A P U B L I CAT I O N O F N O R T H E A S T O H I O M E D I CA L U N I V E R S I T Y â€¢ V O L 19 .2 FA L L 2 018
LISTENING TO OUR DEAR DAUGHTERS…
s I read the stories in this issue, I often felt as if I were reading the diaries of women who could be our daughters—like the young woman setting out to be a surgeon who writes, “I’m still waiting for the day when if I tell people I am a general surgery resident, their response is not a puzzled expression followed by a “Wait, really?” In “Taking Action for Change,” the instructor of an addiction class tells the story of Heather, who is now working to become a chemical dependency counselor. When Heather shared with her classmates how her addiction and incarceration in a women’s reformatory had affected life with her six-year-old daughter, it was a powerful way for future social workers to learn what addiction is really like. Personal experiences as a child seeing her mother being abused motivated NEOMED police officer Kelly DiBona to become a passionate advocate for women’s safety. Officer DiBona worked with Ohio legislators until House Bill 1 passed, allowing people in a dating relationship to obtain civil protective orders. Physical conditions resulting from drugs, domestic abuse and chronic disease are difficult to hide and resources are available to treat them: A story on how a drug has been reformulated to help people recover from opioid addiction is one positive example. But mental health conditions are often silenced, frequently due to social stigma. In “The United Silence of America,” a dad tells us that our collective silence is not good for our well-being. He leaves us with a scary question: What do you do when (a child has) an incident of self-harm that is serious enough to warrant emergency care? As I finished reading this issue, I felt empowered and uplifted by these brave, honest stories. I then reflected on a quote by Dr. Nancy Gantt in this issue’s first story, about the rise of women in the field of surgery: “People know that unless surgeons integrate their work and personal lives to take care of themselves, they won’t be able to care for anyone else.” P.S. Many of the articles in this issue relate to mental illness. We are grateful to Peg’s Foundation for its extraordinary generosity in supporting NEOMED’s endeavors in this realm.
Jay A. Gershen President
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T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S
VOL 19.2 FALL 2018 Northeast Ohio Medical University is a communitybased, public medical university with a mission to improve the health, economy and quality of life in Northeast Ohio through the medicine, pharmacy and health science interprofessional education of students and practitioners at all levels. The University embraces diversity, equity and inclusion and fosters a working and learning environment that celebrates differences and prepares students for patient-centered, teamand population-based care. Ignite magazine (Fall 2018, Volume 19, No. 2) is published twice a year by the Office of Public Relations and Marketing, 4209 St. Rt. 44, P.O. Box 95, Rootstown, OH 44272-0095 Email: email@example.com Jay A. Gershen, D.D.S., Ph.D., President NEOMED Board of Trustees: Daisy L. Alford-Smith, Ph.D. Carl A. Allamby, Student Trustee E. Douglas Beach, Ph.D. Paul R. Bishop, J.D., Vice Chair Sharlene Ramos Chesnes Joseph R. Halter Jr. Robert J. Klonk, Chair Chander M. Kohli, M.D. Richard B. McQueen Phillip L. Trueblood Editor: Elaine Guregian Contributing Editors: Samantha Hickey; Roderick L. Ingram Sr.; Jared F. Slanina Publication Design: Scott J. Rutan Illustrations: Cover and page 12, Dave Szalay, associate professor of art, University of Akron Myers School of Art; Lizzi Aronhalt; Hailey Altman, University of Akron Myers School of Art (’18); Malieka Gurrera, University of Akron Myers School of Art (’18); Emily Wolchko, University of Akron Myers School of Art (’18). Photography: Chris Smanto, Lew Stamp As a health sciences university, we constantly seek ways to improve the health, economy and quality of life in Northeast Ohio. The Accent Opaque paper used for this magazine has earned a Forest Stewardship Council (FSC) and a Sustainable Forestry Initiative (SFI) certification. Strict guidelines have been followed so that forests are renewed, natural resources are preserved and wildlife is protected. Ignite was printed by Printing Concepts in Stow, Ohio, using soy inks. No part of this publication may be reproduced without prior permission of the editors. Copyright 2018 by Northeast Ohio Medical University, Rootstown, Ohio 44272.
DEPARTMENTS 22 TASTES LIKE HOME
30 CLASS NOTES
24 IN THE REDIZONE
32 DONOR SPOTLIGHT
25 HUMANITIES IN MEDICINE
33 WHALE WATCHING
28 INTERPROFESSIONAL EDUCATION
35 PHOTO GALLERY
04 WOMEN IN SURGERY: A RISING TIDE Four new surgery residents look at their future in a changing field.
08 TAKING ACTION FOR CHANGE A workshop model developed at NEOMED is being adopted by communities coping with the opioid epidemic.
12 THE UNITED SILENCE OF AMERICA What if we could talk about our mental health conditions as easily as we discuss our other aches and pains?
16 TAKING A DRUG TO MARKET A long-lasting formula gave a medication new potential to treat substance use disorder. First, it had to pass muster at the FDA.
About the cover: Artist Dave Szalay is an associate professor at the Myers School of Art at The University of Akron, a NEOMED partner school.
20 MAKING A DATING RELATIONSHIP SAFER After seeing her mother suffer in an abusive relationship, a police officer was determined to advocate for change.
For web extras, visit www.neomed.edu/ignite
Ignite magazine was honored in seven different categories for its writing, design, cover art and overall excellence in the 2018 All Ohio Excellence in Journalism Awards of the Press Club of Cleveland. The magazine won three first-place awards and one second-place award in the 2018 Ohioâ€™s Best Journalism Contest, sponsored by the Cincinnati, Cleveland and Columbus chapters of the Society of Professional Journalists.
NORTHEAST OHIO MEDIC AL UNIVERSITY
WOMEN IN SURGERY: A RISING TIDE BY ELAINE GUREGIAN
n March, four women who graduated with the College of academic chairs of surgery across the U.S. The President of the Medicine Class of 2018 matched into general surgery American College of Surgeons (ACS) is a woman; so are the residencies—and Nancy Gantt, M.D., FACS, professor of executive director and the chair of the American Board of surgery, is “over the moon excited’’ for them. Dr. Gantt menSurgery. As more women lead, there is more recognition of tored two of those students as they considered surgery residenissues that uniquely affect women in medicine, such as gender cies and helped a third to disparity in pay, benefits and facilitate M4 rotation arpromotions. Social media “Fifty percent of the students in medical school has been a great tool to rangements. “I was very undecided about long-term broadcast the conversations, classes are women, but only about 20 percent career goals when I started starting with the #ILookLikmy residency, but they all of all surgeons are women. Female surgeons eASurgeon and #NewYorkhave very clear ideas on how erCover campaigns. they want to make a differSurgical training has make 17–20 percent less than their male ence in the world. It’s just evolved. Mark Horattas, colleagues doing the same thing. Fortunately, M.D. (’85), the chair of fabulous,’’ says Dr. Gantt, who is faculty advisor to the surgery at Cleveland Clinic the picture is changing!” Association of Women SurAkron General, has three geon’s medical student chap– Nancy L. Gantt, M.D. daughters in the surgical ter and NEOMED’s Surgery field, now that his youngest, Interest Group. Dr. Gantt is Ileana Horattas, M.D. (’18), co-medical director of the Joanie Abdu Comprehensive Breast has begun her residency. He has been a wonderful role model Care Center at Mercy Health in Ohio. to them. Mark and I trained when grueling on-call schedules were common; fortunately, work rules have improved resident Ignite asked Dr. Gantt and the four new residents—Sarah life. People are paying attention now to physician burnout and Hill, M.D.; Ileana Horattas, M.D.; Maria Knaus, M.D.; and the high physician suicide rate. As faculty members, we support Celine Soriano, M.D.—to reflect on what today’s climate is residents who take time for parental leave. People know that like for women surgeons. unless surgeons integrate their work and personal lives to take We began by asking Dr. Gantt how things have changed care of themselves, they won’t be able to care for anyone else. since she began her career. In the past, surgical leadership was often autocratic and NG: As more women rise into surgical leadership roles, the aggressive. Now, surgeons are part of high-functioning teams. landscape is changing. Currently there are 21 women who are Women lead those teams well. We have excellent interpersonal
Illustration: Lizzi Aronhalt
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and communication skills, we are collaborative and we engage, educate and empower the people on our teams. In addition, female surgical leaders are very proactive about mentoring young surgeons and pulling them up into leadership roles.
Ignite asked the four new residents to talk about their decision to pursue surgery. Here are excerpts from their responses. For more, visit www.neomed.edu/ignite
Why else are things changing now for women in surgery? Many prominent male surgeons have daughters who are going into surgery, including Keith Lillemoe, M.D., the surgeon-in-chief and chair of surgery at Massachusetts General Hospital (MGH), whose daughter is a surgical resident. When Dr. Lillemoe became chair seven years ago, there was only one female professor of surgery at MGH. Now, many women are on track to become professors and salary parity is on the table. It’s amazing how eyes are opened when professional challenges hit close to home. In addition, there is a growing global shortage of surgeons. Patient access can only be improved by developing women as surgeons, especially in low- and middle-income countries. What are other ways that male physicians are learning new attitudes and behaviors? Male members of the Association for Women Surgeons (AWS) are helping to promote women and eliminate disparities that women surgeons face in their training and in their careers. AWS has its own #HeForShe movement. That’s a movement created by UN Women, the United Nations entity for gender equality and the empowerment of women, to help men and boys build on the work of the women’s movement. We are enhancing networks, reaching out to tell young students that being a surgeon is a wonderful career for women. We have all the skills required, and a recent study—“Outcomes of Hospitalized Medicare Beneficiaries Treated by Male vs Female Physicians” (JAMA Internal Medicine)—even demonstrated that patients treated by women physicians do better. Of course, they do—because we talk to them!
AWS has its own #HeForShe movement. That’s a movement created by UN Women, the United Nations entity for gender equality and the empowerment of women, to help men and boys build on the work of the women’s movement. 06 I G N I T I N G
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SARAH HILL, M.D. As a child, I was always very artistic. I loved improving my dexterity and creative abilities, and I made my projects more challenging and time-consuming than I really needed to. Many of my teachers expressed their opinion that I would pursue art as a career, but no one made the leap to surgery, even though many of the same skills are required: creativity, perseverance, dexterity and an eye for detail. Instead of actively being discouraged from certain fields, women face passive discouragement in the form of comments like, “But you can’t have a family if you do that” or being labeled a “career woman,” insinuating that we will only able to lead a one-dimensional life if we pursue these fields. We have come a long way in the past 50 years, but more women need to be incorporated into leadership and administrative roles within surgery, where only a very small percentage of them are filled by women. Women who choose a demanding, male-dominated field face the stigma that we are neglecting our duties as child-bearers. During a clerkship, I had a female attending tell me that my future children would need therapy because I would neglect them—but at least I could afford it on a surgeon’s salary. Remarks like these can be a deterrent, because no woman aspires to be a bad mother. It is in facing dilemmas like these that amazing role models like Dr. Gantt are exceptionally valuable. She has shown my classmates and me that a woman in surgery can be driven in her career, an empathetic physician, a phenomenal teacher, and a devoted wife and mother.
MARIA KNAUS, M.D. For the first couple years of medical school, I was totally starstruck by Dr. Gantt. To see a female surgeon be so successful, so talented, so loved by her patients and respected by her colleagues, and also super in-shape (she loves yoga) motivated me to emulate her. She became my advisor, my role model and my confidante. I began medical school wanting to be an infectious disease doctor. I had always thought surgery was cool but didn’t know much about it. Since my dad works as a certified registered nurse anesthetist near NEOMED, he was able to set up a couple days during my M1 year for me to shadow one of the female chief resident surgeons where he works. On my fi rst day, I scrubbed in on a carotid endarterectomy. As a little M1, the carotid artery was the god of arteries to me. It was fascinating to see the attending and the chief resident surgeon clamp it off, open it up, and remove actual brown fatty plaque. My first inkling that surgery wasn’t necessarily deemed fit for women (because society views them first and foremost as mothers) didn’t come until I chatted with two of the chief residents (both female) during my surgery rotation. No one ever discouraged me from becoming a physician, but attendings, residents, and classmates often discouraged me from surgery. They cited the tough lifestyle, not having time to be a mom, that I was “too nice,” and the fact that the field is majority male. Once during M3 year, an M4 asked me what I wanted to do. When I said surgery, he said, “Oh, you’ll do OB/GYN. That’s what girls that want to do surgery end up doing.” This kind of sexist thinking is rampant and engrained in the subconscious of our society. Although the pay gap between female and male physicians is actually getting worse (!) many people in the male-dominated specialties are finally realizing that women make awesome doctors. But even when people are patriarchal and degrading about my wanting to be a surgeon, it never has deterred me.
When you truly enjoy something, who cares what other people think? CELINE SORIANO, M.D. I always envisioned myself going into a more traditional female specialty like pediatrics or obstetrics and gynecology, but once I completed my surgery rotation, I fell in love with the OR. I found myself addicted to the meticulous details; the ability to treat one’s disease with immediate outcomes; and the spirit of teamwork. As a medical student, I was told by many residents and attendings, “Don’t do surgery if you can picture yourself doing something else.” That was very solid advice, but I think in my case I found that I couldn’t picture myself doing anything except surgery. I tailored my fourth-year experiences in various general surgery and surgical sub-specialty rotations, and I was relieved to find myself still excited to wake up at 4 a.m. to pre-round on my patients every day if it meant getting to be in the operating room later that morning. Passion and resilience kept me going. I am a third-generation female physician. My grandmother and mother both attended medical school in the Philippines. I was the first in my family to graduate from medical school in the United States. I recall being five years old and going to my mother’s clinic after school. I watched her treat her patients with such grace, kindness, and compassion and knew that I wanted to follow in her footsteps. When my grandmother flew from the Philippines to watch me graduate from medical school, we discussed the obstacles she had faced as one of only a few women at her medical school in the late 1960s. We talked about the role she assumed of being the primary breadwinner, and her hard work to maintain balance between being a dermatologist and the mother of five children. I’m still waiting for the day when if tell people I am a general surgery resident, their response is not a puzzled expression followed by a “Wait, really?” or “You’re too nice to be a surgeon.” I am determined
to change the stereotype, so it won’t be shocking for people to hear that a bubbly (or sparkly, as Dr. Gantt likes to say) petite, Asian female is, indeed, a surgeon. ILEANA HORATTAS, M.D. My father is a surgeon and my three older sisters all went into medicine. Two of them pursued general surgery. I do not think anyone who knew us would have predicted that all of the sisters would end up in medicine, but then again, no one ever caused us to doubt for a second that we could if we wanted to do so. Both of my parents constantly supported each of us in pursuing whatever career path we were called to follow. Over the years it evolved, but they were just as excited about the prospect of my going into veterinary medicine or creative writing as they were when I decided on a career in surgery during high school. As a result of their support and the choices my sisters made as well, I never even realized that surgery was once “a man’s field” or that any traces of this way of thinking might persist in the field today. Instead, I learned that if I was dedicated, passionate and hardworking, then surgery would be a good fit. I have found this to be truer than the idea that men or women are more capable of excelling in this demanding profession. That being said, where I am today is the product of the incredibly strong women in my life, including my sisters and my mom, as well as the example my father has been. Seeing the incredibly unique relationships he is able to form with his patients as their surgeon is just one reason that I hope to emulate him as I become the fifth Dr. Horattas. I know there are many difficulties ahead as I continue my surgical training, particularly when it comes to a lifestyle balance. I am hopeful that I will one day be a talented and caring surgeon, and I also look forward to one day becoming a wife and mother. These roles are not exclusive, in my mind.
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TAKING ACTION FOR CHANGE
A “warm handoff ” between stops helps people navigate the journey to recovery. BY ELAINE GUREGIAN
etHelpNow. The name of that new app for drug addiction treatment services gets to the point, doesn’t it? People struggling with opioid addiction need immediate help—and a helping hand to navigate across court systems and addiction agencies so that they don’t get lost along the way. A concerted effort has begun to make a difference in Montgomery County, Ohio—a place that in early 2017 had the highest number of opioid deaths, per capita, in the nation. Initially, 800 deaths from unintentional overdose were projected for 2017. The final report was that 562 died. While there are still enormous challenges, it’s significant progress. By April 2019, 10 other counties in Ohio will have been guided through the same workshop planning process—led by NEOMED staff and funded by the Ohio Department of Mental Health and Addiction Services through 21st Century CURES Act dollars—that has also brought Illustration: Malieka Gurrera
hope to Ross County, Ohio, where overdose deaths declined 25 percent from 2016 to 2017.
BUILDING PARTNERSHIPS How do you mount an attack on the opioid epidemic when the reasons for it come from so many different sources? Ruth Simera, M.Ed., LISW, believes you need to get people out of their silos so they can get together and make an action plan. Simera directs NEOMED’s Ohio Criminal Justice Coordinating Center of Excellence (CJ CCoE), which promotes jail diversion alternatives for people with mental illness. The Center helps mental health and criminal justice systems work together to bridge the gaps that often exist between mental health services, police and courts. In 2015, a NEOMED team had a request from state partners through Ohio’s Office of Criminal Justice Services: Could they replicate their model to create cross-system collaboration among addic-
tion agencies and the criminal justice system? The pilot program would be in Ross County. The demographics: rural, Appalachian, predominantly Caucasian, with one in five people living below the poverty level, a high rate per capita of prescription opioids and a rate of unintentional overdose deaths significantly higher than the state average. Ross County is home to the Heroin Partnership Project, a state-funded initiative to find collaborative community strategies to reduce the demand and supply for heroin and other opioids. Simera agreed to take the challenge, along with Mark Munetz, M.D., The Margaret Clark Morgan Chair in Psychiatry at NEOMED. Their cross-disciplinary team included a social work professor, a retired training officer for the Ohio Department of Mental Health and Addiction Services, and a retired chief city prosecutor. The NEOMED team adapted its Taking Action for Change workshop to conNORTHEAST OHIO MEDIC AL UNIVERSITY
nect first responders and leaders across systems that too often have been disconnected.
TAKING ACTION Here’s how the Taking Action for Change model was first applied in Ross County in 2015 and is now being used in other Ohio counties. On Day 1 of the two-day workshop, local stakeholders and mapping facilitators typically go through a process of “mapping,’’ during which they discuss best practices; identify resources and gaps in service; and identify priorities for change. The term mapping in this case refers to Sequential Intercept Mapping (SIM), based on the Sequential Intercept Model—a framework now in national use that was created by Dr. Munetz and his colleague Patricia Griffin, Ph.D., along with Hank Steadman, Ph.D., from Policy Research Associates. Applied to opioid addiction, SIM identifies how people with substance use disorders progress—or get stuck at various junctures—through hospital emergency departments, detox programs, transitional housing, public schools, county jails and courts. The CJ CCoE’s model is collaborative and pragmatic. “We help participants identify the key points (we call them intercept points) where problems can be addressed before they progress,’’ says Simera. Stakeholders from many different areas participate in the workshop: representatives of hospital emergency departments; community detox programs; county coroners’ offices; social services agencies that provide transitional housing; emergency medical services; law enforcement officers working in tandem with case managers or substance use treatment professionals; public school systems; and representatives of the county jail and court system. And it’s critical to include people in recovery
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from addiction in the workshops, says Simera: They’re more aware than anyone of the barriers. Other stakeholders? Peer support workers and family members of individuals who have addiction. On Day 2, facilitators guide the groups to develop action plans to address their goals.
TAKING ACTION FOR CHANGE Action plans developed at the workshops are short-term and attainable at little or no cost. For example: • The Ross County workshop group decided that a local institution, Adena Hospital, needed a clear protocol for releasing clients and referring them to treatment after an overdose or another drug-related crisis. It created something called the Post Overdose Response Team, consisting of police, an addiction service counselor and a nurse. Now, patients receive referrals from PORT, and if they are at the hospital for an overdose, they are discharged with naloxone kits to stop future overdoses. • Jail inmates are now screened for substance use disorder. Not only are they referred to treatment; they are also given help in signing up for Medicaid if that’s what they need to pay for it.
GETTING RESULTS Ten fewer people in Ross County overdosed in 2017 compared with 2016, despite the increased presence of the dangerous synthetic opioids fentanyl and carfentanyl (a version of fentanyl that is 100 times stronger). Local stakeholders
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have told Simera they see a shift in culture and uptick in community-wide collaboration. When the public library starts offering naloxone training, you know it has gone mainstream. John Gabis, M.D., senior medical director of primary care at Adena Health System, says, “For certain, the SIM exercise brought into sharp focus the efforts of the Heroin Partnership Project. We were already collaborating, but this process helped us become focused on the outcomes and where we needed to spend our efforts and energies. We did bring interventions into the jail and the community that directly impacted those with opiate use disorder.’’
PROVIDING A WARM HANDOFF Jodi Long is co-chair of Montgomery County’s Community Overdose Action Team (COAT)—a quick response team that came out of a Taking Action for Change workshop in February 2017. One key principle is what people in the business call a warm hand-off: directly connecting a person with the service or service provider they need—not just handing them a referral on a piece of paper. Law enforcement officers partner with hospitals, and people who have overdosed can be offered recovery treatment options while still at the hospital. One day, that warm hand extended to a man named Scotty, helping him get into treatment. “Now he’s a certified peer recovery specialist who goes out with the team,’’ says Long. Each team has a full-time employee and a certified peer recovery specialist, like Scotty, as well as access to representatives from treatment agencies. If anyone on the team has had a call about a potential overdose in the last 24 hours, that team goes out and knocks on the door where the overdose happened. They have a conversation with whoever is there (family or friends, if not the person themselves) and
provide information about how to seek treatment. If this sounds like a lot of agencies are working together, that’s correct. And it’s working, says Long. From February 2017 to February 2018, COAT outreach teams in Montgomery County were expanded to reach nine communities. Drug-free workplace policies and second-chance programs were developed for workplaces, while “Building Prevention with Faith’’ training was given so churches could integrate prevention messages. Project DAWN training (an overdose education program that includes how to administer the overdose drug naloxone) was provided to jail inmates. A family dependency court (within the juvenile court) is working with families that are addressing addiction but want to keep their families intact instead of children’s services having custody. Most recovery housing is for single people, but the family dependency court has voiced a need for family recovery housing. “Our recovery housing providers are seeing what that would look like, and how we could offer it,’’ says Long. And then there’s the GetHelpNow app, which helps people connect if they need emergency services, treatment resources, supportive services or housing resources. Long says it’s a great example of how the community has responded. “We were looking for a company to help us build an app, but what we found was Josh, this really passionate advocate on the inside who wanted to make it the best app possible because he experienced the loss of a family member to opiate addiction. If you think about the business leaders who could connect like that…’’ Long doesn’t need to finish her sentence. There’s no one answer to the opioid epidemic. Connecting to work together is helping communities find a multitude of them.
STORY In addition to her day job, Jodi Long teaches addiction classes at the Lima campus of Ohio State University. The story of Heather, who joined a class when active in her addiction, stays with Long.
After serving time in the Marysville Reformatory for Women, Heather started working at a drug court as a peer recovery specialist and now is working toward becoming a certiﬁed chemical dependency counselor. “When you think of people coming full circle, that’s Heather,’’ says Long. “For the last class project, everyone had to pick a special population and how addiction affects it. She picked children. She stood up and there wasn’t a dry eye in the room when she shared how her addiction and incarceration affected her daughter, who was six at the time she was incarcerated, and how it affected her as a mother. Even though she has been working in the community for three or four years, she still doesn’t have custody of her daughter. “We can all talk about the impact of addiction on children, but to have a recovering mom stand up and say these are the things she struggles with, these are the insensitive things people say to her and her daughter, here’s how hard it was for her daughter to tell people where her mom was when Heather was incarcerated—there’s no better way to teach the future social workers in the class about special populations than that. It was a powerful way to create a new picture and face of people in recovery.’’
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THE UNITED SILENCE OF AMERICA BY RODERICK L. INGRAM SR.
he older we get, the more we see ic health conditions, according to the of her mental health campaign. The former FLOTUS’ point is well people around us— colleagues Centers for Disease Control and Prevenat work, business associates, and tion (CDC). Chronic conditions develop taken: We won’t be able to gain the needof course, family and friends—experienc- slowly, often worsen over time and have ed discourse, necessary treatment and ing physical challenges. Perhaps that’s to uncertain outcomes. Although all chron- support for mental health research until be expected: Aging, the environment, ic conditions aren’t physical and all phys- we change our view of mental health and genetics and how we live our lives all ical conditions aren’t visible, the ubiqui- mental illness. add up to our individual WHERE SHOULD health profiles. WE BEGIN? So omnipresent are our ALMOST HALF OF ADULT AMERICANS “Mental disorders are aches and pains, changes WILL BE DIAGNOSED WITH A MENTAL to our physical abilities remarkably common and what I call equal opporand evidence of physical ILLNESS OR DISORDER AT SOME POINT tunity conditions,” says disease that we quite natIN THEIR LIFETIME, AND ACCORDING TO THE Mark R. Munetz, M.D., urally talk about our conNATIONAL INSTITUTE OF MENTAL HEALTH ditions, share wellness the Margaret Clark Morgan Chair in Psychiatry at advice with anyone who (NIMH), NEARLY ONE IN FIVE ADULTS NEOMED. “That is, all will listen, and support LIVES WITH A MENTAL ILLNESS. of us are at risk regardless research that helps to deof our ethnic background, velop vaccinations, stop progressions and seek cures. tous nature of many physical conditions religion, educational or socioeconomic After all, we all have some sort of phys- make them a part of our daily discourse. status. I emphasize this to our students, Almost half of adult Americans will be assuring that they recognize not only their ical difference or illness, right? Physical differences build character and diagnosed with a mental illness or disorder future patients’ vulnerability but also often affect others’ perception of us— at some point in their lifetime, and ac- their own.” sometimes positively, sometimes not. cording to the National Institute of MenAt any given time, about 20 percent Some joke about such differences as they tal Health (NIMH), nearly one in five of U.S. adults are living with mental illness age. Others reminisce about how they adults lives with a mental illness. Yet, of varying conditions and degrees of seonce were “lanky,” “four-eyed,” “chubby,” people don’t discuss these mental aches verity. It is important to understand that or “knock-kneed” kids. The conversations and pains, though they are just as common three quarters of mental disorders have and acknowledgements produce a level of —some even more common—than the become evident by the time a person is 24 comfort and shared experience that nor- physical aches and pains of other chronic years old. Mental disorders are health conditions malize the many changes in physical char- health conditions. “At the root of this dilemma is the way that affect a person’s thinking, feeling or acteristics, illnesses and abilities due to we view mental health in this country. mood. Such conditions may affect someaging, lifestyle or disease. Everyone experiences acute illnesses Whether an illness affects your heart, your one’s ability to relate to others and func(those that occur suddenly, respond to leg or your brain, it’s still an illness, and tion each day. Each person will have diftreatment and last a short time) and about there should be no distinction,” stated ferent experiences—even people with the half of all adults have one or more chron- Michelle Obama in a 2015 speech as part same diagnosis. Illustration: Dave Szalay
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Mental health conditions include ADHD, anxiety disorders, bipolar disorder, borderline personality disorder, depression, dissociative disorders, early psychosis and psychosis, eating disorders, obsessive-compulsive disorder, posttraumatic stress disorder, schizoaffective disorder and schizophrenia. Two categories are often used to describe these conditions: Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses all recognized mental illnesses—mental, behavioral or emotional disorders—and its impact ranges from mild impairment to moderate and even severe impairment. SMI is a smaller subset of AMI. But it’s also more severe, resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. Meeting the needs of individuals with serious mental disorders is the mission of Peg’s Foundation, the largest mental health funder in Northeast Ohio. And the Foundation wants others—grantees, community organizations, those who suffer from serious mental illness and their family members—to be aware of best practice treatments that are available now.
“STUFF WORKS BUT THEY DON’T DO IT.” It was during a recent grant announcement that these words by Rick Kellar, president of Peg’s Foundation, got everyone’s attention. Upon announcing a $7.5 million gift to the Department of Psychiatry at Northeast Ohio Medical University (NEOMED), the West Point grad and U.S. Army combat veteran told the audience that best practices are being disseminated by its partner, NEOMED, and that the University’s three centers—the Best Practices in Schizophrenia Treatment (BeST) Center, the Ohio Program for Campus Safety and Mental Health (OPCSMH) and the Crim-
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inal Justice Coordinating Center of Excellence (CJ CCoE)—provide a model that he hopes others across the country will soon follow. Evidence-based treatment is available, but others aren’t using it, Kellar told the audience at the grant announcement. The Peg’s Foundation-NEOMED partnership challenges a system that provides care in fragmented silos and has a high mortality rate of people who suffer from serious mental illness, said Keller. He described a system that’s slow in addressing a rising suicide rate, jails and prisons that are “end-patient facilities for those who suffer from serious mental illness” and a norm of criminalizing the disease instead of providing treatment. Kellar’s challenges to the status quo and pursuit of improvements in access to care, behavioral health capacity and criminal justice reform were borne out of personal experience. He does what many don’t do—he talks about how mental illness has affected his life. He was first introduced to mental illness as a child, he told the audience at the grant announcement, when his brother tried to take his life. If Kellar silenced the audience by noting that many public systems—law enforcement, jails/prisons, education, courts, primary care, mental health, addiction and human services—are not using best practices available to them, then he awakened them when he talked about his personal experiences. Once people hear others, like Kellar, openly talk about mental illness and how it impacts their loved ones or them, they become more comfortable in discussing their own situations. Talking about mental illness is the best way to realize the prevalence of mental illness because it increases the comfort level of others. The more discussions that are had, the less taboo it becomes. In the best scenario,
more open conversations would lead to more people seeking help, more people becoming aware of the resources available to them, and more dissemination and use of best treatment practices by those who can help them. We need to talk about mental illness —our own and that of others—as comfortably as we do about physical illness. Kellar, who speaks about his daughter’s anxiety disorder in addition to his first encounter with his brother, says that open discussions about experiences don’t just help those who are directly affected by mental illness. They also increase the mental and physical well-being — and the understanding—of us all.
SILENCE IS NOT SALUBRIOUS As told by Rick Kellar: When I first arrived at Peg’s Foundation, I knew that our work would have an impact on individuals and families encountering mental illness and behavioral health disorders. Little did I know I would personally experience navigating a behavioral health emergency, and ongoing treatment, on behalf of a family member. I am grateful for the many clinicians and friends that helped my daughter navigate a difficult stage of her life, and know that not everyone has access to knowledge or care that my family did. Most parents know where to go when our child falls and has a broken arm, or closes her finger in a car door, but what do you do when an incident of self-harm is serious enough to warrant emergency care? And are our systems ready to handle both the physical and mental well-being of our loved one? I am more driven now than ever, having been on the receiving side of excellent, mediocre, and poor care, to make access to and quality of behavioral health care on par with primary care. And I know our willingness to share that journey helps others find the best outcomes for all.
A N A P P R E C I AT I V E G I F T
A FOCUS ON GIVING TO HEARING RESEARCH He simply wants others to be as fortunate as him and his daughter
Jeff Mellott, Ph.D (with daughter Elise)
Elise Mellott is a happy child with no hearing problems. Her daddy, Jeff Mellott, Ph.D., wants to improve the lives of those who aren’t so lucky. Dr. Mellott is an assistant professor in anatomy and neurobiology, and a researcher in NEOMED’s Hearing Research Group. He is doing the work needed to identify auditory circuits that will allow for improved brain therapy to ameliorate age-related hearing loss. Dr. Mellott is also a donor who made a gift to the NEOMED Foundation because he wants to help future colleagues advance science and future patients beneﬁt from the therapies that are developed.
Dr. Mellott established the Elise Mellott Hearing Research Fund to assist graduate students and post-docs in their professional development. Hearing disorders of many types begin in the inner ear, but they have long-term effects in the brain. The Hearing Research Group at NEOMED is interested in how the central nervous system functions in association with hearing and vocal communication, how it is affected by hearing disorders, and how interventions of the peripheral and central nervous systems may ameliorate hearing disorders.
Dr. Jeff Mellott is committed to stopping the progression of age-related hearing loss. His work as a scientist, role as a dad and desire as a donor will make it all possible. THE ELISE MELLOTT HEARING RESEARCH FUND IS HELPING NEOMED SHINE ON. To learn how you can help NEOMED Shine On, please call Lindsey Loftus at 330.325.6674 or email him at firstname.lastname@example.org.
TAKING A DRUG TO MARKET BY ELAINE GUREGIAN
motions ran high last fall in the public testimony portion of the process to approve a new treatment for opioid addiction. NEOMED faculty member Daniel Krinsky, R.Ph., professor of pharmacy practice, was in the room to hear it, as a member of the Food and Drug Administration (FDA)’s national Drug Safety and Risk Management Advisory Committee. “Panelists were saying things such as, ‘We are at a huge crossroads now. We just don’t have many options, especially with this population that is traditionally non-adherent. Asking them to use Suboxone on a daily basis is unreasonable.’ There was one individual who kept saying, ‘We need to do anything we can to help these people! They’re desperate. It’s a disease. We need to recognize that.’’’ As a result of the vote taken that day and the resultant FDA approval, patients receiving medication assisted treatment (MAT) for opioid use disorder got an alternative to the daily-use drug Subox-
one. The FDA panel approved a medication that lasts for an entire month, and Sublocade became available by prescription May 1. Krinsky takes us behind the scenes to two jam-packed days of testimony and
What is the purpose of Sublocade, and how does it work? Sublocade contains the medication buprenorphine, which has been successfully used to help people with substance use disorder wean off opioids. Oral versions (specifically, sublingual tablets that dissolve under your tongue, or “films” placed in the mouth that dissolve and distribute the medication orally) of buprenorphine, such as Belbuca or Suboxone (which also includes naloxone), have been the go-to treatments. However, adherence to these medications is often low because they have to be taken at least daily. And as C. Everett Koop, M.D., the former U.S. Surgeon General, once said, “Drugs don’t work in patients who don’t take them.” An easier alternative was needed, if people were going to receive maximum benefit and get better. That’s where Sublocade comes in. With the once-monthly administration of Sublocade in the physician’s office, patients don’t have to worry about adherence, which is a huge issue
SUBLOCADE BLOCKS 80-90 PERCENT OF THE OPIOID RECEPTORS, SO IT PREVENTS PEOPLE FROM GETTING HIGH IF THEY TAKE OPIOIDS WHILE THEY ARE USING IT TO FIGHT THEIR ADDICTION.
Illustration: Hailey Altman
discussion on two separate but similar products, concluding months of scientific review by the committee—two days culminating in the Committee recommending full FDA approval of a new way to deliver medication for people struggling with substance use disorder.
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in this population. The patient gets the subcutaneous (under the skin) injection once a month. It’s what’s called a depot formulation. Think of a train depot, where a supply of train cars is stored. With this depot injection, a month’s worth of medication is deposited all at one time through the injection, then the drug is gradually absorbed into the body over time. Basically, Sublocade blocks 80-90 percent of the opioid receptors, so it prevents people from getting high if they take opioids while they are using it to fight their addiction. You said the active ingredient was already used in medications on the market. What did you review to be sure that administering the active ingredient in a different way—just once a month via a subcutaneous injection of a depot formulation—would be safe and effective? What we did as a committee was this: Prior to meeting in person, we were sent a few hundred pages of information about clinical trials—on animals and on humans—and about safety and efficacy. We had to review and synthesize the information in order to gain a detailed understanding of the current science and study results for the products. The two days of live meetings involved testimony from a number of parties, including the manufacturers of Sublocade and a competing product. Representatives from each company explained the information that had been sent to us in advance and provided us with new information. In addition, representatives from the FDA provided information they had prepared, based on their assessment of the data. Last, there was time for public
testimony, which consisted of lay people providing personal testimonials of their first-hand experience with addiction and treatment, or a family member’s experience dealing with opioid addiction, as well as representatives of organizations and providers who have experience treating these types of individuals.
each question we had to cast our vote then provide our reasoning as to why we voted the way we did. Anyone who attended the meetings could remain to hear what we as a committee were saying and also see how we voted, as our votes were put up on a screen. The entire process was broadcast live via the internet. This is a very public process, as it should be. I feel that the need to hold each of us accountable for our individual recommendations, which collectively resulted in our committee recommendations to the FDA, is critical for the success of the evaluation process. Because the other product we evaluated is still in the review process, the focus here is just on Sublocade, the product that has been approved by the FDA. What concerns did you raise during the FDA panel discussion? The first concern was communication—ensuring all health care providers involved in the care of patients know that a patient has been administered this medication, since it will be administered almost exclusively in physician offices. Let’s say someone has an opioid addiction and the patient and their physician decides this new monthly dose medication is the best product to help them wean off the drug. The physician starts them on this regimen and they go to the doctor’s office to get this monthly injection. What happens if three weeks into it, the patient gets their wisdom teeth taken out and the oral surgeon writes a prescription for short-term narcotic use to manage the pain? The buprenorphine is already in their system. What do they do? If the patient doesn’t remember to tell the oral surgeon or the pharmacist, there’s a rea-
THERE WERE 19 OF US IN THE ROOM, AND WE WERE BASICALLY MAKING A RECOMMENDATION TO THE FDA THAT, IF ACCEPTED AND APPROVED BY THE FDA, WOULD AFFECT MILLIONS OF LIVES.
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I have to say that hearing some of this and seeing the despair and concern expressed was very compelling. After all the testimony and presentations, committee members and FDA experts had time for questions and discussion. At the end of each day each committee member had to cast votes based on questions posed by the FDA. Because of the complexity of the products (regarding issues such as administration, dosing, monitoring and dose-dependent side effects) the questions were phrased such that we as committee members were asked to address various options to give the FDA more guidance in their final decision. For
NEOMED Trains Community Providers in Medication-Assisted Treatment People who are addicted to opioids can’t simply decide to stop taking them. Best practices for helping them reduce their dependence now include medication-assisted treatment (MAT), says Dr. Christina Delos Reyes, M.D., a specialist in addiction psychiatry. Dr. Delos Reyes is the lead trainer for the NEOMED Primary Care Implementation of MAT program, which provides weekly trainings for health providers throughout Northeast Ohio.
Dr. Delos Reyes also serves on a team for the Ohio Opiate Project ECHO, which uses telecommunications technology (distance learning) to provide continuing professional education on medication-assisted treatment for opiate addiction. Sublocade became available to prescribers May 1, 2018. Since then, Dr. Delos Reyes has taught about it as an additional option.
Opioid, opiate: What’s the difference? If we‘re talking about an addiction to painkillers, is it ok to use the terms interchangeably—an opioid addiction, or an opiate addiction?
natural origin.A few examples of opiates include codeine, heroin, and morphine. Opioids, on the other hand, are a category of medications that include natural and synthetic substances that, when given, bind to opioid All opiates are opioids, but not all opioids are opiates, receptors in the brain. Examples of synthetic opioids says pharmacist Daniel Krinsky, R.Ph. He says it’s best include oxycodone (one of the active ingredients in Percocet, and the active ingredient in OxyContin), to use the term opioids because it is more inclusive. Krinsky explains,“An opiate is a drug that comes directly hydrocodone (one of the active ingredients in Norco from the opium poppy plant, so these have a more and Vicodin), fentanyl and methadone.”
sonable chance the pharmacist will dispense that narcotic medication—and it’s not going to work. Another concern was this: If this monthly reservoir of medication were already administered, but then the patient needed emergency surgery and subsequent pain medication, could this product be removed? The manufacturer had some information about this but details still needed to be addressed, which they were for Sublocade prior to approval. Can the product be removed? Yes, but within the first two weeks of injection, and only through a minor surgical procedure under local anesthesia. However, removal of the depot does not mean the medication is gone. It will likely take several weeks before all the medication has been completely eliminated.
Who is on the Drug Safety and Risk Management Advisory Committee? It consists mostly of addiction therapy experts, practicing physicians, researchers, academicians, and two pharmacists. I would guess most committee members had at least 15 years of experience in this practice area. The other pharmacist was in risk management on the hospital side. I was the only one who brought the community pharmacist perspective into the equation. Final thoughts on the process? For my first experience as a committee member this was somewhat overwhelming. Based on what we as a committee were able to evaluate about this particular product, I felt good about our work and recommendations. It’s a lot of responsibility. There were 19 of us in the room, and we
were basically making a recommendation to the FDA that, if accepted and approved by the FDA, would affect millions of lives. That’s pretty powerful. But once a drug is approved, the manufacturer will continue to conduct post-marketing surveillance and studies to determine what happens after approval—when it’s now being used not just a few hundred patients in a clinical study but by potentially hundreds of thousands of people. Once drugs are available for use, manufacturers and the FDA monitor these medications on a regular basis, as it’s in everyone’s best interests to keep track of things such as how the product is working, safety issues, and where any changes may need to be made. Does insurance cover it? It depends on the plan. You knew I was going to say that.
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MAKING DATING RELATIONSHIPS SAFER BY SAMANTHA HICKEY
any of us dread Sunday evenings, because Monday means preparing to return to work or school. NEOMED police officer Kelly DiBona, on the other hand, holds Sunday evenings close to her heart. For years, Officer DiBona held the Sunday evening shift at Safer Futures, a domestic violence shelter and resource center in Portage County—the same shelter where she stayed with her mother when she was a child. “Sunday evenings were special. Kids were getting ready for that week of school, women were getting ready for the work week and most times everybody was home cooking together, so that was when I really got to listen to the ladies share their personal stories,” says Officer DiBona.
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BECOMING AN ADVOCATE After hearing those stories and watching her mother suffer through an abusive relationship for more than a decade, Officer DiBona wanted to do something to help women like her mother. The opportunity presented itself in October 2015, when Officer DiBona met Emilia Sykes, Representative for the 34th district of the Ohio House of Representatives, during a panel interview at Northeast Ohio Medical University. Soon afterward, the two decided to join forces as advocates for domestic violence. Before Officer DiBona, Rep. Sykes and Nathan Manning, Representative for the 55th district of the Ohio House of Representatives, went to bat for victims of dating violence, Ohio
Photo: Chris Smanto
was one of the last two states to allow people in a dating relationship to obtain civil protective orders against their attackers—the same protection against violence as those who are living together or married. (Georgia is now the last state awaiting updated terminology.)
THE PROCESS OF PATIENCE It took some doing. Officer DiBona testified at hearings in 2015 and 2017, then submitted a written testimony later in 2017. House Bill 392 made it through the House but failed in the Senate vote. But Reps. Sykes and Manning persisted. With patience and the right timing, the team was able to see a new version, House Bill 1, through to success. HB1 took effect on July 6, 2018. Ohio’s revised code now authorizes “the issuance of a domestic violence civil protection order with respect to conduct directed at a petitioner alleging violence in a dating relationship [our emphasis] of a specified nature, to provide access to domestic violence shelters for victims of violence in such a dating relationship, and to require the Attorney General’s victim’s bill of rights pamphlet to include a notice that a person alleging violence in such a dating relationship has the right to petition for a domestic violence civil protection order.” It was a long road, says Officer DiBona, but three testimonies later, she can proudly say she played a role in this important and much-needed update.
CONTINUING TO ADVOCATE With House Bill 1 in place, Officer DiBona continues to be an advocate throughout her community to help reduce domestic violence. Through Crisis Intervention Training (CIT) and Crisis Intervention Team Education Collaboration (CITEC), Officer DiBona educates local educators and law enforcement officials, using her personal experiences to help them recognize and address children or adults who are experiencing domestic violence. She’d like everyone to feel the safety and warmth she saw at the shelter on those Sunday nights.
Being involved in an abusive relationship can lead to mental health conditions such as anxiety and depression. NEOMED Cares is a campus-wide campaign to promote awareness of mental health and wellness resources, educational opportunities and access to help throughout the campus community.
OFFERING COMFORT “I think this is extremely important just because it opens up another avenue for someone to gain an extra layer of protection. The new law means that law enforcement responds completely differently. It escalates the situation and mandates that there is an extremely immediate need for us to be there to help that person out,” says Officer DiBona. As someone who has lived in a home with domestic violence and now as a law enforcement official, Officer DiBona knows the territory better than most. “I actually had a lady once say to me, ‘So if I let him punch me in the face one more time, then I have the criteria for a civil protection order?’ Unfortunately, it was true because of the difference between a civil protection order and anti-stalking order at the time. The criteria was so specific, you either got one or the other. A civil protection order gives you some extra resources beyond an anti-stalking order,” Officer DiBona explains. Now people in a dating relationship, like that woman, have more protection.
The Ohio Program for Campus Safety and Mental Health is operated from the NEOMED campus.The program promotes mental health awareness, suicide prevention and stigma reduction activities at college campuses across the state.
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TASTES LIKE HOME
ABUELITA ROSA’S GUACAMOLE SALSA BY CARMEN JAVIER
hat’s better than guacamole? How about guacamole salsa? It’s the perfect combination for a dip that is not too spicy and not too bland. Growing up in Mexico, I was always amazed by the giant mortar and pestle (aka “molcajete”) made of dark granite that my grandmother used for all her famous salsas. She was a talented cook who always valued authenticity. When it came to cooking salsa, she would say, “If it’s not made in a molcajete, it’s bad salsa.” Now, obviously times have changed, and I would bet that hardly anybody in the U.S. would be willing to cook without a blender. If you can find a mortar and pestle and are eager to work out your pronator and supinator muscles, then all the more savory power to you in following this recipe! While a blender will still bring you flavorful results, a mortar and pestle offers the bonus of texture variations and more released flavors and smells that you can only get from pounding and crushing your ingredients.
Ingredients: 6 serrano peppers (5 if you prefer a less spicy flavor) 3 tomatillos 2 Roma tomatoes 4 ripe avocados ½ cup fresh cilantro leaves ½ white onion 3 garlic cloves Salt to taste Pepper to taste Tajin (seasoning) to taste (optional) Juice of 1 lime 1 tablespoon oil
Illustration: Emily Wolchko
Second-year College of Medicine student Carmen Javier is the president of Northeast Ohio Medical University’s chapter of the Latino Medical Student Association.
Directions: 1. Cut serrano peppers and peeled garlic cloves in half lengthwise, scraping out and discarding the pepper seeds. (Keep your hands away from your eyes; the peppers are hot.) Cut tomatillos, Roma tomatoes, and onion into four pieces each. 2. Heat oil in a comal (a flat griddle or stove pan) or a cast iron skillet. The purpose of the oil is to prevent the vegetables from sticking to the pan or burning as you saute them. Once the oil is hot, add all the vegetables to the pan and allow them to saute on low to medium heat. Watch as your vegetables begin to brown. Turn them over until they have browned through. Turn off heat. 3. Transfer the sautéed vegetables to either a mortar and pestle or a blender. Finely chop the cilantro leaves and add them to this mixture. Cut two ripe avocados in half and scoop out the avocado to add to the mix as well. Add salt, pepper, tajin seasoning, and the lime juice. 4. Either blend everything or get pounding with your molcajete (mortar and pestle)! Pound and crush until all the ingredients are uniformly mixed and you are satisfied with the texture. 5. Dice the remaining two avocados and add them to the mixture, then transfer the mixture to a serving bowl. Stir with a large spoon and enjoy!
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IN THE REDIZONE
For a photo gallery of the organ-on-chip process, visit www.neomed.edu/ignite.
FAILING TOWARD SUCCESS BY JARED F. SLANINA
ust the thought of failure is enough to create anxiety for most of us. But as counterintuitive as it may sound, failing faster is a major goal of the REDIzone’s recently opened Pharmaceutical Proof of Concept Center (PPOCC). Here, the Nortis organ-on-chip system allows researchers to observe the functions and responses of a human organ to a new drug being tested, via a microfluidic chip with an environment engineered to grow and culture human cells. With the help of the PPOCC, companies can get an early view of the effectiveness of new drugs and advance only the most promising candidates to the rigorous—and expensive—human clinical studies. For anyone who uses medications (in other words, just about everyone), a more efficient way of testing drugs comes as good news. Theoretically, this process means that good products can work their way through the pipeline to consumers faster, while not-so-good products are discovered as such— and abandoned—earlier. Testing, as well as training on how to use the system, is available for the first 100 samples free of charge to companies and researchers throughout Ohio, as well as to NEOMED researchers.
KIDNEYS, LIVER ARE THE FOCUS The organ-on-chip technology can be used for a variety of organs. At NEOMED, the kidney and the liver (both areas of 24 I G N I T I N G
research at the University) are currently the organs of focus. “Oftentimes a drug will do well in animal studies but then fail in humans because it is toxic to the liver. That is what we are trying to prevent,” says Elliot Reed, J.D., M.B.A., program manager for the REDIzone. The Nortis organ-on-chip system has the capacity to run up to 24 tests at a time, whether it be 24 separate kidneys, livers, or a combination of both. “By testing a drug on both a liver system and a kidney system, we can learn how the liver metabolizes the drug to see if the resulting substance will be toxic to the kidney,” says Reed. The PPOCC is also being used as a learning opportunity for students. Nazar Hussein, a Ph.D. candidate in the College of Graduate Studies, helps coordinate tests at the PPOCC for external researchers who are visiting. He also can run samples for offsite companies, or for companies in residence at the REDIzone. The opening of the PPOCC in May 2018 coincided with the BioOhio event “Pharmaceutical Pathways: Drug Discovery, Development, and FDA Regulations” held in Cincinnati and at NEOMED. The PPOCC was made possible in part through the i6 Challenge Grant, an award of more than $500,000 made to NEOMED by the U.S. Department of Commerce via the Economic Development Administration’s Regional Innovation Strategies program.
Photo: Lew Stamp
HUMANITIES IN MEDICINE
FINDING TIME FOR REFLECTION BY ELAINE GUREGIAN
When I Saw the Table under a bright quilt and shadowed cup of sunflowers golden red, I thought it was a place
Guest speaker Jay Baruch, director of the Medical Humanities and Bioethics Scholarly Concentration at Brown University
worthy to wait for death. A plate of fruit and thick slice of cake so patient and
ou hear it all the time: “I used to love writing, but I stopped when I got to med school.” Sean McEvoy, the first-place winner of NEOMED’s William Carlos William Poetry Competition in 2018, used to say that, too. But as the University of Arizona College of MedicineTucson student told College of Medicine students attending this year’s awards event, he realized how much he missed it —so he started writing again. McEvoy entered and won NEOMED’s national competition, now in its 36th year. The event is named for the American physician-poet. Back in high school, Kathy Wu’s physiology teacher used to read her class excerpts from Fourteen Stories: Doctors, Patients, and Other Strangers. So Wu, now a second-year College of Medicine student, was excited that the guest speaker for this year’s awards was the author of that collection, Jay Baruch, M.D.—an associate professor of emergency medicine at Alpert Medical School at Brown University, where he’s also the director of the Medical Humanities and Bioethics Scholarly Concentration. Wu wrote after the competition awards event that it “made me reconsider the place that the physician-author dream could have in my career and reminded me of the benefits of reflective writing,” which is part of the four-year humanism curriculum at NEOMED. Dr. Baruch’s advice to students could work for any of us who want to live more reflectively: Keep a journal. Carve out the time to write. Show your work to someone else. Read your work to an audience—and watch the response.
loving, just for me, beside the sugar dish and cream. It seemed only fair to eat slow and sit, and I remembered the man – sick, given a few weeks to live as his throat closed itself. He decided to leave unannounced. Lines on the floor and a trail of blood drops down to Broadway – He never came back. I imagine a mountain, a forest, and maybe a great stone slab on which to lie, hearing the buzzing shapes of insects as I sat still, calmly becoming an offering myself. — by Sean McEvoy
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Our Mission To improve the lives of people with serious mental illness by investing in innovative projects in Northeast Ohio having national transformational impact.
HUMANITIES IN MEDICINE
LETTER TO A FRIEND BY KATHRYN BORTHWICK
Dear Billy, I cannot even begin to reﬂect on what type of person you had been. All I can do is sit in rapt astonishment and imagine. Think of a man, a being. Billy. Ethyl. Gertrude. John. Rose. Names that we gave you. They weren’t your
Second-year College of Medicine student Kathryn Borthwick wrote this letter as a first-year student in a Human Values in Medicine class— one of the courses in the four-year humanities curriculum taken by all medicine students at NEOMED. The subject of the letter is the person who, through NEOMED’s Body Donation Program, made his body available for anatomical study by physicians in training.
names. They were triggers. Little ticks of our own mind to keep you human. To keep you alive in our memory and to keep us focused on you. What you are and who you are. I hope you didn’t mind Billy. We thought you looked like a Billy. A strong man with wide hands. A man with more muscle than I’ll ever have. A man who was alive. That was you. You lived. Your heart beat once upon a time. In life, would you have let me listen to it? Billy. What were you? A carpenter? Lifter? Postman, mover, dreamer, drifter? Fireﬁghter, novel writer, student, preacher? Doctor, farmer, thinker, teacher? A teacher. You are certainly that. You are my teacher. Not my ﬁrst and not my last, but one I will never forget. One to whom I was closer than I’ve ever been to another human being. They call you our ﬁrst patient. That’s true. You were more patient with me than anyone else was. You didn’t insist I learn anything, but you opened to show me everything. I saw it all. What you showed me won’t be in a textbook. What you showed me is how people are and can be. How they will, won’t, might be like what I take from the classroom. You showed me how to understand when something is diﬀerent. How to work with it, accept it, live it. We talked about you, the life you ﬁlled. What you did for a living, for fun. But more than that, I wondered about you. What does it take to donate your body? What sort of person is capable of this decision? It’s someone far greater than me, someone who understands a future they can’t see. Someone who knows that their hand will be on each incision made, each shoulder touched, each prescription signed. Someone who in all the world of friends, family, politics, taxes, working, living, eating, drinking, was able to think of us. Of me. A person whose patient you would never get to be. A beneﬁt that you would never get to receive. I didn’t know your name or your life or your story, but I know what you’ve done for me. I know what you put into my hands: Your heart, your lungs, your bones, your time, your days, the history of your life. I can’t tell you much. My words can only say so much, but I will try. I will try to encompass all that I learned and know and understand and felt into the tight grip of the written word. Thank you. Forever your student, Kathryn Borthwick
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THINK LIKE A PHARMACIST BY ELAINE GUREGIAN
et’s say you’ve been feeling a little down lately. Maybe more than a little, or maybe for longer than you’d like. A friend mentions something they read on social media. The post said that magnesium can be used instead of a prescription medicine to treat depression and anxiety. Should you try it? “Patients get the idea that supplements like magnesium are OK to use because they’re over-the-counter and “natural” but we tell them to talk first to a physician and their pharmacist to see if there are any interactions with other medicines they are taking,” says Jennifer Toth, Pharm.D., a 2018 graduate of the College of Pharmacy. Thinking like a scientist about the effects and interactions of every product we eat or drink takes training—like the evidence-based medicine classes that College of Pharmacy students take in their first year, right alongside College of Medicine students. From Dr. Toth’s classroom training and her experience serving patients at community pharmacy locations, she can offer a few key points to keep in mind when we read the latest claim that a product can make us calmer (or faster, or smarter—you can fill in the blanks).
QUESTIONING THE LATEST MEDIA CURE As consumers in the U.S., we’re used to prescription medicines being highly regulated. That is, we can rest assured that a prescription contains what it says it does. But Dr. Toth notes that the Food and Drug Administration (FDA) does not approve supplements and so-called natural products such as vitamins and minerals before they are brought to market. Wait, really? It’s true. Although familiar brand names can be reassuring, and possibly more reliable, there’s no guarantee from the FDA or any other government body that a supplement labeled as, say, magnesium, actually contains that product or the amount stated on the label, agrees Daniel Krinsky, R.Ph., professor of pharmacy practice. And all supplements are not created equal. Consumers need to consider the other ingredients with which a product 28 I G N I T I N G
may be mixed. Magnesium citrate (a salt form of magnesium) is used as a laxative, for example. If you mistakenly purchase this product with hopes of improving your mood, you will likely be surprised by some very different results. And there’s another potential side effect, says Dr. Toth: Because magnesium is an electrolyte, which is important for normal body function, you could end up with a slower heart rate and lower blood pressure.
SIZING UP THE RESEARCH Evaluating through fact-finding just makes sense to Dr. Toth, who was a math major as an undergraduate and is now pursuing a Ph.D. in pharmacy administration. At NEOMED, in a pharmacy elective taught by professor Krinsky, Dr. Toth and her classmates looked at product claims made in advertorials (paid content designed to blend in, so it could be mistaken for objective content written by reporters employed by the publication). They learned to check out the studies cited in the ads and compare them with the actual evidence, if that even existed—and the students often discovered that the claims were about as substantial as using cotton candy to treat cancer. While we consumers can feel confident that prescription medications have been put through rigorous safety and efficacy tests by the FDA, Dr. Toth learned in class that such clinical studies may not have been conducted to demonstrate that natural remedies actually work. The students dug deep, asking manufacturers for details about control groups and sample sizes. But answers came slowly or not at all. Sometimes the results showed that studies were flawed; for example, they might have had too few participants to be considered significant. NEOMED training taught Toth to consider such information gaps as red flags. The assignment of researching a product that’s not FDA-approved but is promoted in an advertorial was eye-opening, says Toth. What’s the takeaway for consumers? Maybe we can’t help hoping that the latest claims buzzing around in the media are true. But teaming up with a pharmacist who has a scientist’s insistence on evidence? That’s a good way to check them out.
One of Many Reasons to Reconnect … Todd A. Lisy, M.D., is a 1997 graduate of NEOMED and an internal medicine residency program director at Western Reserve Hospital. A former competitive powerlifter, Dr. Lisy competed at the Ohio Powerlifting Championships while attending NEOMED as a student. He once requested that NEOMED provide 80-, 90- and 100-pound dumbbells, which the University did. In 2013, Dr. Lisy showed his gratitude to NEOMED with a donation to the NEOMED Foundation naming the free weight area in the University’s Sequoia Wellness ﬁtness center. Five years later, he did it again, donating new dumbbells to the ﬁtness center. ANOTHER NEOMED GRADUATE WHO IS DOING AMAZING THINGS.
NEOMED has 4,352 alumni representing all 50 states plus Canada and the U.S. Virgin Islands. Alumni hail from over 300 undergraduate universities, are employed by nearly 200 clinical institutions and pharmacies, and practice in more than 50 ﬁelds of health care.
Reconnect with a Who’s Who of Fellow Health Professionals Visit neomed.edu/alumni and check out Reconnect! to update your information and receive the following beneﬁts: • Keep in touch with fellow classmates. • Receive access to all registered NEOMED alumni for personal/business networking. • Get invitations to NEOMED events in your area. • Receive the monthly alumni e-newsletter and our daily or weekly University newsletter ( The Pulse).
Check out “Get Involved!” to see the full menu of options. Don’t miss this year’s ALUMNI REUNION & AWARDS DINNER, SEPTEMBER 8, 6-7 P.M. in COOK ALUMNI HALL. Registration includes entry to the ONE SHINING EVENING gala.
Peter Scott Lund, M.D., was recently promoted to the position of northern physician lead for the Allegheny Health Network’s (AHN) healthcare institutes, with oversight of over 200 physicians. He currently serves as the chair of AHN’s clinically integrated network.
Michael Weaver, M.D., was appointed as the sub-board chairman for the subspecialty of Addiction Medicine to the American Board of Preventive Medicine. Dr. Weaver, a professor of psychiatry, currently serves as the medical director of the Center for Neurobehavioral Research on Addiction at McGovern Medical School at the University of Texas Health Center at Houston.
1995 Douglas Moses, M.D., has been appointed assistant dean of admissions and chairperson of the admissions committee for NEOMED’s College of Medicine.
Johnny A. Negusse, M.D. (’07), Pharm.D., has been named chief of staff at Dignity Health Community Hospital of San Bernardino, California.
Duane J. Taylor, M.D., was named president-elect of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the AAO-HNS foundation.
James Kravec, M.D., was honored by his alma mater, Cardinal Mooney High School in Youngstown, Ohio, at its Distinguished Alumni Awards ceremony.
Elisabeth Young, M.D., dean of the NEOMED College of Medicine, was awarded the 2018 Athena Award, presented by the Youngstown/Warren Regional Chamber. The Athena Leadership Award Program is an international initiative presented by local chambers of commerce, women’s organization and universities.
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Christopher Hritz, M.D., and Tamara Halaweh, M.D. (’12), were married June 23, 2018, in Columbus, Ohio.
Mary E. Klecka, M.D., was presented the “25 Under 35” award by her alma mater, Saint Joseph Academy, in Cleveland.
Philip King, Pharm.D., and his wife, Makena, welcomed their first baby, a boy, Dekland Porter, on June 8, 2018.
Mary Costello, M.D. (’95), Norman Friedman, M.D. (’95), and Elliot Davidson, M.D. (’82), reconnected with fellow NEOMED alumni and staff at President Gershen’s home as they learned about the new Alumni Association Shine On Endowed Scholarship. To date, more than $100,000 has been committed to this new scholarship fund to beneﬁt NEOMED students entering their ﬁnal year of the program. To learn more about the scholarship and how you can contribute, contact Craig Eynon, director of alumni relations and annual giving, at email@example.com.
Allison Optican, M.D., and her husband, Adam, welcomed a baby boy, Ariel, on May 16, 2018.
Therese Greco, Pharm.D., was presented the “25 Under 35” award by her alma mater, Saint Joseph Academy, in Cleveland.
Twenty-four College of Pharmacy alumni met at Bricco in Downtown Akron to meet the dean—Richard Kasmer, Pharm.D., J.D.—as well as other pharmacy faculty. “Having so many alumni willing to reconnect with their alma mater speaks volumes about the quality of relationships they’ve built with classmates and faculty during their time at NEOMED,” said Dr. Kasmer. “We value our alumni and hope to see more engagement with them in the coming months and beyond.”
NORTHEAST OHIO MEDIC AL UNIVERSITY
NEW SCHOLARSHIP BONDS OLD FRIENDS
BY ELAINE GUREGIAN
he year was 2012, the setting, a classroom at Cleveland State University. Everyone was on their best behavior, but there were plenty of sidelong glances as the students in the NEOMED-CSU Partnership for Urban Health class checked each other out in that surreptitious, first-day-of-class way. That day, four of the students would never guess the circumstances that would bring them together again, each changed on their way to becoming primary care physicians helping underserved urban patients. Bill Downing figured he was probably the oldest one there. Married with three young children, he already had an M.B.A. from Harvard and 20 years of experience running his own business, Downing Enterprises. But he had discovered through volunteering at a free clinic that the lure of serving the medically underserved was irresistible, so here he was. Darren Smucker (yes, he’s related to the national jam and jelly company; he gets that question all the time) was new to the medical world, with a passion for working with the underserved. He had completed his graduate training in clinical psychology, spending much of his time working with children with neurodevelopmental disabilities and other mental health needs. Anna McLaughlin understood some of the challenges of urban primary care from first-hand experience. Growing up, she spent hours riding in the back seat of a well-worn Toyota Corolla while her family traveled from office to office, chasing a cure for her mother’s fibromyalgia and trying to piece together the uncoordinated coverage among the string of physicians she visited. Sara Brown had enrolled in the NEOMED-CSU Partnership program because of her commitment to the idea of helping people who are challenged by circumstances—the social determinants of health that work against them. “It’s our job to understand the community our patients live in. It’s easy to say, ‘Eat an apple; don’t drink apple juice’ but if they can easily buy apple juice right at the gas station and the farmer’s market is two bus rides away, what can you expect them to do?” says the empathetic Brown. The four hunkered down for their first year and what McLaughlin calls their new normal of holing up to study for 10-hour days. (“Even when you’re in the shower, you’re thinking about the Krebs cycle,” jokes McLaughlin.) There were inspiring talks by the eccentric and engaging Todd Pesek, M.D., known as Dr. Todd—an urban health seminar leader at the Partnership who proposed the somewhat controversial notion that you could
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Left to right: Anna McLaughlin, Darren Smucker, Sara Brown, Bill Downing
improve a patient’s health through their diet, without necessarily jumping to medical management. Often the four felt the expectations were almost too much, but studying together helped them push on and to develop a bond. So did their dream of helping people who needed it most: “We’re all ‘people people,’ pulling for the underserved,” says Smucker. But first they had to get through the program. At one point, McLaughlin broke her ankle and developed strep throat while her now-husband was hospitalized—just before the first exam of medical school. Like Smucker (and so many others), she found anatomy tough going, so Downing coached her through it, with sessions in the Gross Anatomy Lab. When Downing faced a family health crisis that eventually led him to leave the program, his three classmates stayed close, visiting him at his home an hour’s drive from the Cleveland campus. Spring 2018 found the four reunited around a dinner table near Downing’s home, ready to celebrate. Three of the four were on the cusp of 2018 Commencement, with two weddings on the horizon, too. Downing had finalized his plans to start fresh in the College of Medicine in Fall 2018. He had also taken on a new role, as a philanthropist. Through a gift Downing made to the NEOMED Foundation, Sara Brown, Darren Smucker and Anna McLaughlin were named by the NEOMED scholarship committee as the first Downing Scholars, receiving $10,000 each to put toward their tuition. The Downing endowment will fund one $10,000 scholarship each year in the future. That night, as the three awardees took a moment to reflect during the short break before starting their professional lives, Bill told them he sees them as role models for those who receive the Downing Urban Health M.D. Scholarship in years to come. He envisions them as the first tier of an ever-broadening brain trust/cheering section to support NEOMED students who choose to pursue urban primary health care. Downing’s prediction for this tight-knit trio? “You’ll be phenomenal advocates. My vision is that we can all do good together, combining the vision that began at CSU and was realized at NEOMED.”
STUDENT ORGANIZATIONS BY SAMANTHA HICKEY
Reducing health disparities and advancing social justice are just two of the goals of the many student organizations on the NEOMED campus.
SCIENTISTA The future is female! Northeast Ohio Medical University’s chapter of the largest network of female college, graduate school and professional school students empowers women pursuing education in science, technology, engineering, mathematics and medical (STEM+M) ﬁelds by providing a strong campus community and visible role models.
FAMILY MEDICINE INTEREST GROUP Recently named Northeast Ohio Medical University’s Student Organization of the Year, the Family Medicine Interest Group is expanding the family medicine workforce through hands-on learning, collaborations with the American Academy of Family Physicians, and more. It even helps students learn to budget and pay back student loans through its “Can I Afford Primary Care?” workshop.
DEVELOPMENTAL DISABILITIES AWARENESS CLUB Developmental disabilities can come in a number of forms, from blindness to Down syndrome. The Developmental Disabilities Awareness Club teams together to make a difference in the lives of those affected by those disabilities. As a voice for developmental diseases that aren’t very well known, DDAC hosts an annual Rare Disease Week. Last year, it helped to build a disability-friendly children’s playground.
NATIONAL COMMUNITY PHARMACISTS ASSOCIATION
To prepare students for a career in independent pharmacy, Northeast Ohio Medical University’s student chapter of the National Community Pharmacists Association welcomes speakers from different settings of pharmacy, such as pharmacy owners and part-time pharmacists, to showcase various careers. Feeling entrepreneurial? NCPA presents business proposals at an LATINO MEDICAL annual state-wide business STUDENT ASSOCIATION competition with other Have you brushed up on your Spanish Ohio pharmacy lately? Let Northeast Ohio Medical University’s students. Latino Medical Student Association chapter help you.
As advocates for Latino health, the new organization gives students the opportunity to learn and practice using the Spanish language through medical Spanish workshops, to help underserved Latino communities, and to provide basic health screenings and community resource referrals.
For more information on student groups, contact Student Affairs at 330.325.6735 or visit neomed.presence.io. NORTHEAST OHIO MEDIC AL UNIVERSITY
ANNUAL CAMPAIGN KICKS OFF WITH A SPORTS AND WELLNESS THEME United Way ﬁghts for the health, education and ﬁnancial stability of every person in our community.
Wed., Oct. 3 | 4 - 6 p.m. NEW Center Atrium | 4211 St. Rt. 44, Rootstown, Ohio 44272 Join us for a $5 tailgate style lunch, games, prizes and appearances from professional athletes and local mascots. Attendees are encouraged to wear their favorite sport or athletic gear.
The NEW Center at Northeast Ohio Medical University
Thank you for supporting the United Way of Portage County. Your taxdeductible contribution can be distributed throughout the community to any program funded by United Way or through a speciﬁc impact area of your choice. GIVE. ADVOCATE. VOLUNTEER. UnitedWay.org
United Way of Portage County
HANDS ON, AT LAST! BY ELAINE GUREGIAN
he most fun day of med school—that’s how many rising M3 students describe Technical Skills Day, one of the last sessions of the Prerequisite to the Clinical Curriculum Course (fondly known as Boot Camp) designed to prepare them for their upcoming year of clinical clerkships. More than 50 clinical faculty representing a wide range of Northeast Ohio communities and specialties lead the activities and lectures. Apparently, even Superman can use a little TLC from time to time. Our students will be ready.
Photo: Lew Stamp
NORTHEAST OHIO MEDIC AL UNIVERSITY
4209 ST. RT. 44, PO BOX 95 ROOTSTOWN, OHIO 44272
P L E A S E
J O I N
F O R
A G A L A T O C E L E B R AT E A N D S U P P O R T N E O M E D
6 P. M . | S AT U R D AY, S E P T E M B E R 8 , 2 0 1 8 T H E N E W C E N T E R | 4 2 0 9 S T. R T. 4 4 , R O O T S T O W N , O H I O
ADVANCING STUDENTS, ADVANCING INNOVATION AND RESEARCH, ADVANCING COMMUNITY HEALTH
F O R M O R E I N F O R M AT I O N V I S I T shineonneomed.com/gala
Ignite is a biannual publication designed to showcase and celebrate the advancement of students, innovation and research, and community heal...
Published on Aug 27, 2018
Ignite is a biannual publication designed to showcase and celebrate the advancement of students, innovation and research, and community heal...