effective against

and Florian Krammer, PhD, Associate

Associate Professor of Genetics and Genomic

every strain of influenza and eliminate the

Professor of Microbiology, to investigate this

Sciences, oncologist Joshua Brody, MD,

need for yearly inoculations—became a top

approach, leveraging each lab’s particular

and Dr. Merad have developed a powerful

priority for the National Institute of Allergy

strengths with the goal of developing a

pipeline to identify genes that control

and Infectious Disease early in 2018. It has

vaccine that could have broad, long-lasting

the immune response against breast and

been a top priority for many years for Icahn

protection against every strain of the disease.

lung cancers. Their platform uses two

School of Medicine virologists, who have

Studies conducted in animal models

unique technologies created by Dr. Brown:

made seminal discoveries in both avian and

demonstrated the viability of their approach,

JEDI T-cells, which allow visualization of

human flu viruses. A current focus of their

and two clinical phase I trials in humans are

immune responses, and a novel barcoding

research is the potential of chimeric

currently underway. “One of the well-known

system, which enables new applications of

viruses, or hybrids created from human

challenges is that the influenza virus chang-

the CRISPR gene editing technology. This

and non-human influenza viruses, to boost

es from year to year. But what many people

combination of technologies could have

antibodies to the highly conserved area of

don’t realize is that we also do not have a

profound implications for cancer drug

the virus stalk.

vaccine that is long lasting. So we’re really

discovery. There has already been early

“We believe that targeting the stalk of

working to address two different issues: a

interest in the barcodes, and the Brown

the hemagglutinin, the region most highly

vaccine that will be effective no matter how

Lab has received funding to support

conserved (where the protein has undergone

the virus changes seasonally and one that

the research. For his part, Dr. Brown is

almost no change over time), rather than

will also have efficacy over the course of a

committed to sharing the novel technology

the head of the hemagglutinin, which is

lifetime.” While Drs. Palese and García-Sastre

freely with colleagues across the country

more typically the target of the immune

are reluctant to predict when such a vaccine

and around the world. “We want to keep

response, presents an opportunity to develop

might be approved and made available, there

the culture of sharing in the scientific

a universal vaccine,” says Peter Palese, PhD,

is one thing they can say with certainty:

community alive; that’s how we can have

Horace W. Goldsmith Professor of Medicine

developing a universal vaccine will remain a

the greatest impact.”

and Chair, Department of Microbiology. Dr.

priority at Mount Sinai.

modalities, including novel combinations of therapeutics. To be able to contribute to this effort is remarkable.” Scientists at Mount Sinai are also developing and employing new biological

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

Peter Palese, PhD

32

Brian Brown, PhD

is collaborating closely with Mount Sinai Irene and Dr. Arthur M. Fishberg Professor of Medicine and Director of the Global


Adolfo García-Sastre, PhD

Annetine Gelijns, PhD

“ THIS IS A PIVOTAL MOMENT. WE HAVE THE OPPORTUNITY— AND THE RESPONSIBILITY— TO REDEFINE MEDICINE.” – Miriam Merad, MD, PhD

A DEFINING MOMENT At this moment of great disruption and tremendous innovation in science and medicine, there is a clear constant, a value that has guided Icahn School of Medicine faculty from their earliest investigations 50 years ago to their most ambitious plans for the future. “Doing good for the patient is the number one priority,” says Adam Margolin, PhD, newly appointed Senior Associate Dean for Precision Medicine and Chair and Professor of the Department of Genetic and Genomic Sciences, adding that realizing a transformational impact for patients will require equal measures of scientific and cultural innovation. “To put patients first, we have to embrace the most complex questions with great and specific expertise and precision, employing the most sophisticated tools in an integrated way,” Dr. Merad affirms. “This is a pivotal moment. We have the opportunity—and the responsibility—to redefine medicine.”

The Evidence for Change The Institute for Transformative Clinical Trials

C

linical trials are the critical link between discovery and bringing innovations into medical practice. “While trials are the most powerful tool we have to assess the benefits and risks of diagnostic and therapeutic interventions, we need a lot of innovation,” says Annetine Gelijns, PhD, Edmond A. Guggenheim Professor of Health Policy, System Chair of Population Health Science and Policy, and Director of the new Institute for Transformative Clinical Trials at Mount Sinai. The first of its kind in New York, the Institute has been established to advance three key goals: create a stronger evidence base, change the way care is delivered, and improve the outcomes for all patient populations. There is increasing recognition that the current clinical trial enterprise is inadequate to meet the demands of twenty-first century medicine. “For example, half of Phase III trials fail, primarily because the initial designs of the trials were flawed,” Dr. Gelijns explains. “We’re developing new trial methodologies, including statistical approaches, to enable the ‘smart design’ of trials” and accelerate the introduction of promising therapies for patients. These trials evaluate multiple experimental therapies simultaneously, and, as the data accumulate, drugs or devices that are not working are dropped from the trial. In addition, the Institute plans to dramatically expand comparative effectiveness research—trials that compare approved therapies for the broader populations that receive them. To address the problem of “generalizability” and health equity, the Institute seeks to enroll more women, older adults, and racial and ethnic minorities, all of whom have been vastly underrepresented. One of the Institute’s most important initiatives will be to include patients as partners in the development of trials. “We need to measure the endpoints, or outcomes, that matter most to patients,” says Dr. Gelijns. “Clinical trials are the ultimate team science. The Institute will serve as an incubator of clinical trials, bringing together basic scientists, clinicians, trial methodologists, and patients.” Clinical trials revolutionized medicine. Mount Sinai is poised to revolutionize trials.

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MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

B Y A L I S O N D A LT O N

34

magine the lab of the future. You might envision a bright, white space filled with high-tech, noninvasive instruments; virtual reality devices; and large, interactive video screens. You might further imagine being ushered through the assessment process by an informed, helpful practitioner while viewing videos filled with sophisticated computer graphics. That lab is called Lab100, and it exists right now at Mount Sinai’s Icahn School of Medicine.

LA B

A New Model of Care

Lab100 is a project of the Institute for Next

Generation Healthcare (INGH), which launched last year under the leadership of Joel Dudley, PhD, Mount Sinai Professor in Biomedical

Data Science, who also serves as Executive Vice President for Precision Health for the Mount Sinai Health System. Truly innovative, the

lab straddles the worlds of research and care delivery—highly unusual among academic medical centers.

It’s no secret that the fee-for-service model of health care is not sustainable, as costs continue to rise without a corresponding increase in health. Patients aren’t being motivated to

maintain their health, and doctors aren’t being

incentivized to prevent illness in their patients. “It’s really sick care, not health care,” says

Niyum Gandhi, Executive Vice President and

Chief Population Health Officer of the Health System. That’s why Mount Sinai is pushing hard to change to a population health-payment model, where practitioners are rewarded for preventing disease, not just treating it.


LAB100: MOUNT SINAI’S DAZZLING NEW LAB PROTOTYPE REIMAGINES HEALTH MEASUREMENT AND CARE 35


S TATION TO STATI ON STATION

01 STATION

02 STATION

03 STATION

04 STATION

05 STATION

06 STATION

07 STATION

08

Blood Composition Blood is drawn and placed in an onsite blood chemistry analyzer Anthropometrics and Weight A 360-degree body surface scan is performed to create a precise patient “avatar” Body Composition Percentages of fat and skeletal muscle are determined through bioelectrical impedance analysis Balance Balance is assessed utilizing a depth-sensing camera and belt-worn accelerometer Cognition Cognitive function is measured using standard tests, modified for use on an iPad

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

fellow, and the two began to discuss what a

through high-tech, comprehensive, longi-

next-generation clinic might look like. It was

tudinal health measurement and analysis.

critical to recruit a nontraditional clinician

Collected information will be fed into

to INGH, says Dr. Dudley. “We were looking

intelligent electronic health records (EHRs),

for a clinician who also understood the

powered by computer systems that can

potential for computation and quantitative

analyze huge amounts of health data, to

analysis, and who also understood design

discover earlier predictors of downstream

and engineering. It’s an extremely rare

adverse health effects.

combination of skills, and we were lucky to

“Imagine we have hundreds of clinics like

find that rare combination in Dr. Stark.”

Lab100, all connected to artificial intelligence

Because Dr. Stark was reluctant to leave

(AI)—to the same intelligent EHR system,”

Stanford’s entrepreneurial environment,

says Dr. Dudley. “We could have something

Dr. Dudley urged him to meet with Dennis

similar to what we see in the self-driving car

S. Charney, MD, Anne and Joel Ehrenkranz

world, where every Google self-driving car

Dean of the Icahn School of Medicine and

that drives one mile records that experi-

President for Academic Affairs at the Mount

ence, and every other car connected to that

Sinai Health System. “Dennis convinced me

system experiences that same mile. Our

that Mount Sinai has a healthy appetite

vision is to build a network of intelligent

for risk, for trying new things, which is

clinics that are connected to the same brain,

not often the case in academia or in large

collect all the longitudinal health informa-

incumbent health care institutions,” says

tion, and feed our already-existing powerful

Dr. Stark, now Assistant Professor of Health

algorithms to make better predictions about

System Design and Global Health and

patient health.”

Medical Director of INGH. He was given “an irresistible mandate” to build the clinic of

Dexterity Dexterity is assessed in a pegplacement test, recorded by a high-resolution video camera

Innovation from the Ground Up

the future, he says. In a breathtakingly short

Dr. Dudley keeps a photograph of a doctor’s

span of time—from January to October

office in 1980 as an exhibit of how little has

2017—Lab100 went from concept to reality.

Strength Grip strength is tested while the patient views a responsive ball in virtual reality

doctor’s office today,” he says. “No innova-

A Visit to Lab100

tion has happened on the delivery side.”

Lab100’s physical appearance is beautiful:

Instead of dragging the clinic of 2017 kicking

dazzlingly white and modern while at the

and screaming into the future, Dr. Dudley

same time comfortable and inviting. “People

decided to launch an initiative to create the

enjoy their visits and love the high tech.

clinic of 2025 from the ground up.

They react with awe and wonder,” says

An alumnus of the Biomedical Informat-

Sarah Pesce, ANP-BC, Director of Clinical

ics program at Stanford University School

Operations for Lab100.

of Medicine, Dr. Dudley met fellow Stanford

After completing online self-assessments

alumnus David Stark, MD, then a research

on lifestyle, mental health, and medical

Overall Results Patient and practitioner view and discuss all test results

Sarah Pesce, Director of Clinical Operations, with patient Tino Kamarck

36

Lab100 enables that proactive approach

changed. “It looks exactly the same as a


S UM M O NING M R. S PO C K: A PATIE NT’ S L A B 100 E XP E R I E N CE

history, the patient arrives at the lab to be greeted by the nurse practitioner who will guide and advise, one on one, throughout

What’s it like to visit Lab100? “A very enjoyable experience,” says 68-year-old Tino Kamarck, who went to the lab late last year. “They’ve made the tests almost like games. And the final discussion, in front of the giant screen—it’s like being on the bridge of the Starship Enterprise.” One test in particular made a deep impression on Kamarck: the body surface scan. “Typically, the doctor says, ‘You need to eat better and exercise,’ and we say, ‘Yeah, yeah,’ and we don’t. I’m very fortunate that most of the data said I’m doing fine. But seeing the 3D avatar—I got it. I need to exercise more and eat better. “Seeing results, including the blood test, all together gives you a sense of immediacy. You’re being compared against your cohort, and that makes it meaningful, unlike the usual lab results: What does ‘normal range’ mean, exactly?” Has he actually changed his health habits? “Yes, I’m eating better and exercising more, and I’m sticking with it.”

the visit. A headshot and vital signs are taken, and patient and practitioner sit to discuss the surveys and the test results so far. The patient is then led through a series of stations that assess blood composition, anthropometrics, body composition, balance, cognition, dexterity, and strength. (If the patient consents, a blood sample is sent to BioMe, Mount Sinai’s research biobank.) Throughout the process, videos explain what’s being measured and why it’s important to overall health.

The Power of Immediacy Finally, patient and practitioner discuss findings while sitting together in front of a large-scale, interactive video wall that dis-

Researchers. EHRs contain massive

The Future of Lab100

plays all the data gathered. Results are given

amounts of data, yet they’re not useful for

How might Lab100 evolve from here?

as percentile scores. “It seems to be more

data analytics. EHRs may contain recoding,

Lab100 is a prototype, says Dr. Dudley,

motivating to patients to learn, for instance,

matching the care record to what the payer

and “we have already learned a tremendous

that they’re in the bottom 20th percentile of

is willing to pay for rather than the actual

amount” from building and operating it.

their cohort for LDL than to be told they’re

condition. Moreover, doctors’ notes are

“INGH has an ambitious program to develop

borderline high,” says Dr. Dudley.

unstructured and are mainly for their

next-generation health clinical models and

The dramatic display has immediate

own use.

concepts, and what you see from Lab100

results, says Ms. Pesce. “Patients become

By collecting thousands of data points

is just the beginning of what Dr. Stark, the

activated and want to know how they can

on each patient—much more than can be

INGH team, and I will develop.” In the

move to their new goal.” After the visit,

collected during a typical office visit—and

future, Lab100-type kiosks might be found

patients can go online to access their

by following patients over time, Lab100 will

anywhere, even in your corner drugstore.

complete results.

assemble the most complete health data

Some tests might be done at home: your

collection in existence. Feeding this data to

Making Everybody Happy

bathroom mirror, for instance, might contain

AI will permit data analytics on a huge scale,

a camera to detect concerning facial changes.

Lab100 seeks to benefit all of its stakehold-

enabling the discovery of earlier and better

Balance could be assessed by the motion-

ers: physicians, researchers, and patients.

predictors of disease and adverse health

tracking cameras that will soon be found

Physicians. On a typical day, a doctor

conditions.

in every TV. All the information obtained

spends six hours doing data entry. The aver-

Patients. Individuals with chronic

by one lab would be shared with the others,

age primary care visit lasts 18 minutes; 36

conditions such as diabetes and obesity have

creating a vast amount of health data for

percent of that time is spent entering data

heard, often many times, that they need

AI to work with.

in the EHR.

to change their behavior—yet most don’t.

Says Niyum Gandhi, “Just as today a

Lab100 aims to enable physicians to

Patients who aren’t yet sick but are on a

physician may say ‘Go get these labs done’ to

get back to human interaction by freeing

downhill slide to disease often aren’t seen

a patient, five years from now they may be

them of much of the burden of data col-

by practitioners until symptoms appear and

looking at a comprehensive panel of informa-

lection. “Doctors are already working into

damage has occurred.

tion from Lab100 before patients even come

the evening, typing notes and dealing with

Lab100 motivates patients by giving them

in for a visit.” Physicians could order Lab100

different clinical information systems,”

comprehensive test results during their visit,

assessments with the click of a button. If a

says Dr. Stark. “Here at Mount Sinai, we’re

energizing them to maintain or improve

patient hit specific indicators, recommenda-

engaging with clinician champions who will

their health. By tracking patients over time,

tions for next steps would be made.

help us figure out how to insert this into the

Lab100 will alert individuals and practitio-

“Ten years from now,” says Dr. Stark,

existing health care system without adding

ners of impending danger, before a disorder

“I would like to see Lab100 as the de facto

to physicians’ workload.”

manifests or worsens.

standard for the assessment of health.”

Joel Dudley, PhD (seated) and David Stark, MD

37


A LU M N I

BREAKING BARRIERS AC R O S S

S C I E N C E + M E D I C I N E BY TRAVIS ADKINS

Mount Sinai’s alumni have gone on to break barriers across all disciplines and across the world of medicine, occupying positions of influence from academia and research to public health and policy. Here eight alumni reflect on how their experiences at Mount Sinai shaped who they were—and who they became.

Jeffrey P. Koplan, MD, MSSM ’70

when he first arrived, Dr. Koplan was still eager to explore other specialties with Mount Sinai doctors. Ultimately, it was Kurt W. Deuschle, MD, the founder of the

“Dr. Deuschle had the foresight to say, this is a good match between you and this organization. Basically I owe my career to his mentorship.” 38

A combination of factors brought Jeffrey

Department of Community Medicine and

P. Koplan, MD, to the School of Medicine as

one of the leading public health experts of

part of its very first class of students. Dr.

the twentieth century, who launched him

Koplan had already completed two years of

on his long career, which has included stints

medical school at Tufts University School of

as a Director at the U.S. Centers for Disease

Medicine, where he first became interested

Control and Prevention (CDC) and as the

in social medicine and community health,

Vice President for Global Health at Emory

when a faculty member with whom he had

University. “I didn’t know anything about

been studying left to join Mount Sinai. Dr.

public health or the CDC; I couldn’t spell

Koplan already knew The Mount Sinai Hos-

epidemiology,” recalls Dr. Koplan. “Dr. Deus-

pital well, as his family had been patients of

chle had the foresight to say, this is a good

physicians including Lester Gabrilove, MD,

match between you and this organization.

considered a father of modern endocrinol-

Basically I owe my career to his mentorship.”

ogy. Perhaps the decisive factor, though, had

To his mentorship, and perhaps just a bit to

little to do with Mount Sinai, he says. “I was

the woman for whom he made the critical

dating a woman at the time who matched

decision to move to New York City. “We’re

with a pediatric residency in New York City.”

now celebrating our 49th anniversary, so I

Although interested in public health

guess that was a pretty good choice.”


David M. Nathan, MD, MSSM ’75

at the National Institutes of Health (NIH). That rotation proved formative. Dr. Nathan has gone on to become an internationally recognized expert on diabetes and its

The spirit of the 1960s, the decade in

complications, focusing on the development

which the School of Medicine was founded,

of innovative therapies to treat type 1 and

empowered many to question established

type 2 diabetes, and he was an architect of

authorities and seek new ways of thinking

the landmark Diabetes Control and Compli-

about old problems. David M. Nathan, MD,

cations Trial.

believes that spirit permeated the nascent

Dr. Nathan credits Mount Sinai mentors

medical school, and it was one of the things

such as Karlis Adamsons, MD, PhD, one of

that drew him to the school. “The group of

the foremost obstetricians and neonatolo-

students I was surrounded by were indepen-

gists of his time, for shaping his approach to

dent-minded, and that suited my personality

research. “Dr. Adamsons and others at the

very well,” says Dr. Nathan, Director of the

School of Medicine gave me a real sense of

Massachusetts General Hospital Diabetes

the scientific rigor that was needed to be a

Unit and a professor of medicine at Harvard

good investigator,” he says. “There were so

Medical School. “Mount Sinai allowed me

many really good bench investigators, as

to do what I wanted to do, and gave me the

well as clinical teachers, and bringing that

space and support to do it,” including allow-

investigatory and experimental perspective

ing him to take off part of his fourth year to

to medicine is something I’ve found incred-

complete a rotation in the diabetes division

ibly useful my entire career.”

Joan Y. Reede, MD, MPH, MBA, MSSM ’80

with the physicians, visiting nurses, and social workers in the community to see how medicine played out in the everyday life of patients.

Some of the most valuable lessons that

Dr. Reede, the Dean for Diversity and

Joan Y. Reede, MD, MPH, MBA, learned at

Community Partnership at Harvard Medical

Mount Sinai took place not in the clinic or

School, has drawn on those experiences

on the campus, but within the communities

throughout her career. Among other ac-

where patients worked and lived. “A lot of

complishments, she’s worked as a pediatri-

what drove me and continues to drive me

cian in community and academic health

relates to social determinants of health,”

centers, juvenile prisons, and public schools.

says Dr. Reede. At the time she was applying

She has created and developed more than

to medical school, she was deeply interested

20 programs at Harvard that aim to address

in understanding the health needs of

pipeline and leadership issues for minorities

communities and how health care could

and women who are interested in careers in

be delivered. Within her first year, she was

medicine, academic and scientific research,

doing home visits with the Visiting Nurse

and the health care professions. “What I

Association, which gave her a lens into the

do now is very much rooted in my time at

experience of patients. Later, as a medical

Mount Sinai,” says Dr. Reede. “Mount Sinai

student, she was able to go to Buford Jaspers

helped shape who I became as a physician,

Comprehensive Health Services in South

and it also helped shape me in terms of

Carolina and spent six weeks in the clinic

leadership.”

“Mount Sinai helped shape who I became as a physician, and it also helped shape me in terms of leadership.”

39


Jewel Mullen, MD, MPH, MPA, MSSM ’81 “The way in which I thought about health and medicine was always informed by an understanding of community and the factors outside of the biological that affected people,” says Jewel Mullen, MD, MPH, MPA. With that kind of perspective into how socioeconomic conditions play a central role in health, perhaps it’s not surprising that when asked which people at Mount Sinai were significant influences, Dr. Mullen lists not just doctors and researchers, but also the financial aid office. “One of the people pivotal to me was Jay Cohen (former Assistant Dean for Admissions and Student Affairs, Director of Financial Aid, and Bursar),” says Dr. Mullen. “I was fortunate that he, and the administration and Student Affairs, were very

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

Scott Gottlieb, MD, MSSM ’99, MSH ’02

40

It’s fair to say that when Mount Sinai established its innovative Humanities in Medicine program, through which prospective students with degrees in the humanities can be accepted to pursue a degree in medicine, the School of Medicine had candidates like Scott Gottlieb, MD, in mind. As an undergraduate at Wesleyan University, Dr. Gottlieb had been heavily engaged in writing papers on social science and other topics, and he came to the School of Medicine with well-articulated and reasoned opinions on health care policy. Learning to study science took some getting used to. “My approach that first semester was to study directly out of the textbook, and as most medical students will tell you, that’s not the most efficient way to learn medicine,” Dr. Gottlieb says with a laugh. Dr. Gottlieb continued to write throughout his time at the School of Medicine and as a resident at The Mount Sinai Hospital, authoring policy-focused opinion pieces in The New

supportive of students and their retention.” Mount Sinai’s investment in Dr. Mullen’s education paid off. A renowned public health expert, Dr. Mullen served as the Principal Deputy Assistant Secretary for Health at the U.S. Department of Health and Human Services, where she fostered collaboration among offices within the Office of Assistant Secretary for Health. Internationally recognized for successfully developing and maintaining community-based chronic disease prevention programs, Dr. Mullen’s career has spanned clinical care, research, teaching, and administrative oversight. Financial support aside, among the clinician-educators who inspired Dr. Mullen to pursue her career was Joan Morganthau, MD, the founder of the Mount Sinai Adolescent Health Center, where Dr. Mullen took several electives. “Dr. Morgenthau helped frame my ideas on the medical school’s role in the community through her work in adolescent health,” says Dr. Mullen. “To be able to say I went to medical school at Mount Sinai, and have that resonate with people, says a lot about the past of the School of Medicine and its future.”

York Times, The Wall Street Journal, and other influential publications. His writing took him far: as Commissioner of the U.S. Food and Drug Administration, Dr. Gottlieb oversees the federal agency responsible for some of the most important decisions in public health. For a humanities graduate who didn’t know how to tackle a medical textbook, he’s come a long way. “Part of the spirit of Mount Sinai was to support the individual interests of individual students, and I had interests that were a bit different,” says Dr. Gottlieb. “There was a lot of encouragement, and there’s no doubt that helped me progress in my professional life and pursue the positions I’ve held in Washington.”

Jeffrey S. Flier, MD, MSSM ’72, MSH ’73 Choosing to be a student at a medical school still in its early years means taking a certain amount of risk, but for Jeffrey S. Flier, MD, the fact that Mount Sinai’s medical school was brand-new was part of the appeal. “That’s the kind of thing that might’ve made some people squeamish, but I was attracted to the idea that a fine hospital that hadn’t had a medical school before was going to have a medical school,” says Dr. Flier, Harvard University Distinguished Service Professor and Higginson Professor of Physiology and Medicine at Harvard Medical School. “I thought I might enjoy the experience of being in the founding class and maybe influencing some aspects of how the school developed.” Dr. Flier’s choice was well made; the School’s curriculum included a rigorous, in-depth study of diabetes and its many complications, which he credits for his career-long interest in that disease. Later, while conducting research on diabetes at the NIH, Dr. Flier discovered the existence of autoantibodies to the insulin receptor as a cause of severe insulin resistance, the first of his many seminal contributions to the field. “That established the course of my career,” says Dr. Flier. Mount Sinai changed the course of Dr. Flier’s life in more ways than one: it was there that he met his future wife, Eleftheria Maratos-Flier, MD, who is also a renowned diabetes researcher. As the former Dean of the Faculty of Medicine at Harvard, Dr. Flier welcomed incoming medical students each year, and he often drew upon his experience at Mount Sinai to impress upon the students that it’s performance, not pedigree, that determines success. “I went to a brand-new school that nobody had ever heard of,” says Dr. Flier. “Mount Sinai created terrific things for me.”


Kenneth L. Davis, MD, MSSM ’73 As President and CEO of the Mount Sinai Heath System, Kenneth L. Davis, MD, has been the driving force behind transforming the Health System into one of the largest of its kind in the country—so it’s perhaps a bit ironic that smallness was one of the things that attracted him to the School of Medicine as a student. “I was motivated to attend Mount Sinai by the intimacy of the educational experience, the size of the class, and most of all by the reputation of the hospital,” says Dr. Davis. During his time in the Department of Psychiatry, which he chaired for 15 years, Dr. Davis made major contributions to Alzheimer’s disease research, becoming the first to demonstrate that cholinomimetic therapy could be useful for the treatment of the disease. His work helped Mount Sinai become designated by the National Institutes of Health as one of the first Alzheimer’s Disease Research Centers, and in 2001 was

Bonnie M. Davis, MD, MSSM ’73 Bonnie M. Davis, MD, applied to the School of Medicine because of its “newness, small size, and the reputation of Mount Sinai Hospital,” she says. Little did she know that

elected to the Institute of Medicine, now known as the National Academies of Sciences, Engineering, and Medicine. Since becoming President and CEO, he has led Mount Sinai through a period of unparalleled growth, with its reputation rising to new heights. The Icahn School of Medicine has ascended to one of the top-ranked medical schools in the country during his tenure, while Mount Sinai overall has expanded to become a nonprofit system with $8 billion in revenue, 38,000 employees, seven (soon to eight) hospital campuses, and an extensive ambulatory platform. Although both Mount Sinai and he have come far since the two first met, Dr. Davis still remembers where it all began. “My educational experience was a special and unique opportunity that became the foundation for my career,” says Dr. Davis.

“I was motivated to attend Mount Sinai by the intimacy of the educational experience, the size of the class, and most of all by the reputation of the hospital.”

big things lay in store for her at the young school: a presentation she saw as a student helped launch her long and successful career as a biotech entrepreneur and pioneer in Alzheimer’s disease research. “It was a slide showing that acetylcholine was released from nerve cells in ‘bubbles,’ or quanta, rather than being continuously secreted. Thus, both the amount and pattern of release of acetylcholine could have conveyed the message between nerve cells,” says Dr. Davis, who is married to Kenneth L. Davis, MD, President and CEO of the Mount Sinai Health System and a fellow member of the Class of 1973. “Directly acting cholinergic agonists, of great interest at the time, did not allow for a pattern of release. Cholinesterase inhibitors could be expected to preserve the normal physiology, and they in fact became the agents approved for Alzheimer‘s disease patients.”

Dr. Davis initially helped to demonstrate that insulin resistance, rather than deficiency, was present in most adult-onset diabetics. Subsequently, asked by her husband to identify hormonal measures reflecting that the cholinomimetics he was assessing for Alzheimer’s disease actually got into the brain, she identified galantamine as a potential treatment. She founded Synaptec, to commercialize her patents, including the use of galantamine for dementia of the Alzheimer’s type and related disorders, and serves as its CEO. A member of the faculty of the School of Medicine from 1979 until 1988, she was elected to the Boards of Trustees of Mount Sinai in 2007 and chairs the Committee on Technology Transfer. The Committee’s efforts have helped the medical school develop and commercialize the valuable research conducted by its extraordinary faculty.

41


50 ANNIVERSARY A CELEBRATION IN IMAGES th

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

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Jacobi Medallion Awards Ceremony WHEN: March 15, 2018 WHERE: The Plaza Hotel, New York City WHO: 1. Top row, left to right: Mount Sinai Alumni Association President Burton A. Cohen, MD; Dean Dennis S. Charney, MD; recipients Bruce D. Gelb, MD; Joseph R. Masci, MD; Mary Ann McLaughlin, MD, MPH; and Srinivas Ravi V. Iyengar, PhD; Mount Sinai President and CEO Kenneth L. Davis, MD Bottom row, left to right: recipients Thomas P. Naidich, MD, and Paul R. G. Cunningham, MD; Jacobi Selection Committee Chair Sandra K. Masur, PhD; recipients Wayne A. Gordon, PhD; Yasmin L. Hurd, PhD; and Blaine V. Fogg, Esq. 2. Burton A. Cohen, MD; past recipients Kristjan T. Ragnarsson, MD, and Ramon Murphy, MD 3. Recipient Bruce D. Gelb, MD 4. Recipient Yasmin L. Hurd, PhD

4


Match Day WHEN: March 16, 2018 WHERE: The Icahn School of Medicine at Mount Sinai WHO: Graduating medical students at the Icahn School of Medicine at Mount Sinai joined medical students nationwide on Match Day, matching to many of the nation’s most competitive residency programs, including The Johns Hopkins Hospital, Massachusetts General Hospital, UCSF Medical Center, Brigham and Women’s Hospital, and Penn Medicine. Thirty-four graduates will continue their training within the Mount Sinai Health System. The Class of 2018 will bring their training and accomplishments to more than 20 specialties—from internal medicine, emergency medicine, and obstetrics and gynecology to pediatrics, anesthesiology, family medicine, and neurology.

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Commencement 2018 WHEN: May 11, 2018 WHERE: David Geffen Hall, Lincoln Center, New York City WHO: 1. Dean Dennis S. Charney, MD, addresses MD, PhD, and dual degree candidates 2. Derrick Acheampong, MD, Class of 2018 3. Honorary degree recipient Cato T. Laurencin, MD, PhD, University Professor, University of Connecticut 4. Michael Brodman, MD; honorary degree recipient Cecile Richards, former President, Planned Parenthood Federation of America; Dean Charney 5. PhD student speaker Sarah Motley 6. Mount Sinai President and CEO Kenneth L. Davis, MD; Commencement speaker Timothy P. Shriver, PhD, Chairman, Special Olympics; Dean Charney 7. Degree candidates at ceremony

(Photos by Camera One/NYCPhoto.com)

7


2018 Alumni Reunion & Awards Ceremony WHEN: May 16, 2018 WHERE: New York Academy of Medicine, NYC WHO: 1. 2018 Alumni Awards recipients Benjamin M. Laitman, MD, PhD, ISMMS ’18; Rainier P. Soriano, MD, MSH ’99; Ana Fernandez-Sesma, PhD, MSSM ’98; Mitchell B. Cohen, MD, MSSM ’77; Ann Marie Beddoe, MD, MPH; Ayotunde Dokun, MD, PhD, MSSM ’03; Richard R. P. Warner, MD, MSH ’51; Claude Bloch, MD, FACR, FACG, MSH ’60; Bonnie M. Davis, MD, MSSM ’73 2. Mount Sinai Alumni Association President Burton A. Cohen, MD; Talia H. Swartz, MD, PhD, MSSM ’08, MSH ’12; Ofer Nagar 3. Claire Bloch; Claude Bloch, MD, FACR, FACG, MSH ’60; Jonathan Leigh 4. Keynote panelists Scott Jelinek, MD, ISMMS ’18; Theresa A. Soriano, MD, MPH, MSSM ’01; Senior Associate Dean Valerie Parkas, MD; Dean David Muller, MD, FACP, MSH ’95 5. Mitchell B. Cohen, MD, MSSM ’77 6. David Sachar, MD, MSSM ’70; Lynn Ratner, MD, MSSM ’70 7. St. Luke’s-Roosevelt Alumni Association Executive Board Member Carl W. Braun, MD; awards recipients George Todd, MD and Shanna K. Patterson, MD; Executive Board Member Norma Braun, MD; President George McKinley, MD

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MOUNT SINAI LEADERSHIP AT B Y K AT I E Q U A C K E N B U S H S P I E G E L

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

L

46

ike the scientific revolution

“These breakthroughs are significant

date of 2023, the campaign will raise

over a hundred years ago

enough that when our grandchildren look

funds not just for research, but also to

that gave rise to mod-

back at our times, they will be able to see

strengthen and redesign the infrastructure

ern physics, marked by

what they meant for the future—that cures

that connects the scientific and clinical

breakthroughs in relativity

for cancer are achievable; that the average

sides of the institution.

and quantum mechanics,

expected life span, once 80, is now much

The timing of this new campaign is

we are witnessing today a

longer; and that we are able to understand

critical, says Dennis S. Charney, MD, Anne

revolution in biology and

the genetics and biology of aging,” he says.

and Joel Ehrenkranz Dean, Icahn School

technology that will yield

The question for Mount Sinai that he

of Medicine at Mount Sinai, and President

almost unimaginable breakthroughs in

asks is: how does the institution play a role,

for Academic Affairs, Mount Sinai Health

medicine over the next decades.

and what is its responsibility in understand-

System, noting the imperatives posed by

At Mount Sinai, faculty, clinicians, and

ing these questions and bringing them to

the transformation of research and health

educators experience this revolution daily

its patients?

care delivery in the U.S. “Achieving our goals

as they explore the human genome and

The answer lies in maintaining the leader-

will revolutionize the way diseases are

harness the power of big data to understand

ship position that Mount Sinai has taken on,

diagnosed and treated and the way patients

human biology and disease. But in this new

growing its basic research program and its

are cared for—ultimately, unlocking how

era, there is also a revolution in how health

capacity to support the next generation of

we prevent diseases. We have the chance to

care is delivered in the United States, driven

scientists, implementing the new model of

transform health care right now.”

by the economics of health care. These

care with an emphasis on value instead of

monumental changes are happening as the

fee-for-service, and making a commitment

Leading in Biomedical Research

Health System experiences a seismic shift

to become a true integrated health system

Precision medicine has long been the Holy

with the integration of the Continuum hos-

and not a system of stand-alone hospitals

Grail in health care; the term describes the

pitals into the Mount Sinai Health System.

with redundant services.

ultimate goal of translational research: to

“We are at an extraordinary point in time,”

To that end, Mount Sinai has embarked

develop customized treatments that work

says Kenneth L. Davis, MD, President and

on a new major capital campaign, which

for each individual patient based on his or

Chief Executive Officer of the Mount Sinai

will cover the comprehensive needs of the

her unique genetic and genomic profile.

Health System. “The revolution in biology

institution, from research labs, clinical facili-

But it is only in recent years, with ad-

is leading to possibilities in therapeutics

ties, and faculty to infrastructure and the

vances in gene profiling technologies, that

that we never dreamed of, while health care

modernization of hospitals and the buildout

clinicians have actually begun to apply per-

delivery is being transformed by the failing

of ambulatory facilities. With a “placeholder”

sonalized approaches to caring for patients

economics of the current system.”

goal of $1.5 billion and a target completion

who have been diagnosed with some of the

$1.5 BILLION CA M PA I G N G OA L

2023

TA R G E T C O M P L E T I O N D AT E

5

PRIORITIES • Clinical and research programs • Recruiting talent • Technology and bioinformatics • Innovative medical education • Redesigning infrastructure


T A PIVOTAL MOMENT IN TIME most challenging diseases of our day. Mount Sinai has invested in the infrastructure needed to lead the charge and translate research from laboratory findings into treatments, with the result that it has emerged as a global leader in the pursuit of precision medicine. Its accomplishments have far exceeded even the most optimistic expectations. When Mount Sinai opened the Leon and Norma Hess Center for Science and Medicine in 2012, with state-of-the art research and clinical facilities, leadership expected it would take twice as long to fill it with scientists and patients, notes Dr. Davis. Today, “we’ve filled the building,” he says. “Right now we don’t have enough space for our next generation of scientists. Lack of space thwarts our future and the ability for Mount Sinai to continue as the leader it has been.”

The Economics of the Value Paradigm The campaign reflects a growing need and commitment made by Mount Sinai to address the enormous financial pressures in health care today: moving from a fee-forservice model of care to one that focuses on providing value and measures the quality of care. To that end, “instead of being paid for each procedure we do and every service we provide, we are going to be paid for high quality and high efficiency,” says Dr. Davis. “It’s a different model of care that rewards us for keeping people well.” Mount Sinai has been a leader among major health systems in adopting the new model, which changes staffing levels, decreases the length of hospital stays, and relies on new methods of delivering care, including apps for tracking health and wellness and telemedicine.

With care increasingly moving out of the hospital and into the home and the community, Mount Sinai needs to build new facilities to accomplish this and better meet the needs of the communities it serves. “We’ve made that commitment,” says Dr. Davis. Above all, the campaign has people as its focus. “The center of our new campaign is our people. Our goal is for patients to have more control and better outcomes, to reduce side effects with more accurate and cost-effective treatments, and to promote wellness,” says Mark Kostegan, FAHP, Chief Development Officer and Senior Vice President for Development.

The New Model of Patient Care In moving toward the concept of ambulatory facilities that are “hospitals without beds,” Mount Sinai faces challenges in modernizing its health care platform in

“ With the revolutions in biology and technology and the way health systems are evolving, things are moving so quickly right now in health care; we have to take advantage of the changes, and a campaign helps to fuel that momentum.” – Mark Kostegan

47


“The campaign will strengthen Mount Sinai’s ‘downtown’ presence by supporting the creation of state-of-the-art clinical spaces that address today’s needs.” – Peter May

order to keep its commitment to the new

same time, the campaign will help us push

therapies and treatments,” says Richard A.

model of care. Indeed, Mount Sinai is at the

forward with innovative efforts like combin-

Friedman, Chair of the new campaign.

forefront of the movement toward ambula-

ing research and incubation facilities that

“This isn’t just hyperbole; this campaign

tory, preventive medicine with the opening

will attract the biotech industry to work

is going to get us from here to there,” he

of Mount Sinai Downtown–Union Square,

with us on delivering new treatments.”

says. “It’s still a journey; Mount Sinai has

which, at 280,000 square feet, is the largest New York City. Mount Sinai Downtown–Chelsea

Through a robust and thoughtful strategic

biology, technology, medical education,

provides integrated care in a smaller site,

planning process at the Icahn School of

and clinical care.”

bringing care closer to patients and linking

Medicine and the Health System’s member

“We are launching this philanthropic

research to clinical practice. Sites like these

hospitals, the clinical and scientific goals

effort at a time when the pace of medical

and centers of excellence across the Health

for the institution were aligned, and five

discovery and improvements in medical

System will be rebuilt in order to be more

priority areas emerged that will organize

practice are accelerating at an unprec-

nimble in providing the care needed by their

the funding opportunities of the campaign.

edented rate,” says Mr. Kostegan. “As one of

communities.

These include the following:

the world leaders in discovery and innova-

“We are a system, not a series, of hospitals,” says Dr. Davis, noting that with many hubs, or centers, of excellence throughout the system, each needs to be built in a way that allows it to focus on its area of expertise.

MOUNT SINAI SCIENCE & MEDICINE / SUMMER 2018

The campaign will allow leadership to

48

to chart its own course and we’re not close

Connecting Biology, Technology, Education, and Care

free-standing ambulatory care center in

redesign the connectivity of the Health System and the way care is delivered across the city. Funds raised will upgrade spaces and allow services to be streamlined so that the system is able to care for patients in all

• The innovative and careful design of clinical and research programs • The recruitment and incubation of tal-

to the end, but it’s very exciting to be part of this campaign at the intersection of

tion, Mount Sinai is at the forefront of this evolution. Our strategic plan informs our direction; our campaign will provide the catalytic philanthropy.”

ented clinicians, scientists, and leadership • Technologies, supercomputing, and bioinformatics to drive models for precision health care • The expansion of innovative medical education programs • Capital and space expansions and

of the five boroughs.

enhancements to redesign the Health

“The campaign will strengthen Mount

System’s infrastructure

Sinai’s ‘downtown’ presence by supporting the creation of state-of-the-art clinical

“We are at a crossroads with what’s going

spaces that address today’s needs,” says

on in research, biology, and technology—a

Peter W. May, Chairman of the Mount Sinai

positive inflection point. Mount Sinai has an

Health System Boards of Trustees. “At the

extraordinary opportunity to develop new

“Our donors recognize that the speed with which this organization has adapted, changed, and grown is really amazing.” – Richard Friedman


Innovation in Science and Medicine

October 23 - 24, 2018 #sinainnovations


Match Day! Graduating medical students jump for joy after matching to residency programs and launching their medical careers.

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Mount Sinai Science & Medicine Summer 2018  

Mount Sinai Science & Medicine Summer 2018