SUMMER 2014 CONNE C TING ALUMNI, FRIENDS AND COMMUNITY CONNEC EDIC C INE AND BIOMEDICAL SCIENCES THE UNIVERSITY AT BUFFALO SCHOOL OF M EDI
TEACH ABOUT SUBSTANCE ABU BUS SE RICHARD BLONDELL, MD, IS LEADING A NATIONAL EFFORT TO TRAIN DOCTORS IN ADDICTION MEDICINE
CONSTRUCTION Construction has begun for the new UB School of Medicine and Biomedical Sciences building at Main and High streets on the Buffalo Niagara Medical Campus. The SUNY Construction Fund awarded LP Ciminelli the bid for the first phase of work, which involves excavation, support of excavation, foundations and structural steel, including complete frame-up. Subsequent phases, yet to be bid, will cover work on the buildingâ€™s faĂ§ade, roof, interior, furniture, fixtures and equipment.
To learn more, go to http://medicine.buffalo.edu/alumni.html and click on the Your New School tab.
School of Medicine and Biomedical Sciences John R. Oishei Childrenâ€™s Hospital (Kaleida Health) Conventus medical office building UB Clinical and Translational Research Center and Kaleida Healthâ€™s Gates Vascular Institute Buffalo General Medical Center (Kaleida Health) Roswell Park Cancer Institute NFTA Metro Allen/Hospital station (will be encapsulated within the new medical school)
TA B L E O F C O N T E N T S
Michael E. Cain, MD Vice President for Health Sciences and Dean, School of Medicine and Biomedical Sciences
UB MEDICINE MAGAZINE, Summer 2014, Vol. 2, No. 2
Editor Stephanie A. Unger
Contributing Writers Jim Bisco, Mary Cochrane, John DellaContrada, Ellen Goldbaum, Colleen Karuza
VITAL LINES Progress notes
Copyeditor Tom Putnam
Photography Joseph Cascio, Philip J. Cavuoto, Sandra Kicman, Douglas Levere
Partnerships at work
Art Direction & Design Karen Lichner
30 DOCTOR VISITS
Editorial Advisers John J. Bodkin II, MD ’76 Elizabeth A. Repasky, PhD ’81
Reflections on careers
Major Affiliated Teaching Hospitals Erie County Medical Center Roswell Park Cancer Institute Veterans Affairs Western New York Healthcare System
36 Q & A Conversations with experts
People in the news
Sarah Riley and Anthony Turner are among the many UB medical students working with the underserved in our community as part of the newly formalized service learning curriculum.
12 Time to Teach about Substance Abuse Today’s drug epidemic is highlighting the need for doctors to be more well trained in substance abuse, an initiative UB is leading.
CARE TO MAKE A DIFFERENCE Medical students, residents and faculty at UB learn and give back by serving the underserved in the community. COVER IMAGE: Richard Blondell, MD, UB professor of family medicine, is director of the National Center for Physician Training in Addiction Medicine. Photo by Douglas Levere
A LIFE-CHANGING PLACE William Stendardi, Class of 2016, has found a medical school— and a mentor—who has helped him turn around his life.
26 CHILDREN WITHOUT BORDERS Jim Jarvis, MD, new chief of pediatric allergy/immunology and rheumatology, blends world-class science with service.
Kaleida Health Buffalo General Medical Center Gates Vascular Institute Women and Children’s Hospital of Buffalo Millard Fillmore Suburban Hospital Catholic Health Mercy Hospital of Buffalo Sisters of Charity Hospital Correspondence, including requests to be added to or removed from the mailing list, should be sent to: Editor, UB Medicine, 901 Kimball Tower, Buffalo, NY 14214; or email email@example.com UB Medicine is published by the UB School of Medicine and Biomedical Sciences to inform alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in Buffalo, Western New York and beyond. Visit us: http://medicine.buffalo.edu 14-UC-031
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Rendering by HOK
OISHEI AWARDS $5 MILLION FOR ‘GAME-CHANGING’ UB MED SCHOOL
Architectural rendering of the entrance to the new UB School of Medicine and Biomedical Sciences being built on the Buffalo Niagara Medical Campus.
A major gift from the John R. Oishei Foundation significantly boosts UB’s plans to construct a state-of-the-art medical school, equipped with the best medical technologies, labs and classrooms for educating and training physicians. “This important gift will accelerate the creation of the region’s first and only academic health center, helping Buffalo develop into an international hub for medical research, education and patient care,” says Michael E. Cain, MD, vice president for health sciences and dean, School of Medicine and Biomedical Sciences. Cain welcomed the Oishei Foundation’s participation in “shaping a bold era of progress, discovery and promise” for the medical school. “With this $5 million gift, we join UB as fellow catalysts for change that will dramatically enhance our community’s economic vitality and quality of life,” says Oishei Foundation president Robert D. Gioia. Oishei Foundation board chair James Wadsworth agrees. “The new medical school will strengthen the campus, generate regional economic growth and help to renew downtown Buffalo’s urban vitality,” he says.
The new medical school has received funding from a mix of sources, including state support provided by Gov. Andrew M. Cuomo through the NYSUNY 2020 legislation. UB aims to raise a total of $50 million in private funds. “Private donations are important to the success of the new medical school, and we’re grateful that the Oishei Foundation has offered such generous support at this critical time,” says Nancy H. Nielsen, MD ’76, PhD, senior associate dean for health policy, and co-chair for the Medical School Campaign Steering Committee. The Oishei Foundation’s support, while leveraging additional funding from competitive sources, will stimulate research discoveries, advances in faculty and staff recruitment, and the development of the Buffalo Niagara Medical Campus. Hailing the facility as “a game-changing addition to the Buffalo Niagara Medical Campus,” Gioia says it “will redefine our region as a hub for the very best in health care.”
U B M E D V I TA L L I N E S
Rendering by HOK
When he was a child, Sol Messinger, MD ’57, fled Berlin with his parents to escape Hitler’s Germany. After being denied entry to Cuba and the United States, the family lived in Belgium and later France, again escaping weeks before the Nazis sent most Jews in France to Auschwitz. In 1942, they safely entered the United States. The harrowing experience made Messinger someone who enjoys each day of his life. “It certainly has always made me consciously grateful to be alive,” he says. Gratitude for his medical education has inspired Messinger to give $1 million to name the Active Learning Center in the new UB School of Medicine and Biomedical Sciences. “I knew I wanted to go to medical school while I was an undergraduate here at UB,” he recalls. “My father was a tailor, we had only recently come to the United States, and we had very little money. I knew if I didn’t get into UB, I wouldn’t be able to go to medical school because we couldn’t have afforded for me to go out of town.” The Sol Messinger, MD ’57, Active Learning Center will be located on the ground floor of the new medical school. The largest space on that level, it will seat 200 and be used as a high-technology classroom, meeting room and public events space. Messinger looks forward to the ribbon-cutting of the facility. “I want to have my name associated with the new medical school. I think it’s a terrific thing that is being done,” he says. “I was in the first class to enter what was then the new building on the South Campus of UB, one of the reasons I have a special interest in the new school.”
SOL MESSINGER, MD ’57, GIVES $1 MILLION TO NEW UB MEDICAL SCHOOL
A generous gift from Sol Messinger, MD ’57, associate clinical professor of pathology from 1964 to 2007, will fund the Active Learning Center, depicted below.
CIRCLE OF LEADERS HELPS BUILD NEW MEDICAL SCHOOL “I owe my career to the University at Buffalo medical school—that’s why I’m giving back to the institution that had such a profound influence on my life,” Berkun says. Michael Taxier, MD ’75, agrees: “The new medical school is a unique opportunity for UB and the city of Buffalo. Both my daughter and I are graduates, so I’m doubly grateful for the quality of medical education in Buffalo. That’s why I’ve joined the Circle of Leaders. I hope we can count on others too.” To learn more about the Circle of Leaders, contact the Office of Medical Development and Alumni Relations at (716) 829-2773, or email firstname.lastname@example.org.
From the first day of medical school, the main lecture hall holds special meaning for students. The Office of Medical Development and Alumni Relations has established the Circle of Leaders to recognize donors who step forward to help build the medical education floor in UB’s new medical school. Donors to the Circle of Leaders—which includes gifts of $25,000 to $99,999—will be recognized on a plaque in the new lecture hall. Their gifts will touch almost every aspect of medical education. Rose Berkun, MD ’92, chair of the Circle of Leaders campaign, encourages alumni and friends of the medical school to join her in the new initiative to “help build a great new medical school for all the generations to come. Rose Berkun, MD ’92, chair of the Circle of Leaders campaign.
RUSSELL J. SALVATORE JOINS CIRCLE OF VISIONARIES Russell J. Salvatore, owner of Russell’s Steaks, Chops & More located in Depew, NY, is the newest member of the Circle of Visionaries, a society that honors donors who make major gifts to the School of Medicine and Biomedical Sciences’ fundraising campaign. “It was instilled in me from a young age how important it is to give back to the community to help Russell J. Salvatore, owner of Russell’s Steaks, make it stronger,” says Chops & More. Salvatore. “I have been blessed in my life to meet so many nice people. I love working hard to be able to give back to others. “Having top-notch health care in our city and region is important to me,” he adds. “Building a brand new medical school on the Buffalo Niagara Medical Campus will give medical students, faculty, doctors and researchers an opportunity to work more
closely with one another to provide the best health care possible and to discover new, improved treatments—all while lending a hand to the resurgence of downtown.” In addition to supporting “bricks-and mortar” projects for the school, gifts such as Salvatore’s enhance health care in Buffalo by supporting the hiring of nationally prominent department chairs who recruit top physician-scientists from around the country. Already, these new hires are filling gaps in clinical care in our region and are making Buffalo a destination for world-class care (read about some of these new faculty recruits on pages 26, 30 and 31 of this issue). To learn more about the Circle of Visionaries, contact the Office of Medical Development and Alumni Relations at (716) 829-2773, or email email@example.com.
“It was instilled in me from a young age how important it is to give back to the community to help make it stronger. I love working hard to be able to give back to others.” —Russell J. Salvatore
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From left: Jaclyn Schneider, MD ’10, palliative medicine fellow in the UB Department of Medicine, one of this year’s Scheig Award recipients; Mrs. Denise Scheig; keynote speaker Ira Byock, MD; and Amy Case, MD ’01, assistant professor of medicine and director of the UB Palliative Medicine Fellowship Program. Neha Gupta, MD, not pictured, is the other Scheig Award recipient.
SCHEIG MEMORIAL FUND INAUGURAL LECTURE AND AWARD Ira Byock, MD, a leading palliative care physician, spoke on April 3 to UB medical students, residents, faculty and staff as part of a special grand rounds at the Clinical and Translational Research Center on the Buffalo Niagara Medical Campus. The author of “The Best Care Possible” as well as other popular books about end-of-life care, Byock is a professor of medicine at the Geisel School of Medicine at Dartmouth College and former director of palliative medicine at the Dartmouth-Hitchcock Medical Center. He spoke to a standing-room-only crowd about “What Are Doctors For? The Physician-Patient Relationship Through the End of Life.” The event was part of the inaugural awards luncheon for the Robert L. Scheig, MD, Memorial Fund for Palliative Care Education and Research.
Jaclyn Schneider, MD ’10, and Neha Gupta, MD, palliative medicine fellows in the UB Department of Medicine, were the first Scheig Award recipients. Denise Scheig established the Robert L. Scheig, MD, Memorial Fund for Palliative Care Education and Research to recognize her late husband’s contributions to medicine at UB, in the Buffalo community, and beyond. Robert Scheig was instrumental in creating the first hospice in the United States at Yale School of Medicine. At UB, he worked to make Western New York a leading region in clinical palliative medicine, education and research. Scheig was program director for UB’s internal medicine residency program from 1991 to 1996, and served as a primary care physician at the VA Medical Center and chief of medicine at Buffalo General Medical Center.
SPRING CLINICAL DAY AND REUNION WEEKEND 2014
Photos by Joseph Cascio
Alumni came from around the country this spring to celebrate with classmates, friends, faculty and students. Over 400 people joined in the festivities, which included an alumni cocktail party, dinners, tours of the Buffalo Niagara Medical Campus, and Spring Clinical Day and Medical Residents’ Scholarly Exchange. The weekend was sponsored by the UB Medical Alumni Association and the School of Medicine and Biomedical Sciences.
Celebrating 50 years in medicine, from left: Richard Merrick, MD’64, Mrs. Gayle Merrick, Mrs. Mary Ann Scheiber, Stephen Scheiber, MD ‘64.
Celebrating 20 years in medicine, from left: Petros Ghermay, MD ’94, Christopher Fenton Wood, MD ’94, Idalia Gonzalez, MD ’94, Stephanie Edwards, MD ’94, J. Paul Slavenas, MD ’94, Kim Griswold, MD ’94, and Tegest Hailu, MD ’94.
2014 graduates enjoying a 1979 Iris yearbook, from left: Alice Crane, MD, Shar Thevanayagam, MD, Bradley Buchheit, MD, and David Ciufo, MD.
U B M E D V I TA L L I N E S
UB CHOSEN TO CO-LEAD STATEWIDE EFFORT TO SPUR GENOME RESEARCH Gov. Andrew M. Cuomo has announced that UB will co-lead an effort to position New York State as a national leader in genomic medicine. It will partner with the recently opened New York Genome Center (NYGC) in Manhattan—a consortium of 16 educational and research organizations—to accelerate recent advances in genomic medicine directly into clinical care. As part of this initiative, UB will receive $50 million to increase research capacities and will provide NYGC with expertise and supercomputing power. UB was chosen based on its expertise in highperformance computing, its nationally recognized leadership in genomics and medical research, and its ability to analyze patient data through three of its research centers: the Center for Computational Research, the New York State Center of Excellence in Bioinformatics and Life Sciences, and the Institute for Healthcare Informatics, all located on the Buffalo Niagara Medical Campus. The NYGC will test new methodologies for the
application of genomic medicine in hospitals in New York City. The information generated will initially be analyzed and stored at the genome center. Since genomic medicine requires the analysis of large amounts of information, UB’s Center for Computational Research will provide resources for “big data” storage and complex analytics requiring highperformance computing. As more patients are treated, all information will be stored at UB. The initiative has the potential to usher in a new era of personalized medicine, leading to improved treatments for diseases as well as ways to identify individuals at risk of disease. Gov. Cuomo also recently announced that a new information technology hub anchored by IBM will receive state funding for construction and computer hardware. The IBM center, which will bring 500 new jobs to downtown Buffalo, will be connected to the genomic medicine network that will utilize UB’s supercomputer. To learn more about the genomic medicine initiative, go to www.buffalo.edu/news.html and search “genome.”
HUD RECOGNIZES UB FOR COMMUNITY OUTREACH The U.S. Department of Housing and Urban Development (HUD) has cited UB as a national best practice for its community outreach efforts in neighborhoods around the Buffalo Niagara Medical Campus. “UB is leading redevelopment efforts in distressed neighborhoods near downtown Buffalo, spurring the growth of the regional economy and building neighborhood and regional capacity,” notes an article that appears on HUD USER, an informational website published by HUD’s Office of Policy Development and Research. “Moving forward, UB continues to serve Buffalo’s neighborhoods, the city at large and the region—not only by aligning the university’s expansion with the area’s development needs, but also by ensuring that residents have the ability to effect positive change.”
The article points to the UB 2020 initiative and the plan to move the School of Medicine and Biomedical Sciences downtown as the backbone for UB’s community impact, noting that UB is “lending its expertise to local government and empowering residents to shape their communities from the neighborhood to the regional level.” The article also acknowledges the work of UB’s Office of Community Relations to engage residents in two-way communication and provide information about UB’s programs and jobs that will be created by the university’s expansion downtown. “Our model has always been to work with the community in addressing their needs and wants,” says Linwood Roberts, UB community relations director. “This starts with building trust, which can be easily attained through transparency and communication.”
LOMEO NAMED TO LEAD KALEIDA, GREAT LAKES HEALTH SYSTEMS Jody L. Lomeo has been named president and CEO of Kaleida Health, Western New York’s largest health care system, after having served as its interim leader since January 2014. He also has been named president and CEO of the Great Lakes Health System of Western New York, which has overseen the ongoing integration and collaboration between Kaleida Health and the Erie County Medical Center (ECMC) Corp. since 2006. Lomeo, who has served as CEO of ECMC Corp. since 2009, will step down from this position, a move that is intended to accelerate progress toward integration in accordance with New York public authority law. As president and CEO of Great Lakes Health, Lomeo will provide leadership for all campuses and build a management team that will coordinate care across all Kaleida Health and ECMC Corp. sites. This team will continue the work of the past few months of re-engaging physicians, nurses and staff in transforming the care delivered to patients. “UB is proud of its long-standing partnership with Great Lakes Health enriching the quality of life in our region. We are excited about these new collaborations, which promise to further advance the quality of care in our community and improve clinical training across the system,” said UB president Satish K. Tripathi.
“UB is proud of its long-standing partnership with Great Lakes Health enriching the quality of life in our region.”
“Jody is an ideal leader to help grow these collaborations as our region’s health care institutions work together to build a healthier, stronger Western New York. We look forward to continuing to partner in this effort as we actively bring all of our organizations closer together.” Lomeo is a native of Buffalo and graduate of UB. Under —President Satish K. Tripathi his leadership, more than $200 million have been invested in the ECMC campus to construct a number of facilities, including the recently opened Behavioral Health Center of Excellence (see story on page 10). “As a member of the Great Lakes Health board, I have known Jody to be someone who advocates for shared physician-led decision-making,” said Michael E. Cain, MD, vice president for health sciences and dean of the School of Medicine and Biomedical Sciences. “Jody truly views all physicians—UBMD and community-based— as partners in delivering health care and in our academic health center. I look forward to working with him to serve the patients of our community.”
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ECMC OPENS BEHAVIORAL HEALTH CENTER OF EXCELLENCE A $25 million Behavioral Health Center of Excellence has opened at Erie County Medical Center (ECMC) following completion of a new 36,000-square-foot building on the ECMC Health Campus that includes a psychiatric emergency room and an outpatient mental health and drug dependency treatment center. The center of excellence, under the auspices of the Great Lakes Health System of Western New York, is a physician-driven collaboration between ECMC and Kaleida Health. It is a state-ofthe-art comprehensive psychiatric emergency program with a new outpatient treatment center and new inpatient beds in the main building to serve mental health patients in the eight counties of Western New York. Funding for the new center came from a $15 million grant from the Healthcare Efficiency and Affordability Law of New York, and $10 million from ECMC.
The consolidated behavioral health model combines ECMC and Buffalo General Medical Center’s behavioral health programs to create a single 172-bed inpatient psychiatric program (126 licensed adult inpatient psychiatric beds, 18 geriatric-psychiatric beds, 16 adolescent beds, two forensic beds and a 10-bed psychiatric intensive care unit). ECMC also continues to operate its 18 detoxification beds and 20 inpatient chemical dependency rehabilitation beds. Michael R. Cummings, MD, assistant professor of clinical psychiatry at UB, is the executive director of the new center. In this capacity, Cummings oversees the behavioral health, substance abuse and dependency treatment programs at the medical center and its affiliated clinics.
The new Behavioral Health Center of Excellence at Erie County Medical Center (ECMC), depicted in blue, consolidates ECMC’s and Buffalo General Medical Center’s behavioral health programs to create a single 172-bed inpatient psychiatric program.
REUSE PLANS FOR MILLARD FILLMORE GATES CIRCLE HOSPITAL In a historic real estate transaction, Kaleida Health has turned over the former Millard Fillmore Gates Circle Hospital to TM Montante Development. The company plans to redevelop the nearly 10-acre site as a $63 million complex that features as its centerpiece a downtown campus of Canterbury Woods, a continuing care retirement community. It also will develop a series of mixed-use facilities, including marketrate apartments and condominiums, retail and a community health and wellness center. The planned redevelopment of the site will feature a number of sustainable design elements, including a solar component as a source of alternative energy, and significant green space. Construction is expected to begin in late 2014, with the majority of the work completed by 2016. Robert G. Shibley, dean of the UB School of Architecture and Planning, helped facilitate the public dialogue process for Kaleida Health. He is the founder of the Urban Design Project and a lead consultant on city and regional projects, including the comprehensive plan for the City of Buffalo. “I think everyone understands the significance of this site on one of Frederick Law Olmsted’s great parkway circles,” Shibley says. “The residential use proposed is entirely appropriate. It is consistent with the community values expressed by the citizen advisory committee and offers a design that is sympathetic to that context.”
“I think everyone understands the significance of this site on one of Frederick Law Olmsted’s great parkway circles.” —Robert G. Shibley, dean, UB School of Architecture and Planning
TIME TO TEACH ABOUT SUBSTANCE ABUSE UB PROFESSOR LEADS A NATIONAL EFFORT TO RAISE THE PROFILE OF ADDICTION MEDICINE STORY BY S.A. UNGER PHOTOS BY DOUGLAS LEVERE
Richard Blondell, MD, pictured here teaching medical students, is professor of family medicine and vice chair for addiction medicine for the Department of Family Medicine. He has been tappped to direct the new National Center for Physician Training in Addiction Medicine.
If you ask Richard Blondell, MD, professor of family medicine at UB, how he came to be a national leader in the field of addiction medicine at a time when our country is in the throes of a drug epidemic of historic proportions, he will tell you that he didn’t choose the field, it chose him. And it chose him through a series of humbling experiences he had while serving as director of the family medicine residency program at the University of Louisville, a position he held for eight years, starting in 1989. “In my first few months on the job, I ended up sending two doctors to treatment, one for an alcohol problem, and another for a cocaine problem,” Blondell recalls. “And these were doctors I had previously worked with for two years on almost a daily basis. So there it was, right under my nose, and I missed it.” Blondell spent the next 10 years becoming educated about substance abuse and participating in national programs that examined the issue. He was then recruited by the chair of surgery at Louisville, who saw a need for intervention with trauma patients, over half of whom were in the hospital due to injuries related to substance abuse. After working with this population awhile, Blondell had a second epiphany. “It was never clear to me how to help these patients when they were ready to be discharged,” he recalls. “I realized I didn’t know what I was doing, and nobody else knew what they were doing. When I reviewed the medical literature, there was very little information about how to address trauma patients’ underlying alcohol or drug problems.” Blondell, who is from the Rochester area, left Louisville and took a year off from medicine to conduct research at UB’s Research Institute on Addictions, where he honed his clinical research skills. In 2003, he joined the faculty at UB, where he now serves as professor and vice chair for addiction medicine in the Department of Family Medicine. If you look at what Blondell has done since coming to UB, it’s almost as if he foresaw today’s drug epidemic and spent his time singlemindedly preparing a —Kenneth E. Leonard, PhD, director of UB’s Research national intervention Institute on Addictions program that anticipated the massive scale of the problem. “Since the 1930s, the number one cause of accidental death in every
“What Rick Blondell is doing is groundbreaking. There absolutely is a need for having more physicians to address the addiction problem.”
state in the U.S. has been from motor vehicle accidents. Now, in the past few years, drug overdose—commonly from illicit, diverted prescription drugs—has become the leading cause of death in about 16 states,” he reports. And yet individuals studying to be physicians today, as in years past, receive little or no training in substance abuse. At the center of Blondell’s plan to help counter these trends is his effort to raise the profile of addiction medicine education at all levels, from medical school, to residencies, fellowships and continuing education for primary care doctors. His message is a paradigm shift: “Let’s not wait until treatment is needed, but instead focus on prevention and early intervention, just as we do with other diseases such as heart disease, cancer and diabetes.”
NEW PATHWAYS FOR TRAINING In 2013, Blondell was named director of the new National Center for Physician Training in Addiction Medicine, established by the American Board of Addiction Medicine (ABAM) Foundation with a $2 million grant from the Conrad H. Hilton Foundation. The center, which opened in January 2014, focuses on curriculum development and the training of primary care providers who can become specialists in addiction medicine. “Right now, family doctors and pediatricians who are interested in taking a preventive medicine approach to addiction don’t have a pathway to become credentialed,” Blondell says. “We are creating that pathway with the new center that I am directing from UB.” Blondell is a founding member of the American Board of Addiction Medicine and the ABAM Foundation. He chairs the latter’s Training and Accreditation Committee and directs its National Coordinating Office for residency program accreditation. He was tapped to lead this effort to educate primary care providers in addiction medicine partly because of several high-level initiatives he spearheaded for which he has received national recognition. In May 2011, for example, an addiction medicine fellowship he developed in UB’s Department of Family Medicine became one of the nation’s first postgraduate addiction medicine residencies accredited by the ABAM Foundation. At the time, there were no addiction medicine residencies among the 8,890 American Council of Graduate Medical Education accredited residency programs in the nation’s hospitals. In October 2011, Blondell was named co-principal investigator, along with Jeffrey H. Samet, MD, of Boston University School of Medicine, on a $900,000 grant from the National Institute on Alcohol Abuse and Alcoholism for training clinicians in the emerging specialty of addiction medicine. The grant funds physicians and researchers
A HEALTH CARE CRISIS
Kenneth E. Leonard, PhD, director of UB’s Research Institute on Addictions and research professor of psychiatry.
in UB’s Department of Family Medicine to establish a National Addiction Medicine Residency Assistance Council. The grant addresses the fact that there is a severe shortage of academically oriented addiction medicine physicians qualified to conduct clinical research on addictions, to translate this research into practice, and to teach medical students and a wide range of residents about addiction, says Blondell. “It focuses on the spectrum of addictions, from alcohol, which is America’s number one substance abuse problem, to illicit substances and prescription drugs,” he explains. “The purpose is to educate primary care doctors as well as emergency medicine physicians and, frankly, physicians in all the specialties on how to treat their patients who are already addicted, while also preventing nonaddicted patients from developing addictions.”
Blondell’s efforts to close these gaps in medical education and training couldn’t be coming at a better time, according to Kenneth E. Leonard, PhD, director of UB’s Research Institute on Addictions and research professor of psychiatry. “What Rick Blondell is doing is groundbreaking,” Leonard says. “There absolutely is a need for having more physicians to address the addiction problem. “He also is confronting a larger, more general problem, which is that issues of substance abuse are not sufficiently addressed in medical education and residency training. This is something I’ve been hearing for years.” Leonard points out that up to 40 percent of all beds in hospitals today are occupied by someone who has a substance abuse problem that has contributed to their being there, whether it be alcohol, tobacco or drugs. “Substance abuse has a massive effect on health care across the board in terms of lung cancer, heart disease, trauma and a myriad of other diseases,” he says. Nonmedical use of opiates alone accounted for 306,000 emergency room visits across the country in 2008, Leonard reports. Between 1999 and 2008, mortality rates quadrupled for deaths related to these drugs. Both Blondell and Leonard explain that there are a variety of factors leading to this spike in nonmedical use of opiates, which has indirectly led to a 70 percent increase in heroin use across the country between 2002 and 2011. “Part of what’s driving this is over the last 20 years, physicians have been told to treat pain more aggressively,” says Blondell, “We’ve responded by writing more prescriptions for narcotics, and a certain proportion of opiate prescriptions is always going to be diverted to the illicit market and misused, which creates addiction.” In response, New York State has implemented the I-STOP Prescription Monitoring Program, an electronic database that physicians query to alert them to patients who are asking multiple providers to prescribe opiates. This has reduced the availability of opiates, which has led individuals to seek heroin as a replacement drug at a time when it is cheap and plentiful. These unintended consequences have especially wreaked havoc on the adolescent population, where casual experimentation is resulting in addiction. “In just the last ten years, the shift has been toward younger people,” says Blondell. “I see people 18, 19, 20 years old, in large part because of the availability of diverted drugs.” Nobody knows the scope of this problem better than pediatrician Jerry Daigler, MD ’68, a longtime colleague of Blondell’s and medical director of the Renaissance House in Buffalo, a residential facility that treats youth with substance abuse issues. “Over the 22 years I’ve been doing this, we’ve had various drugs come and go, but in the last five or six years, it’s been opiates, like heroin, and now it’s not just an occasional thing—kids are dying.” Daigler says that a counselor at the Renaissance House recently asked him to sit in on a support group. “The kids said, ‘We don’t know what to do. We’ve lost five of our friends in the last six months from drugs, and we just don’t know how to cope with it.’”
Jerry Daigler, MD ’68, left, medical director of the Renaissance House in Buffalo, a residential facility that treats youth with substance abuse, and Laura Wood, right, whose son successfully completed the program and who today speaks to community groups about her family’s experience.
“Over the 22 years I’ve been doing this, we’ve had various drugs come and go, but in the last five or six years, it’s been opiates, like heroin, and it’s not just an occasional thing— kids are dying.”
Daigler explains that he first college. In high school, he was a bright became involved in this field student who excelled. Chronic stomach because “in talking to medical problems masked his early use of drugs. residents to see what their level “When I first thought it was drugs, the of knowledge of substance abuse school and his doctors were telling me was, I was taken aback by the fact ‘No, it’s something else. He’s too bright that most of them didn’t have and adjusted,’” says Wood. “By the time much experience at all, even in the school started telling me it was drugs, —Jerry Daigler, MD, medical director of Renaissance House their training. I was in denial.” “They will be taught about Wood, who speaks to community obscure diseases they will probably never see their entire careers, but groups today, says she didn’t understand the power the addiction they don’t spend much time talking about prevention of substance had over her son, and it nearly cost him his life. abuse and how critically important it is,” he says. If Blondell’s goal of introducing addiction medicine into Daigler and Blondell both emphasize that intervention needs to be physicians’ education and training is realized, then doctors will have early, especially if there is a family history of substance abuse. a crucial new role in saving lives. Yet according to studies Daigler referenced, more than 50 percent To read more about the training and research initiatives of pediatricians today report that they do not talk to their patients described in this article, go to www.buffalo.edu/news.html and about substance abuse. search “Richard Blondell.” Laura Wood’s son, Brian, completed the program at Renaissance House and has gone on to a successful career after completing Ellen Goldbaum contributed to this article.
Anthony Turner, left, and Sarah Riley, seated, both Class of 2016, talk with Sean Scott during a visit to the Friends of Night Peopleâ€™s free health clinic.
By Colleen Karuza
CARE TO MAKE A DIFFERENCE Medical students, residents and faculty learn by serving the underserved
On his first day as a volunteer at the Friends of Night People’s free health clinic in Buffalo’s Allentown district, second-year medical student Anthony Turner didn’t expect to be taught a lesson in humanity. His first patient, a middle-aged man who complained of blistering and bleeding feet, was unemployed, uninsured and spent his nights sleeping under a bridge. “There I was,” says Turner, “in my dress slacks, shirt and tie helping a homeless man who thought his most pressing needs were a pair of clean socks and a prescription for anti-fungal powder.” The encounter was humbling, and an eye-opener for Turner. “Despite his circumstances, this man was upbeat and joked about his smelly feet, his girlfriend, his lack of finances. He moved me, and from the moment I met him, I knew that I wanted to embody the mission of service.” Affirming a commitment For centuries, institutions of higher learning have been perceived as islands far removed from the real world, despite the fact that community service has historically been part of their mandate. In an effort to more proactively affirm their commitment to outreach, universities are beginning to include structured, credit-bearing community service courses in their curricula, and professional schools, such as UB’s medical school, are enthusiastically on board, calling this national trend a “triple win” for students, faculty and the communities in which they live and work. “There’s no question that there is profound value to experiential learning,” says Debra Stamm, assistant dean for student services in the Office of Medical Education. “Medical schools nationwide are acknowledging that it creates better doctors. Out in the community, students immediately realize why they’re doing what they’re doing and for whom.” David M. Holmes, MD, clinical associate professor of family medicine and director of global health education in the medical school, adds: “Today, more than ever, we need to prepare our future doctors for relevant, real-world experiences and expose them to diverse populations and current health care challenges on regional and global levels.” At UB, service learning is a university-wide initiative that offers students and faculty in every discipline and at every rung of the professional ladder a chance to make a difference.
For students, service learning integrates classroom instruction, meaningful community service and personal reflection; fosters civic and global responsibility and engagement; and teaches cultural sensitivity in realworld settings. For communities, successful partnerships between universities and service agencies result in underserved and overlooked populations receiving much-needed care. For faculty, service learning enriches mentor-student relationships and heightens awareness of and involvement in the changing issues and concerns unique to populations and communities. Not about grades or credit Community outreach has long been an important part of UB’s medical education, says Stamm. For example, students established the Lighthouse Free Medical Clinic on Buffalo’s east side in 2001 and continue to play an integral role in operating it. Yet, the service-learning model was not formally incorporated into the medical school’s curriculum until the fall of 2011, when the credit-bearing elective “Interdisciplinary Medicine” was offered to first- and second-year medical students. The new elective has been very popular, with roughly 75 percent of the students signing up since its inception. Participants attend a mandatory lecture, work a minimum of three hours in the community and submit an essay that captures their impressions.
“I’ve seen how committed individuals are to bettering this community, sometimes at great personal sacrifice.”
Ruchi Mathur, MD ’14, examining Kelle Barney at the Lighthouse Free Medical Clinic, founded by UB medical students in 2001.
The evaluative process for the course focuses on the quality of the experience for the student. “If you take the course and meet the requirements, you’ve succeeded, and success here has its own rewards,” says Stamm, who spearheads the initiative along with David A. Milling, MD ’93, senior associate dean for student and academic affairs, Kim S. Griswold, MD ’94, MPH, associate professor of family medicine and psychiatry, and Linda Pessar-Cowan, MD, professor of psychiatry. “It’s not about grades or credit,” concurs second-year medical student Sarah Riley, president of UB’s student branch of Physicians for Human Rights and student manager of Friends of Night People’s clinic. “The fact that the course is not mandatory allows students who have a genuine interest in service to participate, and for the right reasons. Frankly, there are days when it feels like I’m getting more out of the experience than the people we’re serving.”
Patient-centered learning Riley says she devotes anywhere from two to 10 hours a week to community service. Despite the rigors of medical school, she says her work with refugees, the homeless, the poor, and other medically underserved populations has helped her see a bigger, more inclusive picture of society. “It is selfishly gratifying to provide medical care for people in desperate need of basic TLC. On any given day, at Friends of Night People, we see patients with complaints ranging from simple colds and rashes to endocrine disorders, STDs, hypertension and diabetes. “Many of them are so grateful just to be able to talk to someone that they hug us as they leave,” she says. “It has taught me to never underestimate the importance of communication as the cornerstone of a trusting relationship with another person.” UB medical students can choose their venues for service learning. They are given opportunities to work at community
—Ruchi Mathur, MD ’14
health clinics at organizations such as Buffalo City Mission, Cornerstone Manor, Good Neighbors Health Care, Jericho Road Community Health Center, Friends of Night People, among others. There are also opportunities to work with refugees, rural populations and communities in developing countries. While service learning is primarily clinic based, other equally important outreach opportunities are available through the medical school, including school health programs such as Tar Wars and HeartSmart, or mentoring programs such as Girl Scouts Go to Medical School. In the clinics, students triage patients, take vitals, conduct interviews, perform physical exams, obtain family histories, locate community resources and perform many other services—all under the supervision of an attending physician. Most of the students are attracted to patient-centered volunteer work and say that face-to-face contact with patients—
Nancy J. Parisi
Linda Pessar-Cowan, MD, left, and Debra Stamm moderating a small group discussion with students.
“There’s no question that there is profound value to experiential learning. Medical schools nationwide are acknowledging that it creates better doctors.” —Debra Stamm, assistant dean for student services
and often their families—is key to adequately assessing and addressing their needs. “It’s essential that we understand individuals beyond their physical complaint,” says Ruchi Mathur, MD ’14, who is looking forward to a career in community-based family medicine. “For example, you can’t really teach cultural sensitivity. That’s something you need to learn through experience.” Mathur says that her work at the Lighthouse Free Medical Clinic has given her a comprehensive introduction to the obstacles patients face in achieving health. “The most important thing I’ve learned is that if I don’t understand my patients and their individual needs—physical, mental, cultural and social—I won’t be able to really help them.” Better insight into needs At the end of the elective, students submit a paragraph reflecting on their service
and meet in small groups moderated by faculty to share their experiences with other students. “These discussions become teachable moments because students in the field often have a better understanding of our community’s needs,” says Stamm. Because a large number of patients were coming into the Lighthouse Free Medical Clinic with skin rashes and lesions, for example, a dermatology clinic was established; and because parents were bringing in their children to have physical exams completed for school, these were added to the clinic’s routine services. Most students report that they feel more connected to Buffalo and its residents by participating in community service activities. “I’ve seen how committed individuals are to bettering this community, sometimes at great personal sacrifice,” observes Mathur, a native of Amherst, NY.
Global health scholars At UB, real-world medical training extends beyond medical school into the residency program. The UB Global Health Scholars Track, for example, was launched in June 2013 by the Department of Family Medicine. It provides residents with firsthand clinical health care experiences in such developing nations as Mexico and Congo. “Residents gain valuable exposure to procedures, tropical medicine and infectious diseases that they likely would not encounter during normal rotations in the United States,” says program director David Holmes, MD, who recounts time he spent in Kenya as a fourth-year medical student at the University of Vermont. “I saw diseases that I had only read about: measles, polio, worms, spina bifida. Such exposure not only enhances your professional knowledge base, but also adds perspective and depth to your life experience.
“Many of them are so grateful just to be able to talk to someone that they hug us as they leave.”
—Sarah Riley, Class of 2016
Medical students Anthony Turner and Sarah Riley outside the Friends of Night People’s free clinic.
“That’s what we hope to give our residents.” With the large refugee population in Buffalo, UB family medicine residents also have an opportunity to work with primary care providers and refugee resettlement agencies to attend to the special needs of these patients and their families, Holmes explains. Faculty teach by doing Because UB medical faculty are themselves involved in ongoing community service activities, they are highly influential role models for students. Volunteering their time and talents, faculty work with refugees, organize programs in remote rural areas, serve as attending physicians at health clinics, provide emergency psychiatric support, coordinate health fairs and promote cancer screening programs.
“For me, medicine is a lot more fun when I don’t get paid for it,” says Holmes, who also is the volunteer medical director at Good Neighbors Health Care, a free clinic he helped found on Buffalo’s east side. “The medical staff are all volunteers and patients are so grateful,” he adds. “This makes the experience more inspiring, more personally rewarding. I know that many of our students feel the same.” In the next issue of UB Medicine, we will introduce a new column that spotlights volunteer work being done in the community by UB medical school students, residents and faculty.
Joseph Tanbakuchi, Class of 2018, left, examining Ruben Rivera at Good Neighbors Health Care Clinic, assisted by David M. Holmes, MD, right, professor of family medicine, who helped found the free clinic.
SERVICE ROLE-MODELS HONORED Not surprisingly, about 15 UB medical students are members of the Gold Humanism Honor Society, a national organization that recognizes medical students, residents, and role-model physicianteachers for excellence in clinical care and dedication to service. Organized to promote humanism in medicine, the society works within and beyond medical education to inspire, nurture and sustain lifelong advocates for patient-centered care.
by students. Recently, faculty members Daniel Sheehan, MD, PhD â€™89, clinical associate professor of pediatrics, and Colleen Nugent, MD â€™09, pediatric gastroenterology fellow, applied for residents to be part of the society. Due to their efforts, UB is currently the only medical school in the nation to be represented in all three membership branches: students, faculty and residents.
Third-year medical students are nominated by their peers for membership, and faculty are nominated
A LIFE-CHANGING PLACE William Stendardi, Class of 2016, looks forward to giving back
B y S. a . u n g e r
When second-year medical student William Stendardi spoke at the groundbreaking ceremony for the new medical school, the last thing he expected was the standing ovation that he received. “I was so nervous, I thought I was going to break down,” Stendardi says, recalling the chilly day last October when he stood before a crowd of elected officials, university leaders, faculty, alumni and media in a makeshift tent on the Buffalo Niagara Medical Campus. “My past came back to me, and I just tried to keep myself together.”
hat flashed before Stendardi were memories of the overwhelming odds he had overcome to enter medical school, the affection he felt for UB and the gratitude he had for the physicians who had kept his grandmother alive long enough to have seen him through his adolescence. A native of Brooklyn, NY, Stendardi is hesitant to talk about his past, providing just enough details to explain why it’s important to him to give back to society and to UB for the help he has received. Stendardi says that the first time he remembers meeting his mother was when he was 9 years old and went to live with her, his grandmother and a great aunt. His mother
worked nights as a health care aide, so he rarely saw her. “She was working to put food on the table,” he says, explaining that it was his grandmother who was there when he got up in the morning and when he came home from school each day. And they grew to be the best of friends, sharing meals, watching television, talking and playing games. But the safety net was fragile, as his grandmother had been diagnosed with stage 4 cervical cancer several years earlier and had long-term complications. Also, when Stendardi was 12, he walked into a room to find her having a heart attack. She survived and continued to be there for him and his older brother, encouraging them to do well in their studies. But Stendardi didn’t apply himself in school, even though he
William Stendardi, right, with his mentor, Judith Tamburlin, PhD ’88, associate professor of biotechnical and clinical laboratory sciences.
“Dr. Tamburlin is my mentor. Every day I leave class, I pass by her door just to see if she is there.”
care of my health, eating right. Alumni Arena was the little place where I would go to be OK.” One thing Stendardi did learn that first semester at UB was that he didn’t have the study habits that his dorm mates had, a woman and another man, each of whom carried a 4.0 GPA. “I had never really been exposed to people who studied like they —William Stendardi did,” he says. “I never had an upbringing like that.” A SEED IS PLANTED But a seed was planted that helped After high school, at the urging of his him make the best of a crisis that woke him up and turned mother and grandmother, Stendardi enrolled in CUNY, around his life. College of Staten Island as an engineering major, but his heart wasn’t in it. He focused more on his 60-hour-aweek job in a music store than he did on his classes, DETERMINED TO GET HIS LIFE TOGETHER and floundered. When he returned home after his spring semester, Stendardi When all his friends from high school moved away, broke his leg playing handball. He underwent several Stendardi decided to expand his horizons as well. He surgeries and had to learn to walk again. enrolled at UB because it was the only SUNY school that “It was the best thing that ever happened to me,” he says. had mechanical and aeronautical engineering. “That whole summer, I lay in bed—with my grandmother in Again he struggled, putting time in at the gym the next room struggling with cancer and chemotherapy— bodybuilding, instead of studying. “I tried majoring in and I began to wonder, ‘What am I doing with my life?’ I had engineering, psychology and economics,” he says. “I didn’t seen my mother working so hard, my grandmother suffering know what I wanted to do, but I loved working out, taking with cancer, and I thought, ‘I can’t keep doing what I’m says he had a passion “for building stuff and figuring out how things worked” and showed a strong aptitude for science. He recalls the day his high school physics teacher confronted him. “He said to me, ‘William, why aren’t you getting higher grades on exams?’ And I told him, ‘It’s because I don’t do my homework, but I love learning.’”
“I really didn’t want to go to medical school anywhere else. I didn’t want to give back to any other school or community, because without this university, without this city, I don’t know where I would be right now.” —William Stendardi
doing.’ I knew I had the ability to do better.” Determined to get his life together, Stendardi decided to explore exercise science as a major. That fall, he returned to UB and began a class that changed his life—Anatomy 113—taught by Judith Tamburlin, PhD ’88, associate professor of biotechnical and clinical laboratory sciences in the School of Medicine and Biomedical Sciences. He got an A in the course and Tamburlin offered him a teaching assistant (TA) position. Six years later, Stendardi is still a TA in the course. “I started teaching science and the anatomy of the human body, and I kept learning as much as I could about disease,” he says. “I began to understand my grandmother’s health and my own. “Everybody says anatomy is just memorization, but there’s a language to it, and I loved helping others to understand it like I did. It was just amazing. It gave me meaning and purpose. I thought, ‘I can live for this.’”
KEEP DOING WHAT YOU’RE DOING Stendardi threw himself into his studies that semester and got a 3.98 GPA. His goal was to gain entrance to the exercise science program, which he did, graduating in 2012. “I think I was actually more excited about getting into that program than into medical school because I had come so far,” he recalls. Shortly after beginning the program, Stendardi volunteered at the VA Medical Center in geriatrics. “It began to click that I wanted to go to medical school,” he says. “I saw the physician’s role, and I saw that it was a way I could give back.” He went to see an advisor, who told him how hard it would be to get into medical school. He then talked to his gross anatomy professor, Charles Severin, MD ’97, PhD, associate dean for medical education and admissions, and asked his advice.
“A lot of our students participate in service learning—everybody is out to help each other. Any of my classmates would say a lot of the things I’m saying about giving back.” —William Stendardi
“Dr. Severin told me: ‘Keep doing what you’re doing—the volunteering and teaching—and try to get the best grades you can,’” Stendardi recalls. “So I did. I got all As.” Even now, having completed his second year of medical school, Stendardi continues to work closely with Tamburlin, serving as a lecturer and TA in her Anatomy 113 course. “Dr. Tamburlin is my mentor,” he says. “Every day I leave class, I pass by her door just to see if she is there.”
FOR THE LOVE OF HIS GRANDMOTHER Stendardi continues to be motivated by his love for his grandmother, who died while he was an undergraduate. “She didn’t even see me apply for medical school,” he says. “She wasn’t there for my application. But she knew I wanted to go into medicine.” The memory of his grandmother, he says, helps him to gain perspective on his career and what he wants to give back to his community and UB. “There are very few places in my life that have changed me,” he reflects. “I really didn’t want to go to medical school anywhere else. I didn’t want to give back to any other school or community, because without this university, without this city, I don’t know where I would be right now.” Stendardi received a partial scholarship to attend UB medical school and appreciates that others have been similarly assisted. “UB is really good about spreading around the help. They don’t just give five people full rides,” he says. “To me, that’s more important than just my getting help individually.” This philosophy, he says, carries over into the student body. As Polity president, Stendardi says his best friends are his fellow board members, all of whom are dedicated
to community service. “A lot of our students participate in service learning—everybody is out to help each other. Any of my classmates would say a lot of the things I’m saying about giving back.” If his life to date has taught Stendardi anything, it’s to not jump ahead. He is reluctant to talk about his future plans, but will talk about the person he wants to be for his family, friends, classmates, teachers and students. “One of my mottos,” he says, “is it’s not where you are, it’s who you’re with. And that goes back to medicine for me. It’s all about allowing people to experience life with others, no matter what you are doing—that’s what the physicians gave me with my grandmother.”
FACULTY KEY TO HIS SUCCESS When asked about his third year, he says, “I can’t wait to go on rotations and learn from physicians—have a chance to observe them, ask questions and be mentored.” UB faculty have been key to his success so far, and he sees this continuing. “Some people say, ‘Why does there have to be the first two years of medical school? Why can’t we just learn online?’ But I say, ‘Only the faculty can inspire you. You need faculty to motivate you, drive you’— that’s what faculty at UB have meant to me.” Stendardi feels nothing will better galvanize this type of interaction than the new medical school, set to open in 2016. “It will be so great to have everyone together in one place—students, faculty, residents, attendings—crossing paths in the hallways, in the hospitals and on the street and in gathering places,” he says. One thing Stendardi will say about his future is that he wants to be in
academic medicine—to teach, to research and to treat patients. That is how he would like to give back. For everyone in the audience at the groundbreaking ceremony that day back in October, the message Stendardi brought home is that the future of the school is not just about bricks and mortar, but also about something less tangible that arises when students with potential cross paths with caring faculty who expect from them nothing but the best. Yes, the roaring ovation Stendardi received was a pleasant surprise for him, but he admits that he was mostly thinking about his grandmother and how proud she would have been. “It was the best day of my life,” he says. To view excerpts of William Stendardi’s speech, go to YouTube and search: UB breaks ground for new medical school by UBSupporters.
VIRTUAL TOUR OF THE NEW MEDICAL SCHOOL Take a virtual tour of the new UB School of Medicine and Biomedical Sciences by visiting: medicine.buffalo.edu/alumni/virtual.html
CHILDREN WITHOUT BORDERS Pediatrician Jim Jarvis blends world-class science with service
It’s not a stretch to say that President John F. Kennedy helped map the career trajectory of Jim Jarvis, MD. Jarvis, UB’s new chief of pediatric allergy/immunology and rheumatology, credits JFK’s now-famous 1961 inaugural address with striking a directional chord in him. “Kennedy’s speech was a defining moment for me. When he said, ‘Ask not what your country can do for you, but what you can do for your country,’ the president was urging us to take personal responsibility for something we all have a stake in, and I took it to heart. I was only in the third grade, but I knew right then and there that I wanted a life of service.” 26
Buffalo is poised to lead Over the years, that call to service—and scientific acumen—led Jarvis to become one of the country’s premier researchers in juvenile idiopathic arthritis (JIA), as well as a highly regarded advocate for reducing health disparities of Native Americans. Born and raised in St. Albans, Vt, Jarvis received his medical degree from the University of Vermont College of Medicine, after which he completed a residency in pediatrics at St. Louis Children’s Hospital and a fellowship in rheumatology and immunogenetics at Washington University School of Medicine/ Barnes Hospital. Before coming to UB, he spent over two decades at the University of Oklahoma, and, most recently, a year at Columbia University. Jarvis chose to come to UB because he believes that the university and its partners on the Buffalo Niagara Medical Campus stand on a par with major academic centers across the nation working to advance genome biology and personalized medicine. “All of us in the Buffalo Niagara biomedical community have an enormous opportunity to create something important that other rust belt cities will want to emulate,” he says. “Buffalo is poised to lead the translation of genome biology into everyday medical practice, and I want to be part of that.” Revolutionary teamwork Jarvis’s research on JIA, supported by a $1.2 million grant from the National Institutes of Health, focuses on how genes are controlled and the processes involved in the development of the disease—“essentially, the first steps in the evolution of personalized medicine for this disease,” he explains. Looking at microarray-based biomarkers, he hopes to identify those children who respond best to specific JIA drug therapies, with the ultimate goal being to tailor therapies to individual patients to achieve optimal outcomes. He envisions a day when a blood test will diagnose JIA in children at high risk for the disease. Ask Jarvis how close we are to applying this research to standard clinical practice, and the excitement in his response is both convincing and contagious: “If you’d asked me that question five years ago, I would have said that we are a long way off. Not now. We are much closer than anyone ever imagined. If I had to make a prediction for my area of medicine, I’d say 10 years or less.” Another major aspect of Jarvis’s research is to assess the role of epigenetic factors, such as stress and anxiety, and to determine how these factors influence the high prevalence of JIA. Working in UB’s Clinical and Translational Research Center affords Jarvis a unique set of resources: like-minded allies. “There’s a cross-fertilization of ideas from researchers who hail from many different fields,” he says. This research-based approach—a dramatic but successful departure from more conventional department-based, or “silo,” collaborations— facilitates creativity and new ways of thinking. “Where else would a genome biologist have the chance to sit next to and exchange insights and ideas with an engineer who studies fluid mechanics or a scientist who studies brain aneurysms?” he asks. “This type of teamwork is revolutionary.”
“Buffalo is poised to lead the translation of genome biology into everyday medical practice, and I want to be a part of that.” —Jim Jarvis, MD
Health disparities in native populations Jarvis emphasizes that there is a second, equally important reason why he came to Buffalo: its proximity to indigenous American populations—populations with which he is deeply connected. “I am of Native American descent,” he says. “My greatgrandmother, Louise Barkyoumb, was a Mohawk,” a tribe that is part of the Iroquois Nation in the Great Lakes region. Native Americans have the most serious health issues of any ethnic group in the country, with “jarringly disproportionate rates of cancer, diabetes, accidents, alcoholism and suicides,” Jarvis notes. He attributes the vast majority of these conditions to chronic stress stemming from a legacy of cultural trauma, dislocation and upheaval. “We see how this operates on the immune system,” he says. “Over time, repeated trauma has a significant impact on how cells function. I believe that this has less to do with genes than it does with epigenetic factors.” Jarvis, who chairs the American Academy of Pediatrics Committee on Native American Child Health, has a strong interest in learning why rheumatic diseases are more common and aggressive in indigenous American children. Last summer, UB and the Indian Health Service (IHS) signed a memorandum of understanding to reduce health disparities in Native Americans in New York State and Southern Ontario. Jarvis will play a leadership role in this initiative to address the health needs of these medically underserved populations. “I am lucky to be working with IHS Chief Medical Officer Dr. Susan Karol, a member of the Tuscarora Indian Nation,” he says. “Along with our ties to New York State tribes, we share the same vision, which makes for a good working relationship.” Jarvis hopes to help develop Native American physicianscientists in New York State through partnerships with local tribes and colleges and strong mentoring programs, as well as to make Buffalo the “go-to” place for Native American children with arthritis and related illnesses. He says his experience working with Native Americans in Oklahoma taught him how much work must be done to build trust. “Most indigenous people have good historical reasons to associate interactions with outsiders with impending disaster. I appreciate how vibrant and resilient traditional cultures are and how much these cultures have to teach us.”
U B M E D C O L L A B O R AT I O N S
GIFT CATALYZES SCHIZOPHRENIA RESEARCH Patrick P. Lee Foundation adds crucial impetus to pioneering studies By Colleen Karuza
When spider webs unite, they can tie up a lion. This Ethiopian proverb elegantly summarizes the rationale behind the approach Michal K. Stachowiak, PhD, and his colleagues are taking to unravel the mysteries of schizophrenia—a disease of leonine proportions that wreaks havoc on the wiring, chemistry, and structure of the brain. More than 2.4 million Americans have this disabling illness,* which runs in families and affects men and women equally, usually in their late teens or early adulthood. Stachowiak, professor of pathology and anatomical sciences, and a powerhouse of collaborators from Buffalo, North Carolina, Poland and Germany recently determined how a gestational misfire in a vital neurodevelopmental pathway can trigger the onset of the disease. Such information may accelerate the design of personalized therapeutic interventions that halt the progression of the disorder, perhaps even in utero or during early postnatal development. “The scientific community finally has the tools, creative synergy and support to alter the course of schizophrenia, all of which have helped us reach a potential watershed in our understanding of the disease,” says Stachowiak, also a professor of neuroscience.
Supporters as collaborators The latest research partner to join Stachowiak’s team does not wear a lab coat, yet is adding crucial impetus to its pioneering studies. The Patrick P. Lee Foundation has awarded UB $600,000 to fund three four-year fellowships for PhD and MD/PhD trainees in Stachowiak’s lab. By supporting this training, the gift not only helps to further Stachowiak’s research but also lays the foundation for a Schizophrenia Translational Research Center on the Buffalo Niagara Medical Campus. The Patrick P. Lee Foundation was founded in 2005 by Buffalo businessman and community leader Patrick P. Lee, who built the holding company International Motion Control Inc., a global leader in the manufacture and distribution of automation and motion control technology. The company was sold to ITT Corp. in 2007. “Dr. Stachowiak’s vision and passion align with one of the main mission areas of our foundation: to promote awareness of behavioral health through education and research,” says Lee.
Lee praises Stachowiak for targeting the causes and neurodevelopmental mechanisms of schizophrenia—an area of research that he believes has been long neglected. “Dr. Stachowiak’s work is a first step in finding a cure for a disease that has touched millions of American families, including our own,” he says. “When science points us in an exciting new direction that has the potential to change lives and offer hope, it’s a road worth traveling.” Tracing the source of the disorder In a paper published in the February 2013 issue of Schizophrenia Research, Stachowiak’s team became the first to offer a global explanation for schizophrenia. The pioneering study—funded by New York State Stem Cell Science, UB and the March of Dimes—describes how disruptions in a neurological pathway during early development may flip the switch that activates schizophrenia years later. Many genes have been implicated in the cause of schizophrenia. The problem is that each patient with the disorder exhibits a mutation in a different gene. Stachowiak and his colleagues turned their attention to a question that for decades has posed a daunting challenge for scientists and clinicians: How can mutations in so many different genes trigger the complex set of abnormalities observed in the schizophrenic brain? They hypothesized that the culprit was a defect in a common neurological pathway that governs many brain circuits and transmitter systems. The team suspected Integrative Nuclear FGFR 1 Signaling (INFS), a pathway that controls the development of the entire brain. INFS integrates diverse neurological signals that regulate the development of embryonic stem cells and neural progenitor cells and intersects with other pathways involving as many as 160 schizophrenialinked genes. They proposed that an alteration or mutation in a single schizophrenia-linked gene causes a major malfunction in
“When science points us in an exciting new direction that has the potential to change lives and offer hope, it’s a road worth traveling.” —Patrick P. Lee
Michal K. Stachowiak, PhD
INFS. Using embryonic stem cells, they determined that some of the schizophrenialinked genes bind the FGFR 1 (fibroblast growth factor receptor) protein, which in turn converges on the INFS pathway. In genetically engineered mice, the researchers created an FGFR 1 mutation that attacked the INFS pathway and mimicked the characteristics of human schizophrenia: altered brain anatomy, impaired cognition, delayed onset of behavioral symptoms and overloaded sensory processes. “The FGFR 1 protein had a cascading effect on INFS that resulted in a major system failure,” says Stachowiak. “Our work indicates that schizophrenia may occur when there is a disconnect in the transition from stem cell to neuron.” Stachowiak believes this research model is the first to trace the actual course of the
disorder—from genes and brain structure to development and behavior—and opens the door to targeted interventions that arrest the disorder before it fully develops. Educating the next generation The fellowship program funded by the Lee Foundation gift was launched in January. “We’re making a long-term investment in young talent that will continue this research and contribute to its evolution,” says Stachowiak. “Think of a creek that will one day flow into a large river with a strong, steady current of ideas and advances. We’re hanging a shingle that says ‘Come join us.’” Equally important, the gift lays the groundwork for establishing the world’s first Schizophrenia Translational Research Center. “UB is developing fantastic facilities on the downtown medical campus and the most up-to-date scientific tools—DNA
sequencers, supercomputers, a stem cell program and culturing facilities, a modern pharmacy, and bioinformatics expertise— to support a pipeline of new therapies for schizophrenia,” says Stachowiak. The center would provide unique capabilities for linking clinicians with bench scientists, with the ultimate goal of deepening the understanding of schizophrenia and pioneering new treatments to improve patients’ quality of life. Stachowiak predicts that with essential funding, the center will be operational within the next several years, further uniting webs that can tie up the lion. To read more, go to www.buffalo.edu/news. html and search “Stachowiak.” Ellen Goldbaum contributed to this article. *Source: National Institute of Mental Health
UB MED DOCTOR VISITS
Photos by Douglas Levere
“The benefit of having resources all in one place is that most of these conditions are interrelated.”
OB-GYN CARE FOR OLDER WOMEN Tova Ablove brings new expertise to Buffalo
Tova Ablove, MD ’96, specializes in disorders that most women are embarrassed to talk about, even Jim BiSCo though one in four—most beyond child-bearing age—is affected. Her focus is on pelvic floor disorders, primarily incontinence and pelvic organ prolapse. Ablove is a urogynecologist in a new subspecialty called female pelvic medicine and reconstructive surgery, certified by the American Board of Medical Specialties in 2013. Last year, when Vanessa Barnabei, MD, PhD, UB’s new chair of obstetrics and gynecology, launched a national search for an expert in this field, Ablove was excited to explore the opportunity. “It was the first time I had seen a posting for urogynecology in Buffalo,” she says. In September, after a decade at the University of Wisconsin, Ablove joined UB’s faculty as clinical assistant professor of obstetrics and gynecology. Since then, she has become the founding medical director of the Buffalo Niagara Center for Pelvic Health, located on the Buffalo Niagara Medical Campus. The center is unique to the region because of its multispecialty approach to care, Ablove says. “Our plan involves both urogynecology and female urology, as well By
as colorectal surgery and rehab, so patients have all of their issues addressed in the same place.” While Ablove acknowledges that area physicians have met some of these needs individually, the continuity of care offered by the new center represents a significant advantage. “The benefit of having resources all in one place is that most of these conditions are interrelated,” she says. “The providers are able to coordinate their expertise so that patients have better outcomes.” Ablove was first drawn to the field of urogynecology while at UB. After medical school, she trained in OB-GYN and served a fellowship in female pelvic medicine and pelvic surgery at Albany Medical Center, finishing in 2003. “The specialty combines surgery and medicine, and I enjoy tending to women’s health issues, especially in an older population,” she explains. “For the most part, these are healthy women whose quality of life is being taken away. There are significant things that we can do to improve their lives in this regard.” Together with Teresa Danforth, MD ’07, the center’s urologist and a UB assistant professor of urology, Ablove has begun work on several clinical trials. “We’re interested in conducting cutting-edge clinical research to help advance standards of care in this field,” she says. It’s a happy return to Buffalo, where Ablove has fond memories of her medical school years; where she met her husband, Robert Ablove, MD ’93, clinical associate professor of orthopaedics; and where the couple is now resettling with three young daughters. To make an appointment at the Buffalo Niagara Center for Pelvic Health, call (716) 242-8520.
Photos by Douglas Levere
Since coming to UB, Johnson has concentrated on standardizing care and expanding services in fetal therapy.
PERINATAL PROGRAM INFUSED WITH NEW LIFE Jeffrey Johnson, new division director for maternal-fetal medicine
As head of perinatal diagnostic services at Dartmouth Medical School for seven years, Jeffrey Johnson, MD, was the only maternalfetal medicine specialist for all of southern New Hampshire. Yet when Vanessa Barnabei, MD, PhD, the new chair of UB’s Department of Obstetrics and Gynecology, approached him to lead the department’s Division of Maternal-Fetal Medicine, he was intrigued by the challenge—and the opportunity. In talking with Barnabei and others, Johnson learned that the UB program had a distinguished past—with prominent faculty, a record of strong research and a fellowship training program—but had lost footing in recent years due to faculty turnover. “The thing that drew me here was the opportunity to rebuild a perinatal program that capitalizes on a legacy of excellence,” explains Johnson, who joined UB’s faculty in February. “When Vanessa was hired, it was a priority both for UB and Kaleida Health to strengthen this important service, and I welcome the challenge of leading that effort.” Since coming to UB, Johnson has concentrated on standardizing care and expanding services in fetal therapy. He is the only specialist Jim BiSCo
in Western New York who can offer certain in utero fetal surgical and diagnostic procedures, and so is filling a gap in clinical services. Another priority is to recruit more faculty so that more patients can be served. To date, one new faculty member has been hired, and two additional positions are being considered. The long-term plan is to expand research and re-establish the division’s fellowship program. Johnson’s own research interests include hypertensive diseases of pregnancy and infectious diseases and antibiotic use in pregnancy. He wants to begin a placental project that looks at the etiology of pre-eclampsia, work that he had pursued a decade ago when he was director of labor and delivery at Harvard Medical School’s Beth Israel Deaconess Medical Center. Noting UB’s collaborative culture, he hopes to engage molecular science faculty in studying certain substances produced in the placenta. Johnson has a strong desire to teach at all levels and has received several teaching awards over the years. In all, he sees a foundation in place to build a stellar program at UB, which he finds to be a welcoming community with a welldeserved, positive image. “UB has an excellent reputation in New England. It’s coincidental, but at Dartmouth we had five faculty members who studied at UB. They said, ‘Oh that’s a great place. You’ll really like it there.’” Johnson is eager to bring his wife and 10- and 12-year old children to the area, along with his Swiss mountain show dog, who is working on her third title in agility competitions.
U B M E D PAT H WAY S
CHILDHOOD OBESITY EXPERT NAMED AAAS FELLOW Leonard H. Epstein, PhD, SUNY
Distinguished Professor of pediatrics, has been named a fellow of the American Association for the Advancement of Science (AAAS) in recognition of his contributions to the prevention and treatment of childhood obesity. Known as one of the most creative and productive investigators in the field of behavioral medicine and nutrition, Epstein leads UB’s pediatric behavioral medicine division. Epstein was the first to demonstrate that less television viewing improves childhood obesity treatment outcomes. His innovative approaches to reducing this habit have improved the standard pediatric obesity treatment. He also pioneered the use of lifestyle exercise as a component of obesity treatment and developed the family-friendly Traffic Light Diet, widely used to instill healthy eating habits in overweight children. The diet is a key component of the Buffalo Childhood Weight Control Program that Epstein developed and directs at UB.
a long-term success rate far higher than the typical 10 percent or less.
Institute and is a research health scientist at the VA Western New York Healthcare System.
Epstein has received more than $20 million in research funding from the National Institutes of Health.
This spring, in recognition of this and other accomplishments, Fliesler received a SUNY Chancellor’s Award for Excellence in Scholarship and Creative Activities.
FLIESLER HONORED AS A TOP OPHTHALMIC RESEARCHER Steven J. Fliesler, PhD, Meyer H.
Riwchun Endowed Professor of Ophthalmology, has been named a 2014 ARVO Gold Fellow by the Association for Research in Vision and Ophthalmology. The association’s gold-tier honorees represent the top 1 percent of its nearly 13,000 members from more than 80 countries. Fliesler is an internationally recognized scientist and current president of the International Society for Eye Research. A prolific researcher, he has been studying cholesterol metabolism in the retina for more than 30 years. For the past two decades, the National Institutes of Health has funded his pioneering studies into retinal dysfunction and degeneration associated with Smith-Lemli-Opitz syndrome.
Results show that half of participating children maintain a healthy weight after 10 years,
Fliesler is vice chair and director of research for UB’s Department of Ophthalmology. He also directs research for UB’s Ross Eye
UB PHYSICIAN-RESEARCHERS RANKED AMONG THE NATION’S TOP IN THEIR FIELDS UB is one of the nation’s top five institutions for research on and treatment of chronic obstructive pulmonary disease (COPD). The other four institutions are Brigham and Women’s Hospital, the University of California, Los Angeles, The Johns Hopkins University and National Jewish Center. The national ranking also names Anne B. Curtis, MD, Charles and Mary Bauer Professor and chair, Department of Medicine, and Sanjay Sethi, MD, professor of
medicine, as top experts in their fields. Published by Expertscape, the ranking is based on detailed reviews of the past 10 years of scientific publications in PubMed in each medical specialty. Sethi was named one of the nation’s top five experts in COPD. He is vice chair of medicine for
research, chief of the Division of Pulmonary/Critical Care/ Sleep Medicine at UB and a staff physician in pulmonary/critical care/sleep medicine at the VA Western New York Healthcare System. Along with Timothy Murphy, MD, SUNY Distinguished Professor, Sethi runs the COPD Study Clinic at the VA Medical Center, now in its 20th year. Murphy and Sethi have published widely on COPD, including research that fundamentally changed how clinicians treat bacterial exacerbations. Sethi also has worked on redefining the role and understanding mechanisms of infection in the pathogenesis of COPD and has led important clinical trials in the field. Curtis was named one of the world’s top 10 experts conducting research on implantable defibrillators. Her studies have significantly advanced knowledge of human cardiac electrophysiology and heartrhythm abnormalities. In 2013, she was first author on a New England Journal of Medicine paper on the Block HF (Heart Failure) trial, which she led, demonstrating significant benefit from cardiac resynchronization therapy (CRT).
THREE HONORED AS DISTINGUISHED UB ALUMNI Three graduates of the School of Medicine and Biomedical Sciences were among the 13 honored this spring by the UB Alumni Association for bringing distinction to the university. Charles D. Bauer, MD ’46, who received the
association’s highest honor, the Samuel P. Capen Award, has been giving to his alma mater since 1953, when he donated $45. He and his wife, Mary, have since directed the majority of their support toward endowed faculty positions, scholarships and unrestricted support to be used by the School of Medicine and Biomedical Sciences. In the next issue of UB Medicine, we will feature UB’s Clinical and Translational Research Center and the major gift the Bauers have made to the center to create a nurse manager position.
Jeffrey Wigand, PhD ’73, is a former Brown &
Williamson employee who gained national fame in the 1990s as a tobacco industry whistleblower who revealed that tobacco companies concealed the knowledge that cigarette smoking was highly addictive and caused lung cancer. His story was told in the 1999 movie, The Insider. Today Wigand works to educate children about the dangers of smoking through his nonprofit foundation called Smoke-Free Kids.
Allen Barnett, PhD ’65, is a former pharma-
ceutical industry executive. Under his leadership, ScheringPlough introduced two blockbuster drugs: Claritin, a non-sedating antihistamine that is the most successful drug in SP’s history and the fifth-leading drug, based on sales, in the world; and Zetia, a cholesterollowering agent that has achieved multibillion dollars in sales. After retiring in 1999, Barnett co-founded Kinex Pharmaceuticals, a local biotech company that currently has four oral anticancer drugs in different stages of clinical development.
VISIT OUR NEW WEBSITE! Alumni and Friends, we invite you to visit our new website at http://medicine.buffalo.edu/alumni.html Read about your classmates and colleagues, view online issues of UB Medicine, scan the latest news about your new school, and more.
PAGES OF SPECIAL INTEREST THAT WE ENCOURAGE ALUMNI TO EXPLORE CLASSNOTES—WHAT’S UP, DOC? Your classmates and colleagues want to read about you as much as you want to read about them. So write us and let us know what’s new! MEMORABLE MED SCHOOL MOMENTS? Do you have a favorite memory of UB Med School—a professor, a fellow student, a class, an event, a “teachable moment,” etc.? If so, please tell us about it. To submit a classnote or a Memorable Med School Moment visit http://medicine.buffalo.edu/alumni.html and click on “Classnotes” to complete the online form. (There is a space on the Classnotes form to include your favorite memories of your time at UB Med.) Or you can email us at firstname.lastname@example.org. Pictures are welcome!
NOMINATE A DISTINGUISHED MEDICAL OR BIOMEDICAL ALUMNUS/A Each year we present a Distinguished Medical and Biomedical Alumnus/a Award to an MD and PhD graduate of our school. The Medical Alumni Association and the School of Medicine and Biomedical Sciences invite you to submit nominations. To review criteria and submit a nomination, go to http://medicine.buffalo.edu/alumni/nominate.html.
U B M E D PAT H WAY S
FOR THE LOVE OF RESEARCH GREGORY ROLOFF, CLASS OF 2017, IS A NATURAL IN THE LAB
By Jim Bisco
Gregory Roloff’s entry into UB medical school last fall came on the heels of some heady research opportunities.
the National Institutes of Health (NIH) working in the National Cancer Institute (NCI) lab of Tom Misteli, PhD, a pioneer in the field of genome cell biology.
In the summer of 2011, Roloff was admitted to UB’s competitive CLIMB UP (Collaborative Learning and Integrated Mentoring in the Biosciences) Undergraduate Program, which lays the groundwork for graduate school, especially in fields related to drug discovery and translational science. Roloff worked in the lab of Satpal Singh, PhD, associate professor of pharmacology and toxicology, exploring the pharmacological aspect of drug interaction with the heart. The summer before that, he landed in the stem cell lab of UB biochemist Te-Chung Te-Chung Lee, PhD, where the team used stem cells to regenerate heart tissue lost to cardiac disease. The experience led to his first published paper at age 20. What has prompted Roloff to aggressively pursue such opportunities? “Everyone encourages you to do research in order to get into medical school,”
The Buffalo native had just spent more than a year at
he explains. “I did it because I find it intellectually stimulating and am inspired to characterize disease with genetic and molecular detail.”
someone like me who loves research but also wants to become a clinician, it was the perfect combination of everything I was interested in.”
His passion for bench work was fostered as a biology major at SUNY-Geneseo, engaged in lab work on breast cancer. He completed his honors thesis in genetics and tumor immunology, deciding he would concentrate his career on cancer and become an oncologist.
Roloff feels his lab experiences helped give him solid footing during his first year in medical school. “I love interacting with patients, and yet I love learning about the basic underpinnings of what it’s all about,” he says.
Roloff’s experience at NIH proved exhilarating. He became involved in studying the cell biology and genetics that determine outcomes in prostate cancer and in efforts to locate possible DNA patterns to establish predictive measures. “If we knew more about the underlying drivers that make a cancer indolent versus invasive, we would be able to transform the field,” he says. “For
This summer, Roloff is returning to the NCI to work in the laboratory of molecular immunogenetics, headed by Lauren Wood, MD, senior investigator in the vaccine branch. Their work is focused on the immunological dynamics of human papillomavirus in HIV-infected adolescents enrolled in a vaccine trial. For Roloff, the experience is just one more step in his bench-to-bedside quest.
MENTORING WOMEN IN O R T H O PA E D I C S U R G E R Y JENNIFER GURSKE-DEPERIO, MD ’05, A ROLE MODEL FOR STUDENTS AND RESIDENTS
Jennifer Gurske-dePerio and two other women shook up things in the summer of 2005 when they earned three out of four of the highly coveted residency slots in UB’s Department of Orthopaedics. At the time, a national advocate for women in orthopaedics had heard of only one other instance of such a female majority occurring, due largely to a widely held belief that “you have to be a 300-pound linebacker” to tackle the rigors of the profession. Well, Gurske-dePerio, now entering her fourth year of practice, is treating linebackers and other Buffalo Bills players at the UBMD Orthopaedics & Sports Medicine office located across from Ralph Wilson Stadium. In addition to professional athletes, she sees a steady stream of patients of all ages and backgrounds. As an orthopaedic surgeon, Gurske-dePerio’s primary areas of expertise are foot and ankle injuries, but she is also proficient in trauma,
By Jim Bisco
wound care and general orthopaedics, applying her skills at several area hospitals. An athletic student growing up in Rochester, N.Y., N.Y ., Gurske-dePerio came to Buffalo in 1995 to train in physical therapy, which she now incorporates into her patient care. She credits many of her exceptional opportunities at UB to the support she received from Lawrence Bone, MD, recently retired chair of the Department of Orthopaedics. Bone encouraged her to enter medical school and then championed her determination to buck the odds of women in the field of orthopaedic surgery. In 2011, Gurske-dePerio completed fellowship training at the Florida
Orthopaedic Institute, after which she returned to Buffalo to join the faculty at UB, where she embraces her role as clinical assistant professor in the Department of Orthopaedics. “I can still make a difference educating the next line of orthopaedic surgeons or doctors of any discipline,” she says. “Community practice is so very important, but it’s nice to stay active in the academic circle.” And yes, among those whom she teaches are women residents and medical students. “I’ve had the unique opportunity to encourage them to go into orthopaedics— and they have,” she notes. “It’s important to pass on the belief that you can do this.”
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UB MED Q&A SMOKING AND PREGNANCY, A LASTING EFFECT Babies born to mothers who smoked cigarettes while pregnant are often at greater risk than babies born to mothers addicted to drugs other than nicotine. Nicotine is a leading preventable cause of infant mortality and morbidity in the U.S., and there may be reason for concern about the lasting effects of maternal smoking on childhood development. Scientists in UB’s Research Institute on Addictions (RIA) are studying behavioral and biological differences between children exposed to cigarette smoking before and after birth and those who were not. UB Medicine spoke about this research with its principal investigator, Rina Das Eiden, PhD, senior research scientist at the RIA, and research associate professor in the Department of Pediatrics and in the Department of Psychology, College of Arts and Sciences. Eiden recently received a $3 million grant from the National Institute on Drug Abuse to continue work that has been funded since 2005.
Q: What significant differences have you found between children whose mothers smoked during pregnancy and those who didn’t? A: I should note first that mothers who smoke during pregnancy usually have other risk factors: they are more likely to be single, younger and less educated. Cigarette smoking during pregnancy causes prematurity and low birth weight. It affects the auditory receptors in the brain, with subsequent consequences for speech and hearing. In households where family members smoke after birth, infants are at higher risk of sudden infant death syndrome and respiratory difficulties such as asthma. Beyond these early outcomes, exposed children are at higher risk for conduct disorder and problems with attention and arousal regulation. Q: How do these effects compare with those produced by cocaine use during pregnancy? A: Nicotine produces stronger effects on the fetus and is more prevalent than cocaine exposure. In fact, nicotine and alcohol are the most powerful teratogens we know of. In a low-income urban population such as our sample, cigarette use during pregnancy was about 25-35 percent.
“The behavioral and physiological variability in the children exposed to nicotine during pregnancy is the most important line of inquiry in this project.”
Q: How do you observe developmental differences? A: We started with 251 mothers and babies and after three years, 90 percent are — Rina Das Eiden, PhD still enrolled in the study. We assessed children at 2, 9, 16, 24, and 36 months. The new grant funds us to follow the children into kindergarten. We hope, ultimately, to follow them into adolescence. In the lab, we look at parent-child interactions, a child’s capacity for self-regulation, such as ability to comply with rules, control negative emotions and control impulses. Physiologically, we look at autonomic regulation and cortisol changes in response to frustration. In the school setting, we conduct classroom observations and collect teachers’ reports of children’s self-regulation and social competence in the school. Q: Some children appear to be less affected by smoking exposure than others. Why? A: The behavioral and physiological variability in the children exposed to nicotine during pregnancy is the most important line of inquiry in this project. Not every child who is exposed has the problems we see in many of them. Could this be a dose-response effect? Is there a threshold level of exposure that makes a critical difference? Does the timing of exposure make a difference? What is the role of environmental risk and parenting? What are the mechanisms that explain certain behaviors, and could they lead to interventions with children who are at risk? These are some of the questions we hope to answer. —Judson Mead
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“Join me in the Circle of Leaders to help build a great new medical school for generations to come.” Rose Berkun, MD ’92, chairs the Circle of Leaders. She is an anesthesiologist at the Buffalo Cancer Center and Aesthetic Associates Center, both in Amherst, NY. To read more about this special group of medical school supporters, see page 5 in this issue of UB Medicine.
Building a completely new medical school is a once-in-a-lifetime opportunity. Seize this chance to revolutionize medical education, health care and research in Western New York. Become a partner at this pivotal moment in UB’s history. There are many ways to support your new medical school today or in the future. Opportunities include: Medical School Building Fund Circle of Leaders Circle of Visionaries Please contact Kim Venti for more information. 716-829-2773 | firstname.lastname@example.org | www.giving.buffalo.edu/ubmedicine
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My office will always be full of children. Bridget Obzud was always going to work with children. She loved babies, she had the magic touch comforting youngsters, and she liked talking with and teaching kids. Her academic affinities steered her to medicine as a good profession. Scholarships helped her attend UB medical school, where the Clinical Competency Center gave her a strong foundation in patient care. Bridget later matched with the pediatric residency program at New York University School of Medicine, exactly where she wanted to be. Sheâ€™ll arrive confident and well prepared to train for the kinds of cases sheâ€™ll see every day in her practice with children, her favorite patients. When you support our students, this is who you help.
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