GrandRounds_Fall_2010

GrandRounds

Tearing Down the Silos The School of Medicine leads the way with interprofessional education

Ethics on call

Construction projects enhance community

Remembering Coy Fitch, M.D.

Philip O. Alderson, M.D. Dean | Saint Louis University School of Medicine Vice President | Health Sciences Schwitalla Hall M268 1402 S. Grand Blvd.

St. Louis, MO 63104-1028

School of Nursing

The School of Medicine is at the forefront of interprofessional education, which promotes team care and better patient outcomes. The school’s revised curriculum allows medical students to share classes and philosophies with other health care profession students on and off campus. See page 8

Doisy College of Health Sciences

On the cover

School of Social Work

Grand Rounds is mailed to alumni and friends of the School of Medicine.

St. Louis College of Pharmacy

ing and include new and often mysterious terms such as AHECs (Area Health Education Centers), EHRs (Electronic Health Records), RHIOs (Regional Health Information Organizations), IPE (Interprofessional Education) and ACOs (Accountable Care Organizations). Not only are these terms important and current, but a number of them (ACOs in particular) are concepts in a state of rapid evolution. As the practice and structure of American medicine change rapidly, medical education also must change to keep pace. A modern curriculum must include many new aspects of health care along with traditional core subject matter. Dr. Stuart Slavin, our associate dean for curriculum, and the Curriculum Management Committee strive constantly to create the proper balance between old and new subject matter and old and new approaches to teaching. Traditional lecture-based teaching approaches are being replaced by interactive learning, community learning and project-based/case-based approaches.

It is of particular interest that this current era of rapid change and progress in medical education comes precisely 100 years after the landmark Flexner Report. In 1910 Abraham Flexner published a report of the survey that had been recommended by the American Medical Association Council on Medical Education and sponsored by the Carnegie Foundation. The report advocated higher standards in admissions and performance in medical schools and placed science at the core of medical education. Science remains a core platform for the profession 100 years later, but the details of that science have changed dramatically. Collectively speaking, medical education also has changed dramatically and is likely to continue changing in this dawning era of health care reform. To keep pace, we will continue to evaluate and change the balance of the subject matter we teach, the organization of our teaching programs and the methods we use to measure the success of student outcomes.

The new Education Union Building described in some detail in this edition of Grand Rounds is one manifestation of the way that SLU continues to move forward. The building will contain state-of-the-art electronics to deliver information to our students in the most modern ways. There will be relaxation space, simulation learning space, and the building will become the focus of the SLU Medical Center. It will bring together students from varying health sciences backgrounds in ways that we believe will promote mutual understanding, acceptance and respect. We believe that Abraham Flexner would find these changes to be pleasing, and we hope that you will, too. Please visit the campus soon and see first-hand how the School of Medicine at SLU is changing and getting better.

Grand Rounds is published biannually by Saint Louis University Medical Center Development and Alumni Relations.

School of Public Health

From the Dean | The ABCs of medical education are chang-

Grand Rounds Editorial Board

Philip O. Alderson, M.D. Edward J. O’Brien Jr., M.D. ’67 Thomas J. Olsen, M.D. ’79 Coordinator and writer

Marie Dilg | SW ’94

Designer

Dana Hinterleitner Contributors

Laura Geiser | A&S ’90 | Grad ’92 Nancy Solomon Carrie Bebermeyer | Grad ’06 Sara Savat | Grad ’04 Photo Credits

Jim Visser |

Steve Dolan | 18 Kevin Lowder | 3 Chad Williams | 4 11-15, 19 and back cover Lawrence Group | 6-7

GrandRounds

© 2010, Saint Louis University All rights reserved

Fall 2010

Vol. 8

No. 2

Saint Louis University School of Medicine

For more information about the magazine or to submit story suggestions, please contact 314 | 977-8335 or grandrounds@slu.edu.

Philip O. Alderson, M.D. Dean | Saint Louis University School of Medicine Vice President | Health Sciences

A Growing Community New

construction projects enhance the sense of community on the Medical Center campus. |

page 6

Ethics in Action

New director of health care ethics stresses clinical skill development | page 12

Their Living Legacies The School of Medicine loses leaders in medical education

| standing outside the Doisy Research Center

page 16

Poised for Discovery

A fetal surgeon and a cancer researcher make headlines and raise hope | page 18

Vital Signs |

page 2

Alumni Pulse and Living the Mission

| page 20

Profile of Philanthropy |

back cover

VitalSigns Research Harnesses Enzyme’s Anti-BloodClotting Abilities SLU molecular biologists have discovered a way to harness the enzyme thrombin’s anti-blood clotting properties. The finding opens the door to new medications that will treat diseases related to thrombosis, which is responsible for nearly a third of all deaths in the United States.

“Thrombosis is one of the most prevalent causes of fatal disease,” said lead researcher Enrico Di Cera, M.D., chair of the department of biochemistry and molecular biology. “If we could develop an anti-thrombotic drug that didn’t carry a risk of hemorrhage, it would revolutionize the treatment of cardiovascular disease, the leading cause of death in the United States. This research carries us closer to that goal.”

Funded by the NIH, and published in the June 18, 2010, edition of The Journal of Biological Chemistry (Vol. 285.

No. 25), researchers zeroed in on thrombin, a vitaminK-dependent enzyme key to blood coagulation.

An unusual enzyme, thrombin performs distinct and even opposing functions, acting as a pro-coagulant and pro-thrombotic but also as an anti-coagulant factor depending on which target protein — fibrinogen, PAR1 or protein C — becomes activated in the blood.

Researchers studied thrombin to decipher the structurefunction code that enables this protein to do so many different things.

Tackling this problem far below the level of tissue and organs, molecular biologists looked deep inside the structure, examining thrombin’s amino acids to note how they behave and interact with each other.

Using protein engineering, researchers produced mutations in the enzyme’s amino acid sequence, carefully taking out pieces and replacing them, a few at a time, to find the exact locations that influence the function of thrombin.

Once they found these “hot spots,” researchers went even further — trying each of the 20 natural amino acids to see which mutation would allow them to turn on and off the pro-coagulant, pro-thrombotic and anticoagulant functions.

“We asked the question, ‘What if we can take this enzyme and dissociate the functions, allowing only the function we want?’ ” Di Cera said.

In earlier research, Di Cera’s team did just that. They engineered thrombin to promote activity toward protein C — the anticoagulant target protein — and minimize activity toward fibrinogen and PAR1 — the pro-coagulant and pro-thrombotic targets.

“In 2000, we engineered a thrombin mutant with potent anti-coagulant properties both in vitro and in vivo, and we are moving this mutant to a phase I trial,” Di Cera said.

“In this study, however, we pressed further. We wanted to optimize this mutant to completely abrogate activity toward fibrinogen and PAR1.

“With this research we optimized the mutant so that there is no clotting at all.

Furthermore, we generated a new mutant with exclusive prothrombotic activity, thereby demonstrating that the individual functions of thrombin can be dissociated by replacing a single amino acid in the protein.”

Once clinical trials are performed, researchers hope to have developed an alternative to heparin.

New Research Center to Target Drug Discovery

Saint Louis University has launched a new research center that will be staffed by ex-Pfizer scientists to target medical problems that are common in the developing world, as well as other unmet medical needs.

“The new research initiative, called the Center for World Health and Medicine, is another demonstration of SLU’s investment in the region,” said University President Lawrence Biondi, S.J. “Our decision reflects not only SLU’s commitment to keep talented and productive scientists in St. Louis, but the University’s commitment to pursue initiatives that are consistent with our Jesuit, Catholic mission.”

Pfizer decided last year to refocus and consolidate its research efforts, a decision that displaces approximately 600 pharmaceutical scientists, representing a significant loss for the region.

“While this event represents a major challenge for the St. Louis region, it also represents an opportunity to add a cohort of highly skilled scientists dedicated to research in areas consonant

with the University mission,” added Raymond Tait, Ph.D., vice president for research.

“These are people who have expertise in moving scientific discoveries from the laboratory to the clinic.

They also demonstrate an entrepreneurial spirit,” Tait said. “Of course we wanted to find a home for them.”

The new research center hired about a dozen ex-Pfizer scientists in July.

The center is part of a regional push to keep scientific talent in the area, a major priority of the Regional Chamber and Growth Association and Coalition of Plant and Life Scientists, Tait added.

“As Father Biondi has indicated, the center dovetails with SLU’s Jesuit mission of service to others because it focuses on improving the health of those most in need, including people who live in the developing world where health care is lagging,” Tait said.

“To that Tait end, the center will initially focus on medical conditions associated with high mortality in developing world countries, such as childhood diarrhea.”

Finally, the scientists in the center are expected to bring unique skills that can yield synergies with research strengths already present at the University.

“While it is too early to assess the impact of this initiative,” Tait said, “I fully expect that the impact will be positive for the University, the region and, ultimately, for the countries of the developing world.”

William Sly Recognized for Lifetime Achievement

William Sly, M.D., the SLU biochemist for whom the genetic disease “Sly Syndrome” is named, has received a prestigious international award for his lifetime contribution in researching a group of inherited and life-threatening conditions known as the mucopolysaccharidoses (MPS).

The Life for MPS award was given in June at the 11th International Symposium on Mucopolysaccharide and Related Diseases in Adelaide, Australia.

“I was thrilled and humbled by the award. It was an acknowledgment from colleagues, patients and their families that our work was pivotal in improving the course of these diseases, which is really satisfying,” Sly said. “While there is no cure, some MPS conditions can be treated, which is a cause for more optimism about these rare but life-threatening and crippling conditions.”

Sly holds the James B. and Joan C. Peter Endowed Chair and is a professor of biochemistry and molecular biology at SLU. Since his 1969 discovery of MPS VII, or Sly Syndrome, Sly has spent his entire research career investigating causes and possible treatments of MPS-related disorders.

Sly’s research into the disease has paved the way for an effective treatment — enzyme therapy — that dramatically changes the progression of other, more common MPS disorders.

Radiologists Honor Dean Alderson

Philip O. Alderson, M.D., vice president for health sciences and dean of the School of Medicine, has received the American Roentgen Ray Society’s highest award, the Gold Medal for Distinguished Service to Radiology.

A radiologist and nuclear medicine physician, Alderson has been active in many professional organizations throughout his career. In addition to being a past president of the American Roentgen Ray Society, Alderson has served as president of the American Board of Radiology; the Association of University Radiologists; the Association of Program Directors in Radiology; the Academy of Radiology Research; the Fleischner Society; the Society of Chairmen of Academic Radiology Departments; the New York State Radiological Society; and the New York (City) Roentgen Society.

Alderson’s work has been printed in more than 200 publications, including four books, 40 book chapters and more than 150 journal articles. He has received the Gold Medal of the Association of University Radiologists and the Achievement Award of both the Association of Program Directors in Radiology and the New York Roentgen Society.

Before becoming dean of the SLU School of Medicine in 2008, Alderson had been chair of the department of radiology at the College of Physicians and Surgeons of Columbia University and director of radiology service at New York-Presbyterian Hospital/Columbia.

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White Coat Ceremony Welcomes First-Year Students Members of the Class of 2014 slipped on their white coats in front of family and friends in August at the annual White Coat ceremony in St. Francis Xavier College Church.

Michael T. Railey, M.D., associate professor of family and community medicine and associate dean of multicultural affairs, delivered the keynote address and offered a piece of advice.

“Your path will be smoother and all the more complete the more complete you are as a person,” Railey said. “We will set the bar high for academic accomplishment, but you must not forget your personal and spiritual development.

The concept of men and women serving men and women should be the fuel that keeps you going on those lonely and fatigued evenings and early mornings certain to come before major testing. If you develop academically and defer your spiritual, personal belief system and communication skills until later, you can victimize yourself as a total human being.”

Class of 2014 stats: Overall GPA: 3.8 Average MCAT: 32.4 Number of colleges represented: 82 Number of states represented: 33 Number of countries represented: 5

Grand Rounds Saint Louis University School of Medicine

Future Focused

Adrian Di Bisceglie, M.D., received a standing ovation as he was formally invested in August as the inaugural holder of the Badeeh A. and Catherine V. Bander Endowed Chair in Internal Medicine.

“This ceremony is not about me,” said Di Bisceglie, chair of the department of internal medicine. “It’s about this gift to Saint Louis University. It secures the future of the leadership of the department and will keep on giving to the University for years to come.”

The chair was made possible through a gift from Steven J. Bander, M.D., and his wife, Patricia A. Bander, who named the chair in honor of Bander’s parents.

“My parents stressed constantly the need for education and to do what’s right by yourself and others,” Bander said at the ceremony. “These are very simple rules that I think have allowed me to achieve some of my success.”

Bander graduated from SLU in 1975 with a degree in biology. Generous supporters of the University, the Banders also donated $3 million in 2006 to establish the Bander Center for Medical Business Ethics, which promotes ethical business practices in medical care and research through the development of training and investigation opportunities for medical students, residents and physicians. Bander has a private practice and is a clinical professor in the department of nephrology.

Dr. Adrian Di Bisceglie, Dean Philip Alderson and Dr. Steven Bander

Health Disparities Among Black and Latino Kidney Donors Black and Latino kidney donors are significantly more likely than white donors to develop hypertension, diabetes and chronic kidney disease, according to SLU research published in the Aug. 19 issue of the New England Journal of Medicine.

“We’ve long known that diabetes and hypertension disproportionately affect blacks and Latinos. Our research found that these racial disparities also exist among living kidney donors,

VitalSigns

post donation,” said Krista Lentine, M.D., associate professor of internal medicine and lead researcher.

“Increased attention to health outcomes among demographically diverse kidney donors is needed.”

Researchers say that while these findings should not be used to discourage anyone from donating on the basis of race and ethnicity alone, these factors should be taken into consideration when counseling potential donors about their future health risks.

The need for live kidney donors is greatest among blacks, who are significantly more likely to develop end-stage renal disease, yet have less access to kidney transplants. Researchers say

that blacks are less likely to identify a potential donor, and their potential donors are more likely to have health conditions at evaluation that limit their ability to donate.

Researchers used insurance claims from a private insurance provider, linked with identifiers from the Organ Procurement and Transplantation Network, to examine variations in the risk of post-donation medical diagnoses according to race.

All potential kidney donors undergo an evaluation that focuses on excluding patients with medical abnormalities at the time of assessment. After kidney donation, researchers found that in comparison to white donors, black donors were 52 percent more likely to be diagnosed with hypertension.

Latino donors also were 36 percent more likely than white donors to be diagnosed with hypertension.

Additionally, black and Latino donors were more than two times as likely as white donors to be diagnosed with chronic kidney disease and to have drug-treated diabetes.

The pattern of disease among donors is similar to what is found in the general population.

While normal predonation medical evaluation increases the overall likelihood of long-term good health for donors, Lentine says these screenings alone cannot be expected to eliminate the impact of epidemiologic risk factors for disease over time, such as aging and race.

“We are not proposing any change to donor selection policy based on these data,” Lentine said. “However, these findings show that we need a national policy for longer donor follow up, as opposed

to the current two-year mandated tracking, so that we can capture and monitor the outcomes of donors from all sociodemographic groups.”

According to Lentine, more studies are needed to understand the consequences of post-donation diabetes and hypertension on the overall health of the donors.

In the general population, hypertension and diabetes are typically associated with increased risk of end-organ complications. However, because kidney donors often receive closer surveillance and early intervention, the implications may be milder in this group.

Even if the risk of serious end-organ damage is small with good care, better understanding of the risk for hypertension and diabetes is relevant to counseling donors on possible financial risks from future prescriptions, medical treatment and associated insurance premiums.

$2 Million Grant Funds Anti-Falling Educational Campaign

SLU will receive more than $2.1 million for the next five years from the federal Health Resources and Services Administration (HRSA) to fund educational programs about falling and other topics of interest to health care professionals who work with the elderly.

“For more than two decades, the division of geriatric medicine at Saint Louis University has been a leader in the Midwest in educating health care professionals about the issues that touch the lives of older adults,” said John Morley, M.D., director of geriatrics at SLU.

“As the baby boomers turn 65, it’s extraordinarily important that we continue to increase awareness of the differences in treating older people,” he said. “It’s not enough that we teach doctors.

It takes a village of trained professionals to provide quality elder care.”

Among other initiatives, the division of geriatric medicine will use grant funds to create educational programs for health professionals that focus on falls, a common problem among the elderly with potentially deadly implications.

The most serious consequence of falling, Morley said, is breaking a hip.

About 80 percent of those elderly adults who fracture a hip don’t completely recover, and about 30 percent die within the first year of injury.

Falls also take a toll on those who are lucky enough to escape serious injuries.

Once older adults fall, many become afraid that they might fall again. This makes them reluctant to move, which decreases the physical activity that is so important for them to stay healthy. It also can trigger a cycle of social isolation.

“Fear of falling cuts down on social interactions,” Morley said. “People refuse to go out, and they become disconnected from others and lonely, which leads to a host of other problems.”

The good news is educational programs on preventing falls for social workers, physical therapists, nurses, doctors and other health care professionals can markedly decrease the problem, said Nina Tumosa,

Ph.D., professor of geriatric medicine at Saint Louis University and co-principal investigator of SLU’s Center for Aging Successfully.

“Falls are very complicated. We need to look at the whole person — not just the activity of falling — to get to the root cause of falls. Health professionals from different fields must bring their expertise to address the problem,” Tumosa said. “Geriatrics is an interprofessional team sport.

If we don’t work together, we don’t win the game, which is to help older people maintain their quality of life.”

Saint Louis University also will use grant funds to create a certificate in gerontology for working health professionals who care for older adults.

School of Public Health Names New Dean

Saint Louis University has chosen Edwin Trevathan, M.D., M.P.H., as its next dean of the School of Public Health.

Before joining SLU in September, Trevathan directed the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC) in Atlanta.

Last year, when H1N1 influenza loomed as a threat to public health, Trevathan took the lead in planning the CDC’s strategic response to protect the health of children. He also worked as an epidemic intelligence officer at the CDC from 1987 to 1989.

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Trevathan is no stranger to St. Louis. He was on the faculty at Washington University School of Medicine from 1998 until 2007, first as an associate professor, then Trevathan as professor of neurology and pediatrics.

He served as Washington University’s director of the division of pediatric and developmental neurology from 2004 to 2007 and was the neurologist-in-chief at St. Louis Children’s Hospital.

Trevathan also has had connections to the School of Public Health since 2002, with appointments first as an adjunct associate professor of community health, then as an adjunct professor.

Trevathan succeeds Homer Schmitz, Ph.D., who had served as interim dean of the School of Public Health for two years and will continue to be on faculty as professor of health management and policy.

Vitamin E Helps Those with Fatty Liver Disease

An NIH-funded study published in the New England Journal of Medicine found that daily vitamin E improved the livers of patients who have a type of liver disease known as nonalcoholic steatohepatitis (NASH). The study results are welcome findings because there are currently no approved treatments for the disease, said a SLU researcher on the project.

Increasingly common, NASH is characterized by excessive fat that causes inflammation and damage in the liver.

“Fatty liver disease is a growing problem in the United States, and we have no approved medication to offer patients,” said Brent Tetri, M.D., director of gastroenterology and hepatology and study researcher. “With this study, we’re pleased to find that vitamin E should help some of our patients.”

During 96 weeks of treatment, patients with NASH were given 800 IU daily of the natural form of vitamin E or a placebo.

Researchers found that 43 percent of those treated with vitamin E showed significant improvement of the liver; only 19 percent of those who received a placebo improved.

Separately, researchers also studied the effects of a drug, pioglitazone, in treating NASH. It, too, improved the condition of patients’ livers, although its use was associated with weight gain.

Researchers caution that neither treatment improved liver disease in all patients, and that diabetic patients were not included in this study. Diabetes is common in NASH patients, and further research is needed to determine if vitamin E or pioglitazone will be appropriate treatments for diabetic patients.

Grand Rounds Saint Louis University School of Medicine

right | 1. An addition to the east side of Health Sciences Education Union. 2. A rendering of the recreation complex.

3. The building at the entrance to the recreation complex. below | A rendering of the Health Sciences Education Union.

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2

Two construction projects under way at the Medical Center are designed to change the face of the campus and enhance its sense of community.

a growing community

The new nucleus of the Medical Center will be the Health Sciences Education Union located behind the School of Nursing in the former orthopaedic treatment clinic. The vacant building is being remodeled and expanded to create a modern, 30,000-square-foot union with a glass and steel atrium and a sleek clock tower — a fitting entrance for a campus that provides cutting-edge education for health care professionals.

The first floor of the Health Sciences Education Union will hold a 225-seat auditorium. An entire wall of the auditorium will be covered with 25 high-definition video screens that can display a single image or be divided into quadrants, giving educators flexibility in presenting material. The high resolution images are so crisp the lights do not need to be dimmed during presentations.

Tables will be fixed in the auditorium, but chairs will not — allowing for team teaching and group learning.

The first floor will also include: a café-style restaurant, student lounges, digital signage to alert faculty, students and staff of upcoming events, and the interprofessional education office, which is pioneering education for future health care professionals. (See the story on page 8.)

The second floor of the Education Union will be dedicated to the School of Medicine’s standardized patient simulation education program. The program, which the school was among the

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first to pilot approximately three decades ago, offers students learning opportunities to practice new diagnostic and communication skills. The labs are outfitted with state-of-the-art video cameras and software that will improve the overall teaching and learning experience.

The union is scheduled to open in the fall of 2011.

Land east of the Hickory East Parking Garage is being leveled to make way for a new recreation complex that will serve the needs of the Medical Center, club sports, intramurals and Billiken athletics. The complex will include an NCAA-regulation soccer field and an eight-lane track. The track will be the new home for SLU’s Division I track team, and also will be available for exercise use by faculty, staff and students. The soccer field will provide new playing opportunities for growing club sports and intramural teams. Construction is expected to be completed by spring.

These two projects are made possible, in part, by donations from alumni and friends of the University, who support the growth of the Medical Center. More support is needed. There are many ways alumni can be a part of these projects, including designating gifts for the Education Union and recreation complex. There also are ways for donors to be permanently connected to the projects through naming gifts. For more information about supporting these important Medical Center projects, please call Matthew White, executive director of Medical Center development, at 314-977-3287.

“ Having these central congregating places will cement the sense of community among students, faculty and staff at the Medical Center.

Along with the Doisy Research Center, both projects will change the face of the campus to make it an even more inviting place.”

Construction projects energize the Medical Center.

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Philip O. Alderson, M.D., Dean, Saint Louis University School of Medicine and Vice President, Health Sciences

Grand Rounds 7

Medicine

When Philip O. Alderson, M.D., dean of the School of Medicine and vice president for health sciences, welcomed the Class of 2014 at the annual White Coat Pharmacy

ceremony in August his address emphasized the word “team.” He told students that their future patients would benefit from a team approach to care and that their ability to work as members of a team will make them not

Nursing

Team Players

only better physicians, but more satisfied people.

Alderson wasn’t just setting the tone for the Class of 2014, he was promoting a cultural shift within the medical school.

After several years of meetings and pilot projects, the school has embedded within its curriculum a required course on interprofessional patient care. Beginning this academic year, third-year medical students are required to take an Interprofessional Team Seminar with students from SLU’s School of Nursing, Doisy College of Health Sciences, School of Public Health, School of Social Work and the St. Louis College of Pharmacy.

“Complex and chronic health problems can surpass the scope of any one profession,” Alderson said. “Rather than placing the entire focus on the physician, we can learn to utilize the complementary skills of a group of health care professionals in a more efficient way and in doing so we can enhance patient care.”

SLU’s School of Medicine is one of the first medical schools in the country to require an integrated course in interprofessional education (IPE), and plans are in the works to weave the collaborative care concept throughout all four years of medical school and into residency.

Taking the Initiative

The goal of IPE is to teach students from different health professions how to work together effectively. Through lectures, simulated experiences and clinical activities, students work toward a better understanding of the roles and responsibilities of the other professionals. Advocates say IPE can maximize efficiencies, modify negative attitudes and perceptions, and remedy failures in communication.

The Institute of Medicine has suggested that this team approach improves health care quality outcomes. The institute has issued a number of reports during the last few years demonstrating that patients are more likely to receive safe, quality care when health professionals work together and communicate well.

As a concept, IPE has been around since the 1960s but did not gain much traction nationwide, in part because the reimbursement system did not support it. The idea, however, took hold at SLU’s Medical Center for a couple of reasons. Because the campus has a wide array of health science schools in close proximity to one another, collaboration is easier. In addition, the collaborative care model is patient centered and community oriented — a good fit with the University’s Jesuit mission. The medical center’s early IPE endeavors remain models for today’s programs (see sidebar on page 11).

Building on Success

The recent health care reform debate breathed new life into SLU’s interprofessional programs. In 2006, the School of Nursing and the Doisy College of Health Sciences became the first in the country to embed IPE into their undergraduate core curricula. Nursing and Doisy students are required to take five IPE courses, including an interprofessional practicum, in order to graduate and earn a certificate in interprofessional practice.

Irma Ruebling, P.T., assistant professor of physical therapy at Doisy College and director of interprofessional education for SLU Health Sciences, believes that the skills required for interprofessional practice soon will be recognized as essential in the preparation of health professionals. Ruebling has written about IPE and has spoken at national forums about SLU’s interprofessional initiatives.

Health Sciences

Social Work

Medical students learn there is strength in

Public Health

numbers when it comes to patient care.

Grand Rounds 9

“Traditionally, most health care practitioners are educated in independent silos,” Ruebling said. “Each profession is trained in its own methods and philosophy. There might be a brief overview course to survey other professions or an interprofessional seminar, but for the most part, each goes its own way. Students lack opportunities to study or work with other professions, so they leave school without the skills needed to function as part of an integrated team. We train our students so that it becomes second nature to ask what another team member can bring to this patient’s care.”

The Next Level

The IPE program was so successful at the undergraduate level that Ruebling and her colleagues put together an Interprofessional Team Seminar for post-baccalaureate students studying medicine, accelerated nursing, social work, public health, and as physician assistants.

Students from the different professions came together twice a semester to discuss cases. The seminar was offered in 2007 as an elective for first-year medical students. Because the medical students lacked clinical experience, however, the collaborative message had limited impact, said David Pole, M.P.H., deputy director of the Area Health and Education Center in the department of family and community medicine and assistant director of interprofessional education.

Pole and his colleagues, including Stuart J. Slavin, M.D. (’83), M.Ed., associate dean for curriculum, revised the seminar and piloted it again as an elective for third-year medical students with an emphasis on improving the quality and safety of patient care and outcomes. Having students engaged in the clinical stage of their training increased the relevance of the content and the success of the seminar.

“Student engagement in the course increased dramatically once they realized this wasn’t just a seminar about talking nice to one another,” Pole said. “It was about how

their patients could suffer bad outcomes or die if health care providers don’t communicate well.

“Appreciating and utilizing the talents that other professions can bring to improving patient care really got their attention. Through the case-based discussions, students come to understand that being able to work collaboratively is not a value-added piece. It is a change in the care process that is becoming recognized as an essential skill in practice.”

A Seat at the Table

Two years ago, to further coordinate interprofessional initiatives, Alderson assembled the Medical Home Working Group, a committee to explore the best ways to integrate IPE into all health sciences curricula. The group, which meets monthly, is comprised of representatives and deans from the schools of medicine, nursing, Doisy College, public health, social work and the St. Louis College of Pharmacy, located in the Central West End. Also in the group is an award-winning quality care expert from the SSM Health Care system and the executive director of the SLU Center for Outcomes Research to help evaluate the effectiveness of SLU’s initiatives.

“We have to engage in outcome-based research,” Alderson said. “No matter how much we believe we have a great model, we still have to demonstrate in a scientific way that a collaborative care environment can be more efficient and effective.”

Room to Grow

Further testament to the University’s commitment to IPE is the construction of the new Education Union north of the School of Nursing (see renderings on page 6). The former orthopaedic rehabilitation facility is being renovated to house a 225-seat auditorium for large lecture classes.

Out in Front Interprofessional education is not new to SLU’s Medical Center. In the late 1960s when IPE was initially introduced as a care model, Robert M. Heaney, M.D., associate dean for graduate medical education and Veterans Affairs, created interprofessional education opportunities for students training at City Hospital. He established one of the first nurse practitioner programs in the country where medical and nursing students trained side by side.

Goronwy Broun Sr., M.D., former dean of the School of Medicine, and Max P. Pepper, M.D., founder of what is now the department of family and community medicine, created opportunities in the early 70s. They allowed advanced practice nursing students to work and learn alongside medical students and physicians in a cardiovascular clinic. They also invited nursing professors to lecture in the medical school on occasion.

In 1995, James Kimmey, M.D., Ph.D., then vice president for health sciences, formed a task force on interprofessional education that led to an interprofessional rural health outreach demonstration program in Washington County, Mo. That program still exists today as the Great Mines Federally Qualified Health Center in Potosi.

And in 2002, the SLU Area Health and Education Center program initiated a highly-rated elective course in Interprofessional Care of Medically Underserved Populations introducing broader issues that have an impact on access to quality health care.

The new building also expands teaching space for the school’s standardized patient simulation education program. The standardized patient simulation clinic will allow for individual medical students to interact with standardized patients and to participate in team-based simulation training.

The new building is being wired as a high-tech facility that will allow for team learning via video and Internet connections.

This will help overcome one of the major logistical obstacles of IPE — scheduling. The medical school, nursing school and allied health programs all have different academic calendars and clinical training schedules. Finding ways to teach teamwork and have collaborative, experiential learning in the same space is essential to success.

The new building also has places in which students from the various professions can mix informally.

“A lot of biases about other professions can be broken down just by giving students a place to hang out, talk and study together in a non-classroom setting,” Pole said.

Out in the Real World

Students are not the only ones learning about the collaborative approach to patient care. Faculty members at the School of Medicine are being taught how to teach from a collaborative care perspective.

“Going from large didactic to small group facilitation to work through cases and problems requires a different set of educational skills,” Pole said. “And finding ways to incorporate collaborative concepts into established course material can be a challenge. That’s why we’re working on a faculty development component and continuing education programs to facilitate that changeover.”

The Medical Home Working Group also recognizes that while training students in the knowledge, attitudes and skills to think and function as part of a team, the collaborative practice environment does not yet exist in most health care settings. The group, therefore, is developing continuing education programs in team care for practicing health professionals.

“The idea is to teach them what the students are learning about IPE and collaborative care and, hopefully, they’ll incorporate it into their practice,” Ruebling said.

The ultimate success of the interprofessional care model will depend upon how the government health care reforms pay for services. If studies demonstrate that collaborative care is cost effective and improves patient outcomes, funding will follow.

Ruebling and her colleagues are optimistic.

“When I go to conferences I barely get five sentences out before someone is asking me how we’re running our programs and how we’re developing our culture of interprofessional care,” she said. “Health care professionals know that navigating today’s complex health care environment while assuring the best patient care is a team effort. They’re interested in what we’re doing because our curriculum is cutting edge and the University is being recognized as a leader in preparing students for what’s to come.”

right | Charlotte Burnside gets her questions answered during a Medical Home luncheon on diabetes.

10 Grand Rounds

There’s No Place Like Home Charlotte Burnside pulls a glucose monitoring device out of her purse and begins a series of questions.

“I bought this monitor six months ago and haven’t had to put in new batteries yet. Does that seem right? My mother had to put new batteries in her monitor all the time. How do I know when it’s time to get new batteries? Do low batteries have an impact on my results?”

Then she pulls out the lancet holder she uses to prick her finger.

“And I’m not sure about this. I think all the needles should be used up by now but I can’t tell. How can I tell when it’s time to get a new one? Can you show me?”

Normally patients might feel too rushed or too intimidated to ask their physicians as many questions as Burnside has, but she is no ordinary patient. She is a patient in SLUCare’s Medical Home, a program launched in January exclusively for SLU employees and their dependents. The Medical Home brings together a team of SLU health care experts from different disciplines to work together to keep patients healthy.

If a physician prescribes a new medication, a pharmacist is there to answer questions. If a patient is advised to change eating habits, a dietician is available for consultation. If a patient is struggling with transportation to clinic appointments, a social worker connects the patient to resources.

In addition to this personal care, patients can take part in weekly group education sessions, such as the one Burnside attended on diabetes. Any and all questions are answered by members of the Medical Home team.

“ We realized that if we were going to teach interprofessional care, then we need to practice interprofessional care.”

Gillian Stephens, M.D., assistant professor of family and

community medicine and medical director of the Medical Home

“Some of the faculty members who teach IPE courses participate in the Medical Home team. They experience first-hand the advantages of coordinated patient care and use of resources,” Stephens said. “When they are in the classroom, they can reflect their experience to students.”

Ethics inAction

New director of health care ethics stresses clinical skill development

Health Care Ethics at Saint Louis University. Previously, Bishop directed Vanderbilt University’s Clinical Ethics Education and Consultation Services program. He also served as associate professor of medicine and biomedical ethics, associate professor of theological ethics and was an active hospitalist at Vanderbilt.

Prior to Vanderbilt, Bishop spent time in the United Kingdom teaching health care ethics.

He succeeds James DuBois, Ph.D., D.Sc., the Mäder Professor of Health Care Ethics, who directed the center for five years. DuBois will continue to direct SLU’s Bander Center for Medical Business Ethics, where he will expand the social science research group of the Gnaegi Center.

Bishop’s research focuses on the historical and political conditions that come to structure medical practices. He recently completed a book titled Otherness, Death, and Medicine. The book, a philosophical history of the care of the dying from ICU care to palliative care, will be published by the University of Notre Dame Press in the spring.

Bishop practiced medicine and was on the faculty at the University of Texas Southwestern Medical Center for nearly a decade. He said he hopes his clinical experience complements the work already being done at SLU.

JB: Jim DuBois left the Gnaegi Center in a great position. He is well known in both the clinical and the research ethics worlds. The center has one of the strongest research ethics program in the country.

What I bring to the table is extensive experience on the clinical ethics side of health care ethics.

At Vanderbilt, doctors, nurses and social workers would call the Clinical Ethics Consult Service for help with ethical issues. My job

Science always interested Jeffrey P. Bishop, M.D., Ph.D., but during premed studies at the University of Texas, he found himself equally fascinated by the theological and philosophical questions raised by medicine. When should breathing machines or feeding tubes be started or stopped? Who decides which patient gets what care? What if a patient refuses medical treatment? When is enough enough?

they’re not likely to get off those machines, but we still go down

JB: There’s so much we do in medicine that we assume is good,

but maybe using it leads to things we hadn’t anticipated.

and yet we keep being reminded that maybe it’s not. We have

Bishop, an internist with a doctorate in philosophy, was appointed this summer as the Tenet Endowed Chair in Health Care Ethics and director of the Albert Gnaegi Center for

patients in the ICU connected to machines. Medically we know

12

was to come in and assist in those sticky situations — talk with the attending, the nurses and the family to try to get a feel for where everyone was. Then we would walk together with the health care team, the family and the patient through the difficult process of coming to decisions. Griff (Griffin Trotter, M.D., Ph.D., professor in the Gnaegi Center) has been doing some of that kind of work. We need to see our ethical consulting services grow.

With this balance between research and clinical ethics, I think the University’s health care ethics programs will be leaders in the field.

Many health care ethics centers have strength in only one area.

Some are philosophical centers, where the professors are all philosophers like me, and some are empirical research centers, where the professors only do one thing. We’re able to have dialogue across both the philosophical and empirical, and the clinical and research arenas.

What’s at the top of your to-do list?

I want to create more opportunities for our Ph.D. students to get hands-on clinical ethics consultation experience. We already do a great job of teaching them to be scholarly inquirers. For those interested in clinical ethics, we need to give them the tools to actually go into clinical settings and apply that knowledge.

Rather than having books as primary dialogue partners, we need to get real people as dialogue partners. The American Society for Bioethics and Humanities is very likely to require that clinical

that road. It’s as though we’re on a conveyor belt. We try to keep the patient alive only to find out the patient may perceive it as a life worse than death. We don’t stop to think about the unforeseen consequences of our actions. Sure, we all like the new technology,

Grand Rounds 13

ethicists have specialized clinical training, and clinical ethicists will need to be credentialed. I want our students ready before that change comes. I want them to get used to going into hospitals. I want them to learn the language on the floor, to learn to think the way doctors think, the way nurses think and the way social workers think. They need to be able to talk to those professionals and to families about what their loved ones would have wanted.

I’d also like to expose undergraduate students to more issues in health care ethics. There is so much information in medical school. The curriculum is packed. You don’t have much time to reflect. While you’re an undergraduate you have a little more time to breathe, and that’s a good time to approach these issues.

What plans do you have for medical school students?

Right now we have a few contact hours in the first year, but students really don’t encounter ethical problems until their third and fourth years, when they’re in the clinics and hospitals. So, Griff and I will explore ways to engage students in a dialogue about ethical and moral questions in their third and fourth years — when the rubber hits the road.

What differences do you find between working in a secular institution, such as Vanderbilt, and a Jesuit institution, such as Saint Louis University?

I believe the discussions might be richer here because in a religious institution everything is open to debate. What might go unchallenged in a secular university often will become an important topic of discussion at an institution with a religious affiliation. If a certain controversial speaker is invited to campus or a controversial play is produced, no one bats an eye in a secular institution. But at Saint Louis University or Notre Dame someone might say, “Should we be doing this?” It seems to me that people debate the ideas, and that’s a good thing. There’s more opportunity for open discussion — more open thought.

I imagine the health care debate has been interesting for you as an ethicist. Some argue that the “most ethical” health care system is a government-run health care system. Others think the system must control costs or eliminate profits or ration care to those most in need and that is the most ethical thing to do. What are your thoughts?

My job is to show the pitfalls in any system. I believe it’s foolish to think that because we now have health care reform in place that all of our issues, ethical and otherwise, are going to go away. Every move presents a whole set of ethical issues. I taught in England, where they have the National Health Service. Everybody has access to care. That’s a good thing, right? But that system has its own problems. If you have peripheral vascular disease and you smoke, they won’t even consider performing angioplasty or bypass surgery until you stop smoking, and they can get militant about it. If they discover you continued to smoke, you will be told you won’t get the procedure, or you’ll be put on the bottom of the list. Is that wrong? Is that Big Brother? On the one hand, it appears to impinge on freedoms. On the other hand, if society is paying for it, shouldn’t society have something to say about those who engage in risky behavior? That is precisely the question that we’ve been dealing with.

We joke now about death panels. I dislike that phrase, but the truth of the matter is someone has to make these decisions, and the person paying for the care has always had some say in these decisions. Even before President Obama’s health care reform came about, there was literature out there that demonstrated palliative care saves money. I don’t believe President Obama is going to put his people on committees to make sure we save money by letting people die; that’s a little hysterical. But at the same time it’s true that the people who are paying for care will want to decide what they’ll pay for.

Have the reforms made ethical dilemmas more challenging?

Not really. Every system of health care has its failings. No matter what system you choose, something will fail in time. Our current system needed to change. There isn’t much debate on that question. The question was what to change. The current system is unsustainable. Technology is driving costs through the roof. Health care is plentiful, but high-tech health care is very expensive. Technology will continue to drive up costs. An economist at Notre Dame, Williams Evans, noted that this was the side of health care reform that we should have addressed first. Yet everyone wanted to focus on financing rather than on the costs of what we were financing. And that is where the ethical, rather than the economic question, comes into relief.

We’re so uncomfortable with our mortality that if there’s any inkling of hope, we take it — even if it means finding ourselves in the ICU in a state worse than death. The moral question is about the worth of a human life, but also about when that life can become idolatrous. Catholic moral teaching holds that the ultimate end of human life lies with God. As Pope John Paul II noted, “… life on earth is not an ultimate but a penultimate reality.” Life and sustaining it are strict moral imperatives; yet life at all costs can become idolatrous. If there’s something other than this life, then there comes a time when we need to resign ourselves to the fact that we’re mortal. Even if the technology is there, we don’t always have to use it.

In a way then, hidden beneath the economic question and beneath the technological imperative, there is a fundamental moral question about human life that has always been and will always lurk beneath the systems. So whatever system is used to finance health care, the financing of health care will never really change the fundamental moral and ethical question.

14

Vanderbilt University 2007-2010: Associate professor of medicine and biomedical ethics, director of clinical ethics education and consultation services.

Peninsula College of Medicine and Dentistry United Kingdom, 2005-2007: Principal lecturer, associate professor, in medical ethics and law.

University of Texas Southwestern Medical Center 1996-2005: Associate professor of internal medicine, interim director of the Program in Ethics in Science and Medicine.

Education Ph.D. University of Dallas, 2009 M.A., Philosophy University of Dallas, 2002 Internal medicine residency training University of Texas, Southwestern Medical School 1993-1996 M.D. University of Texas Medical School, Houston, 1993 B.S., Theology Institute for Christian Studies, Austin, 1989 B.A., Zoology University of Texas, Austin, 1988 Personal Bishop moved to St. Louis with his wife, Cyndy, who teaches English composition at Chaminade College Preparatory School, and their three daughters: Madeleine, 13; Isabel, 11; and Lydia, 6. They live in Ballwin, Mo.

Our current system needed to change.

There isn’t much debate on that question.

The question was what to change.

Previous positions

Grand Rounds 15

Their Living Legacies Coy Fitch, M.D.

1934-2010

Coy Fitch, M.D., the physician who helped lead SLU’s department of internal medicine to prominence, died in May at the age of 75.

Formerly chairman of the department of internal medicine, Dr. Fitch most recently was a professor of internal medicine at SLU and chief of the medicine service at the St. Louis VA Medical Center.

Dr. Fitch was a “triple threat” – an exceptional educator, clinician and researcher, said Robert Heaney, M.D., senior associate dean of the School of Medicine, who first met Dr. Fitch during his residency in internal medicine at SLU. “He was a real mentor and was one of the best people I’ve worked for. He was determined and committed to excellence in medical student and resident education.

In addition, he was a tremendous recruiter who helped build the

department of internal medicine to a position of prominence regionally,

nationally and internationally while always maintaining his own research in his area of specialty – malaria,” Heaney said.

Dr. Fitch, an endocrinologist, joined SLU in 1967 as associate professor of internal medicine and biochemistry. He was chief of the medical service for SLU Hospital from 1976 to 1977 and from 1983 to 2000. He was director of the division of endocrinology from 1977 to 1985. He was acting chairman of the department of internal medicine from 1985 until 1988, and served as department chairman from 1988 to 2000.

During his time as internal medicine chair, Dr. Fitch recruited several division directors who have helped to bring international recognition to the School of Medicine – Bruce Bacon, M.D., gastroenterology; Kevin Martin, M.D., nephrology; John Morley, M.D., geriatrics; and Robert Belshe, M.D., infectious diseases.

Frank R. Burton, M.D.

1951-2010

16 Grand Rounds

a very caring physician,” said Brent Tetri, M.D., interim director of gastroenterology and hepatology. “As more results from his research are published in the upcoming years, his legacy of helping those with pancreatic disease will continue.”

Dr. Burton joined SLU in June 1985 and developed the hepatobiliary and pancreas therapeutic endoscopy program. He served as the medical pancreatologist for the pancreas transplant program and director of the gastroenterology physiology laboratory at SSM St. Mary’s Health Center.

A founding member of PancreasFest, a yearly

Carol R. Archer, M.D., former professor of radiology and neurology, died in June at the age of 79.

Dr. Archer was the chief of neuroradiology at SLU Hospital until her retirement in 1998. During her career, she published more than 50 research publications and won a gold medal for her research on the staging of carcinoma of the larynx. She was a member of numerous professional organizations and past president of the St. Louis chapter of the American Medical Women’s Association.

Jo Ann Shipp, Dr. Archer’s former assistant, remembered her both as an accomplished doctor and researcher and a genuinely nice person.

“Dr. Archer was a very compassionate and dedicated person. She truly cared about her employees and was known as a good teacher,” Shipp said.

“He was a straight shooter and

always kept his promises. Once he

committed to a project, he would see it through,” said Belshe, who brought his Center for Vaccine Development to SLU when he joined the faculty in 1988.

“Dr. Fitch loved to describe himself as an Arkansas country boy,” Heaney said. He became a physician in part because of the generosity of someone who helped him buy textbooks when he was in medical school at the University of Arkansas.

“That person never let Coy Fitch pay him back. I believe Coy was always paying back that first person by paying it forward,” Heaney said.

“You can look around and see a lot of Coy Fitch here. That’s the biggest legacy anyone can hope for.

He helped bring people to Saint Louis University to make it a better place.”

John Collins, M.D. (’57)

2011 marks the 100th anniversary of the School of Medicine’s department of internal medicine.

An upcoming issue of Grand Rounds will celebrate this milestone with a feature story, photos and your memories.

Please share your stories at mdalumni@slu.edu. If you have photos you think might be useful, we would appreciate the opportunity to scan and return them.

Frank R. Burton, M.D., professor of internal medicine and a leading researcher of pancreatic disease, died in August at the age of 58.

Among his many professional accomplishments, Dr. Burton’s NIH-funded research finding that chronic pancreatitis is strongly associated with smoking and not solely tied to alcohol use leaves an important legacy. His findings helped dispel the widely held assumption that at times led patients to be labeled incorrectly as problem drinkers.

“Frank chose a very challenging professional career. Pancreatic disease is an extremely difficult disease to take care of, and he was

1934-2010

John J. Collins Jr., M.D., the School of Medicine’s 2002 Alumni Merit Award recipient, died in March at the age of 76.

Dr. Collins was professor of surgery emeritus of the Harvard Medical School. From 1987 until his retirement in 1999, he served as vice chairman of the surgery department at Brigham and Women’s Hospital. He was chief of the division of cardiac surgery from 1970 until 1987.

In 1984, Dr. Collins and a surgical team from Brigham and Womens’ Hospital performed the first heart transplant in New England. Although relatively common today, such transplantation was rare at the time.

“We were out there alone,” Dr. Collins explained in a 1999 interview, “but with the introduction of the immunosuppressant drug cyclosporine we were confident in our team’s capability.”

Dr. Collins proved heart transplantation was a viable treatment alternative and inaugurated one of the most respected organ transplantation programs in the country.

17

conference aimed at better understanding the pancreas, Dr. Burton was known for his

enthusiasm in sharing knowledge about the field.

“When it came to teaching, Frank had the patience of a saint,” said Charlene Prather, M.D., professor of internal medicine who worked with Dr. Burton for more than 12 years.

“He really gave students time to learn.

“Patients loved him, too.

He would always go an extra mile to make sure they were well taken care of. He had a very generous heart.”

Carol Archer, M.D. 1931-2010

Dr. Collins received numerous honors and awards for his extensive contributions to cardiac transplantation, the treatment of coronary artery disease, coronary artery bypass surgery and valve surgery.

C. Rollins Hanlon, M.D., renowned surgeon and former chairman of the School of Medicine surgery department, trained Dr. Collins and was his mentor.

“If there had been no Dr. C. Rollins Hanlon there would have been no Dr. John Collins Jr.,” said Mary Hogan Collins, M.D. (’68), whom Collins met and proposed to on their first date. “Dr. Hanlon means a great deal to our family.”

John and Mary Collins had four children and were married 41 years. The family has extended ties to Saint Louis University — 17 members of the Collins family earned degrees from SLU. To honor Dr. Collins’ contributions as a surgeon, leader, husband and father, the Collins family has established the John J. Collins Jr., M.D., Memorial Endowed Scholarship in the School of Medicine.

From the tiniest of infants to the smallest of cells, researchers in the School of Medicine are proving Saint Louis University is

indeed one of the top research universities in the nation. In this issue of Grand Rounds we profile a physician who specializes in treating babies yet to be born and a scientist who has discovered how cancer cells are able to evade the body’s defense mechanisms.

» Edmund Yang, M.D.,

Ph.D., gives hope to expect-

ing parents facing unthinkable — sometimes fatal — diagnoses. As co-director of the Fetal Care Institute at SSM Cardinal Glennon Children’s Medical Center, Yang helps diagnose the full spectrum of the problem, giving parents a clear picture of the prognosis, and he helps them develop a plan for care.

The Fetal Care Institute is the only comprehensive facility for fetal therapy in the Midwest. For babies facing life-threatening conditions in the womb, the Fetal Care Institute offers a range of interventions including: open surgery, the most risky procedure and reserved only for conditions that threaten the life of the baby; minimally invasive surgery, which uses slender scopes guided through tiny incisions to reduce the risk for premature delivery; and exit procedures, where the baby is partially delivered through a Caesarean section and remains attached to the placenta through the umbilical cord during the procedure.

Since 2009, Yang has treated fetal complications such as sacrococcygeal teratomas, the most common type of tumors found in newborns; twin-twin transfu-

» Edmund Y. Yang, M.D., Ph.D. Associate Professor of Surgery Division of Pediatric Surgery Joined SLU in 2009

18

sion syndrome, a frequently fatal disorder where one twin receives too little of the shared blood supply while the other twin receives too much; and amniotic bands, which restrict blood flow and can result in amputation or severe deformity of the affected limb.

Recently, Yang became the first doctor in the world to perform a tracheal occlusion surgery, which essentially causes the lungs to stretch like a balloon and expand throughout the pregnancy, using a dissolvable gel substance similar to gelatin. The baby had a condition called Congenital Diaphragmatic Hernia (CDH), where a hole in the diaphragm caused the intestines to grow into the chest cavity and obstruct normal development of the lungs. By using a dissolvable substance rather than a traditional balloon, Yang eliminated the need for a second fetal surgery to remove the tracheal occlusion before the baby was born.

“What makes the Fetal Care Institute unique is that we bring together neonatal and pediatric surgical specialists with obstetricians who specialize in high-risk pregnancy to evaluate the mom and her future baby and offer alternatives. It’s great when

» Govindaswamy

Chinnadurai, Ph.D., has spent the last 35 years exploring why cancer cells do not follow the rules of normal cell proliferation and why they are able to evade defense mechanisms within the body.

His findings are helping scientists and clinicians at SLU and throughout the world develop drugs to fight the more than 100 types of cancers diagnosed today.

By studying two adenovirus genes, E1A and E1B-19K, Chinnadurai has discovered several cellular genes that are implicated in the development of cancer and cell death regulation. He and his team found that a mutation in the distal half of E1A, in cooperation with a cellular cancer gene known as Ras, induces highly aggres-

sive and metastatic cancer cells. Chinnadurai proposed a concept that E1A, in addition to causing cancer, also suppresses cancer. While searching for cellular proteins that are involved in controlling the tumor-suppressive activity of E1A, his group identified the cellular protein CtBP and two other protein complexes that play important roles in the spread of cancer cells. His group also showed that the tumor-suppressive activity of E1A is shared by a protein coded by certain benign human papilloma viruses.

Chinnadurai has edited a book on CtBP and is considered the nation’s leading expert on the protein. His group is working to design agents that interfere with the functions of CtBP and other protein complexes that interact with E1A to disrupt tumor growth and spread.

During their work on the adenovirus gene E1B-19K, Chinnadurai and his team discovered important cell death regulatory genes known as BH3-only members, which are essential for cell death.

“Chemotherapy drugs can’t kill some cancer cells because the cells express high levels of anti-cell death pro-

G R A N T S at a Glance Enrico Di Cera, M.D., chair of the department of biochemistry and molecular biology, received a $1.8 million grant from the National Heart, Lung and Blood Institute for the project, “Studies in Thrombin Allostery.”

Alireza Rezaie, Ph.D., professor in the department of biochemistry and molecular biology, received a $1.5 million grant from the National Institutes of Health for the project, “Protease Activated Receptor Signaling by Coagulation Proteases.”

William Sly, M.D., the James B. and Joan C. Peter Endowed Chair and professor in the department of biochemistry and molecular biology, received a $1.4 million grant from the National Institute of General Medical Sciences for the project, “ReceptorMediated Transport of Lysosomal Enzymes (A1 Application).”

The department of pharmacological and physiological science has received a $1.1 million grant from the National Institute of General Medical Science to train 30 pre-doctoral students during the next five years. This is the fourth time the grant has been renewed. The SLU School of Medicine is the only medical school in Missouri to receive the grant for its training program in the pharmacological sciences.

Govindaswamy Chinnadurai, Ph.D. Professor of Molecular Virology Institute for Molecular Virology Joined SLU in 1974

tein,” he said. “If we understand E1B-19K, we can learn how these genes protect cells from death.”

Two of the BH3-only members discovered by Chinnadurai’s group are inactivated in a number of human cancers. Several anti-cancer drugs activate expression of these genes, causing death of cancer cells. Chinnadurai hopes a new generation of drugs that efficiently activates these genes would lead to more effective anti-cancer

Grand Rounds 19

agents than are available now.

The National Institutes of Health has funded Chinnadurai’s groundbreaking research for more than three decades.

All of the genes and proteins he has discovered are drug therapy targets.

“An important rule in research is to stick with one or two intellectual problems and see where they take you,” he said. “That’s what I’ve done, and it’s taken us closer than ever to finding a cure for cancer.”

»

Poised for Discovery

we can reassure the mom and family that their baby’s future is good and help them understand the resources that they will need,” Yang said. “But we are also here to provide high risk fetal operations for lifethreatening problems. The satisfaction of saving a baby, of building a family, is what the Fetal Care Institute is all about.”

Owens

Living the Mission Call of the Wild

If being retired means doing what you want, when you want and with whom you want, then Harry Owens Jr., M.D. (’66), figures he retired at the age of 35.

That’s when Owens closed his family medicine practice in Palmer, Alaska, and began traveling the world with nonprofit health care agencies.

Initially, Owens worked for Project Hope on a hospital ship in northeast Brazil.

He soon was recruited by Esperança, a relief agency with a boat that plied the Amazon River and its tributaries to bring health care to remote villages.

One of his most memorable stops was in a village deep inside the jungle in the late 1970s. Owens came upon a mother who had been in labor for three days because her

baby was poorly positioned.

He considered a C-section, but Owens knew she would not receive adequate followup care. He then remembered a lecture he heard at the School of Medicine. He reached inside her, repositioned the baby in the birth canal, and she was able to deliver the baby safely. Mother and child survived, and the grateful mother named the boy Haroldo d’Esperança in honor of Owens. When Owens returned to the village a decade later, the boy was waiting to greet him at the river’s edge.

“I still get choked up thinking about it,” Owens said.

Owens loved the jungle, but he missed rural Alaska.

He came back to the States and worked in Nome for a non-profit organization that served Eskimos in outlying

Some people ask me how I do it — how can I travel so often and so far from modern comforts. I tell them my way of life is more of a reward than a sacrifice. OWENS

“I have the perfect temperament for it, “ Owens said.

“I love the outdoors, I’m not scared to stray two feet off the pavement, and I love taking care of people.”

When not practicing in McMurdo, or Africa or the Amazon jungle, Owens is at home in a little cabin on the McKenzie River in Blue River, Oregon, 50 miles east of Eugene. Owens uses what little money he makes to cover his basic needs. The rest goes to charity.

He said he learned to appreciate the simple life as a young boy working summers on his aunt and uncle’s sheep ranch in Arizona.

“Survival wasn’t a challenge,” he said. “It was a way of life. You don’t need much to get by. This approach helps me feel at home no matter where I go. Whether I’m in the jungle or the mountains or the polar regions, I’m not daunted by the remoteness of an area. I’m invigorated by it.”

Every so often Owens likes to “stop the world and get off.” Since 1987 he has taken periodic retreats at a Trappist Monastery to “make any necessary course corrections.” He shares his insights and experiences in a book of short stories titled, A Healer’s Call.

For a copy of the book or to learn more about Owens’ work, contact him at harrybutchowens@aol.com. left | A few of Owens’ friends greet him at the airport at McMurdo Station.

20 Grand Rounds Saint Louis University School of Medicine

From Your New Alumni Association President Edward J. O’Brien, M.D. (’67)

I am pleased to assume the role as president of our Medical Alumni Association.

My first order of business is to thank retiring president, Dr. Tom Olsen, for his many years of service and contributions. Tom’s outstanding talent and time commitment will continue to be noticed in the department of internal medicine, in important clinical outreach efforts and on the School of Medicine Executive Advisory Board.

I will build O’Brien on his efforts to improve alumni outreach and connectivity. I ask our loyal alumni to remain faithful and ask those who may feel less connected to become engaged. The medical school and the alumni association have improved online web access and ease by updating links and by adding the relatively new communication, “Dialogue with the Dean,” which allows alumni to comment on important medical topics that have an impact on our school. In addition, mail communication will continue to improve, including Grand Rounds magazine, and alumni class and reunion information. To assist in this outreach, please send any new or updated e-mail addresses to the alumni association office.

Watch for announcements of medical school and alumni events and receptions, some related to major medical organization meetings in some of the larger metropolitan areas of the country. All are invited.

Lastly, I invite you to share with us any memories or pertinent stories of your time at the medical school or in one of our residency programs.

As we have recently lost several outstanding and legendary physicians and teachers, any tale or event related to your time with one of these icons would be appreciated.

We are particularly interested in your stories about the department of internal medicine because we are celebrating the department’s 100th anniversary in the next issue of Grand Rounds.

To assist in this outreach, please send any new or updated postal or e-mail addresses to mdalumni@slu.edu.

In memoriam

John Soucy, M.D. (’29) Cornelius Kline, M.D. (’34) Edward Nixon, M.D. (’37) Herschel Cohen, M.D. (’41) Michael LaHood, M.D. (’41) Ellis Lipsitz, M.D. (’43) James Myers, M.D. (’43)

markyourcalendar

Alumni Pulse

villages. He also spent time in the Aleutian Islands caring for the Aleut people.

In between making house calls in his Jeep, Owens earned a master’s degree in international management and began consulting for private enterprises, higher education institutions, the African Development Bank and health care organizations in GuineaBissau, Mozambique and Brazil. He took breaks from his practice to volunteer with the Flying Medical Service in Tanzania, working with the Maasai people in the Serengeti Plains. More recently, he volunteered with Sudan Medical Relief in southern Sudan but had to make an emergency exit due to intertribal warfare near the clinic.

In 2006, a colleague suggested Owens would be a good fit for lead physician at the McMurdo Station, a National Science Foundation research center located on the shore of McMurdo Sound in Antarctica. Each year Owens bundles up and spends seven months caring for the station’s 1,100 scientists and support staff at a three-bed hospital and clinic.

Ralph Miller, M.D. (’43) Amadeo Saeli, M.D. (’43) Arthur Friskel, M.D. (’44) Cyrus Pachter, M.D. (’44) Harvey Itano, M.D. (’45) Gerald Blanchard, M.D. (’46) Stanley Lutz, M.D. (’46) Gilbert Wilhelmus, M.D. (’46) Vincent Marecki, M.D. (’47) Glenn West, M.D. (’47) Richard Nelson, M.D. (’48) George Tenoever, M.D. (’48) Belmont Rodney Thiele, M.D. (’48) W. Atkinson, M.D. (’49) Francis Jacobs, M.D. (’49) John Justus, M.D. (’49) Edwin Schmidt, M.D. (’49) Claire Cotton, M.D. (’50) Robert Doisy, M.D. (’50) Russell Welsh, M.D. (’50) Stephen Buckley, M.D. (’52) Joseph Connolly, M.D. (’52) Charles Galbraith, M.D. (’52) Robert Healey, M.D. (’52) Robert Lyden, M.D. (’52) Harold Rowland, M.D. (’53) William I. Stryker, M.D. (’53) John McCue, M.D. (’54) Joseph Dewitte, M.D. (’55) Norman Rose, M.D. (’55) Joseph Traynor, M.D. (’55) John McLychok, M.D. (’56) Edward Rongone, M.D. (’56)

Peter Citrone, M.D. (’57) Elmer St. George, M.D. (’57) Theodore Scharf, M.D. (’59) Robert Ratliff, M.D. (’60) Daniel McLaughlin, M.D. (’61) Merle Walker, M.D. (’61) James Beckner, M.D. (’62) John Cicconi, M.D. (’65) Peter Farley, M.D. (’65) Bruce Heyl, M.D. (’65) Marshall Kessler, M.D. (’65) Daniel Brennan, M.D. (’67) Narendar Datta, M.D. (’68) Frances Ficker, M.D. (’69) Joel Ruffman, M.D. (’70) Theodore Munns, M.D. (’71) Moustafa Naguib, M.D. (’71) Cullie Funderburk, M.D. (’75) Robert McConnell, M.D. (’75) Stephen Surtshin, M.D. (’79) Edward Parrish, M.D. (’80) John Fennig, M.D. (’81) Karen Knox, M.D. (’81) Robert Yowell, M.D. (’81) Sataya Satayaviboon, M.D. (’83) Lynda Lombardo, M.D. (’86) Kathleen Barcia, M.D. (’89) Michael Mecinski, M.D. (’90) Raemma Luck, M.D. (’95) Eugene Averbuch, M.D. (’98)

School of Medicine Alumni Events

Feb. 4 American Academy of Dermatology - New Orleans

Feb. 15 - 19 San Diego-area Alumni Reception/American Academy of Orthopaedic Surgeons March 18 - 22 San Francisco-area Alumni Reception/American Academy of Asthma, Allergy and Immunology

April 8 – 10 Missouri State Medical Convention - Kansas City April 30 - May 3 Denver-area Alumni Reception/Pediatric Academic Societies

May 7 - 10 Chicago-area Alumni Reception/Digestive Disease Week Continuing Medical Education Programs

Jan. 12-15 Rheumatology Winter Clinical Symposium-Hawaii

Jan. 27-29 Fourth Annual Cervical Spine Research Society Hands-On Cadaver Course

Feb. 3-6 Fourth World Congress on Cerebral Revascularization and 11th Annual Hands-On Workshop: ECIC Bypass and Microanastomosis Techniques

Feb. 11-13 Advances in Cosmetic Blepharoplasty, Brow and Midface

For information on the CME programs, please call the SLU School of Medicine continuing medical education office at 314-977-7401. See updates and Show your school colors details about Practical Anatomy and Surgical Education Workshop programs at www.clubcolors.com/slu pa.slu.edu.

Travel with alumni For any other events, please contact the Alumni Relations Office at

www.slu.edu/alumni/travel 314-977-8335 or visit medschool.slu.edu/alumni/.

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PROFILE OF PHILANTHROPY Paul H. Young, M.D. (’75), was only 10 when he began tagging along with his father on weekends to the anatomy lab at the School of Medicine. Paul A. Young, Ph.D. (’53), would prepare cadaver brains for his upcoming neuroanatomy lab and answer any questions his son had.

“I didn’t take my first class with him until I was in medical school, but he was teaching me well before then,” said Paul H. Young. “To tell you the truth, I’m still learning from him today, as are many medical students.”

Paul A. Young, who has been teaching at the medical school for more than 50 years, has as heavy a course load today as he had two decades ago. For his animated lectures, famous two-handed illustrations and dedication to students, Young has received nearly every teaching award the School of Medicine grants. In addition to educating his son, Paul A. Young has taught four of his grandchildren: Julie Young, M.D. (’99); Jason Young, M.D. (’05); Nicholas Rottler, a medical school senior; and Christopher Young, a medical school sophomore.

“Teaching always was and is his passion,” said Paul H. Young, or PHY as his colleagues call him to avoid getting him confused with his father. “He does it better than anyone I’ve ever seen.”

It was only fitting then that PHY recently led an effort to donate to the School of Medicine

the historical St Louis Metropolitan Medical Society Building — a building dedicated to the education of medical professionals — and to name it in honor of his father.

Paul A. Young Hall at 3839 Lindell Blvd. houses SLU’s Practical Anatomy and Surgical Education programs, which PHY founded in the early 1980s to offer physicians high-tech surgical training. The programs began in the School of Medicine histology lab with four courses a year offered on weekends and during academic breaks.

The demand for training became so great, however, that in 1990 the programs moved to their own facility at the St. Louis Metropolitan Medical Society Building, now Paul A. Young Hall. Today, the world-class facility hosts more than 50 workshops a year for surgeons, nurses, physicians and other medical professionals, as well as workshops for middle and high school students who are interested in medicine.

“How appropriate to dedicate this building to my father,” said PHY. “I can’t think of a better way to honor him and to thank him for what he has given to the thousands of students who’ve had the privilege of sitting in his classroom.”

To learn more about Practical Anatomy and Surgical Education programs administered by the School of Medicine’s Center for Anatomical Science and Education, send an e-mail message to pa@slu.edu.

Dr. Paul A. Young and Dr. Paul H. Young

T o learn more about giving opportunities and tax benefits that may be associated with your gift, contact the office of development at the School of Medicine at (314) 977-3287 or Matt White at whitemt@slu.edu.