Back on Cedar Street

This year’s reunion kicked off on the evening of Friday, June 2, in the Medical Historical Library with welcoming remarks from Dean Robert J. Alpern, M.D., Ensign Professor of Medicine.

“This is a special time for me. I came here two years ago on June 1. Right after I arrived, the first special occasion was the alumni reunion weekend. As I came here and was absorbing the complexity of the medical school, it was very invigorating to see all the alumni and see how enthusiastic everyone was about their experience at Yale, how much they loved it and how much they love coming back here. It was really uplifting. I look forward to experiencing that again and seeing everyone come back and hearing nothing but compliments,” he said, before concluding, to laughter from alumni, “The faculty is not that kind to me.”

By the time of the reception in the library, reunion activities were well under way. Events began the day before, with a presentation from the Yale Surgical Society, and continued earlier on Friday with Alumni Day at Epidemiology and Public Health at the New Haven Lawn Club, and two presentations in the Jane Ellen Hope Building.

The state of the school

The next morning, at the business meeting of the Association of Yale Alumni in Medicine (AYAM), Alpern brought alumni up to date on the state of the medical school. A new deputy dean of education, Richard Belitsky, M.D., associate professor of psychiatry, has been appointed, as has a new associate dean of admissions, Laura R. Ment, M.D., professor of pediatrics and neurology. “The educational program is outstanding,” Alpern reported, “but there are always ways to improve it, especially during the third and fourth years.”

The medical school ranks in seventh place in total funding from the National Institutes of Health, and about 30 biotech startups affiliated with the medical school have begun operations. “We have become a major engine of the local economy,” Alpern said.

He also cited the formation of a translational research center at the medical school, a new stem cell center with potential funding from the state of Connecticut, a center for clinical investigation and the start of construction of a new 14-story addition to YNHH for cancer care.

Honors for alumni

Francis R. Coughlin Jr., M.D. ’52, and Sharon L. Bonney, M.D. ’76, each received the Distinguished Alumni Service Award.

Coughlin was honored for his service to the medical school, including a term as president of the AYAM. His citation noted that Coughlin went to law school in 1985 and has since served on medical and legal commissions in New York and Connecticut.

Bonney’s citation traced her career path from clinical work to clinical research and development in the pharmaceutical industry. She served on the alumni executive committee twice and is currently the medical school representative to the Association of Yale Alumni (AYA).

At the business meeting, members elected a new secretary, new board members and a new representative to the AYA. Robert W. Lyons, M.D. ’64, was elected to a three-year term as secretary, replacing Christine A. Walsh, M.D. ’73, who was named AYAM representative to the AYA, along with Irving G. Raphael, M.D. ’71. Carol J. Amick, M.D. ’59, Arthur C. Crovatto, M.D. ’54, HS ’61, and Richard D. Kayne, M.D. ’76, HS ’79, were elected to the AYAM executive committee as members at large.

Working across disciplines

Alumni began the day with a symposium on a new model for interdisciplinary research.

In order to break barriers in medicine, Yale is knocking down intramural walls that tend to confine researchers within their own disciplines. Why keep some of the world’s best scientists cooped up in their specialized fields, the thinking goes, when they can conquer diseases by sharing their expertise?

This synergistic model recently took the form of the Interdepartmental Program in Vascular Biology and Transplantation, whose work was outlined at a forum during the School of Medicine’s Alumni Weekend in June. Bringing together experts from many fields is “bridging the taxonomies of science and medicine,” said Francis M. Lobo, M.D. ’92, president of the AYAM. “The walls are coming down.” Lobo spoke in a literal as well as metaphorical sense. The loosely knit vascular biology and transplantation team will work together in the Amistad Building under construction on Amistad Street. The interdepartmental program was established in 2000 and now has 36 faculty members from a range of disciplines, including surgery, medicine, dermatology, anesthesiology, cardiology, immunobiology, pharmacology, genetics, pathology and biomedical engineering.

Jordan S. Pober, M.D. ’77, Ph.D. ’77, director of the program since its inception, said he “had a personal epiphany” in 1996 at a meeting of vascular biologists. Vascular biologists examine the cellular structure of the vessels that feed every organ in the body and whose failure lies at the root of many deadly diseases. Although vascular biology had been a specialty only since the 1980s, “the field had matured,” Pober said. “We understood the basic principles. What we didn’t know was how we could use this stuff to treat patients.”

Pober convinced former Dean David A. Kessler, M.D., to launch the multidisciplinary program even though there was no blueprint for it. Team members acknowledged that the “translational” aspect of the program would involve more research than actual therapy in its early stages. If something works in mice, “most of the time it doesn’t work” in humans, Pober said. “We decided that we couldn’t cure everything.” The researchers focused on a few targets: arteriosclerosis, alleviating organ shortages through xenotransplantation or tissue engineering, and regeneration—or, as Pober put it, “How do you get new blood vessels to grow?”

Pober, a professor of pathology, immunobiology and dermatology, specializes in the role of blood vessel cells in immunology. Working with his late colleague, Jeffrey S. Schechner, M.D. ’91, Pober used his knowledge of blood vessel cells to grow vascularized synthetic skin. He studies the role of endothelial cells, which form the inside layer of blood vessels. William C. Sessa, Ph.D., deputy director of the program and professor of pharmacology, said that researchers want to solve the problem of endothelial dysfunction and the peripheral artery disease (PAD) that it causes. PAD appears in 20 percent of patients over age 55 and has a 25 to 30 percent mortality rate within five years. Sessa said that a key to pad appears to be the inability of the cells to produce nitric oxide or use it efficiently, and that his lab is working on injections of an enzyme called endothelial nitric oxide synthase. This enzyme protects against disease by improving blood flow through the vessels by relaxing vascular tissue.

George Tellides, M.D., HS ’93, Ph.D., associate professor of cardiothoracic surgery, said that the goal of his research is to find the immune mechanisms behind vascular injury and remodeling—specifically, the effects of interferon-gamma following injury. Interferon-gamma appears to stimulate an overgrowth of muscle cells in the wall of the arteries, which eventually causes narrowing of the arterial lumen.

And Laura E. Niklason, M.D., Ph.D., associate professor of anesthesiology and biomedical engineering, said her role is to create new blood vessels through tissue engineering “so that we might one day have an endless supply.” The formation of these vessels comes through biodegradable scaffolds that contain enough space for the vascular cells to develop a new artery, she said.

Innovations in the classroom

The patient had missed her dialysis and was steadily deteriorating as a group of medical students debated treatment options. Thankfully, she was in no danger—the patient was a high-fidelity patient simulator, a mannequin capable of physiological responses that is used to train third-year medical students.

The simulation program presented by the Society of Distinguished Teachers to alumni at reunion on Friday, June 2, and one of six programs funded by the society during the last academic year, is part of the society’s effort to develop innovative teaching methods. Leigh V. Evans, M.D., HS ’02, assistant professor of surgery (emergency medicine), showed a video of the simulation program and explained that students use partial task trainers to practice such procedures as airway management, as well as more sophisticated mannequin simulators to unravel complex cases.

In another program funded by the society, AMISTAD (Advanced Methods of Interactive Simulations Through Academic Design), students work with standardized adolescent patients, a component often lacking in medical school programs, according to Karen Santucci, M.D., associate professor of pediatrics (emergency medicine).

This program trains 14- to 17-year-olds as standardized patients. The students interview each patient to arrive at a diagnosis. This approach allows the students to develop a level of comfort interviewing members of an age group with whom they might otherwise come into contact only after graduation.

Bugs—they’re not always bad

Later Friday afternoon alumni learned what happens when pathogens interact with the human body. Most of the time, nothing, according to Jorge E. Galán, D.V.M., Ph.D., professor and chair of microbial pathogenesis. But in a presentation to alumni at reunion in the Hope Building, “Bacterial Type II Secretion: Not Your Average Needle Stick,” Galán explained what happens when pathogens interact with human cells and how this interface can be used to fight disease.

Pathogens are designed not to cause disease but to replicate, and in so doing they have developed an elegant “machine” to enter cells. Galán described this mechanism as a nanosyringe that injects proteins into cells. It can theoretically be used as a delivery platform to transport vaccines or antigens that could provoke the immune system into destroying tumors. In the lab, Galán has shown that orally administered Salmonella engineered to express a tumor antigen can destroy tumors in mice. He hopes to conduct trials in human subjects next year.

Surgical society honors a mentor

On Thursday, June 1, the Yale Surgical Society paid tribute to William F. Collins, M.D. ’47, the Harvey and Kate Cushing Professor Emeritus of Neurosurgery, who served as chief of neurosurgery at the medical school and as chair of surgery from 1984 to 1994. Retired and dividing his time between San Diego and Guilford, Conn., Collins has been writing short stories, novels and murder mysteries during the past few years. He was in town for the reunion and listened as the surgeons he trained recalled what they learned from him.

“The things we learned on the rotation in neurosurgery were the importance of the accountability of being a physician, a passion for patients—many with devastating spinal injuries—and the fact that you embraced innovation,” said Walter E. Longo, M.D., M.B.A., HS ’87, chief of the section of gastrointestinal surgery at the medical school. “You were always available to listen to us. You always looked for ways to increase our clinical experience. You made sure that we were educated, that we were mentored and that we were inspired.”

Dennis D. Spencer, M.D., HS ’77, the Harvey and Kate Cushing Professor of Neurosurgery and chair of neurosurgery, recalled meeting Collins when he came to Yale in the 1970s. “It was palpable,” Spencer said. “I felt this passion he had for training not just neurosurgeons, but all young surgeons.”

Richard D. Bucholz, M.D. ’77, HS ’83, director of neurosurgery at the Saint Louis University School of Medicine, said Collins encouraged him on an unusual career path. Bucholz had a longstanding interest in computers and believed they could help to improve surgery and surgical outcomes. By coupling computers to new imaging technologies the surgeon can perform a “virtual” surgery to help reduce mistakes in the subsequent real procedure. “With these systems you can do the procedure ... before you even get into the operating room,” Bucholz said. Then, by using navigational computers that track instruments during the operation, surgery can be simplified and made safer. “Surgery takes on aspects of a video game—which may appeal to our younger surgeons,” Bucholz said.

He envisioned a system in which all operating room devices are connected and provide real-time data about the patient. That information can be transmitted to consultants outside the operating room so that they can offer the benefits of their clinical experience. “In a very real way we can share and record experiences and use them to enhance outcomes,” Bucholz said.

Also at the society’s meeting was Charlotte Ariyan, M.D., Ph.D., an oncology surgeon, who received the fifth annual Samuel Harvey Award as an outstanding chief resident.

Public health—from disparity to equity

With 46 million people uninsured and an equal amount underinsured, our health care system is broken, Cynthia A. Gomez, Ph.D., told the audience at Alumni Day at the Department of Epidemiology and Public Health, on June 2. “A weak and inequitable health system is going to create poor health in our nation. We have a nation and a world in which health is deteriorating to the degree that it is definitely going to affect the future of this country and the world,” said Gomez, director of Health Equity Initiatives at San Francisco State University.

Her keynote speech, “Separate and Unequal: Confronting Disparities in Health,” kicked off a discussion on one of the biggest challenges in health care today. Many of the diseases confronting society, such as obesity, diabetes and cardiovascular disease, can be prevented by changes in behavior, Gomez said. People of color suffer disproportionately from these chronic diseases, but the nation spends more money on treatment than on prevention, she said.

Gomez urged alumni to shift the conversation from disparities to health equities, which concerns justice. “When the water rises, all boats rise,” she said. “Do we as a society care if there’s a future? If we do, how do we make a society not so burdened by disease?”

Panelists at this year’s reunion symposium, moderated by Jeannette R. Ickovics, Ph.D., associate professor of epidemiology and psychology, explored the complexities of health disparities and suggested new approaches. The Yale School of Nursing is working to achieve equity by creating a partnership with the Howard University Division of Nursing, said Marjorie Funk, M.S.N. ’84, Ph.D. ’92, professor of nursing and director of the Yale-Howard Partnership Center on Health Disparities. In 2000, Yale and Howard created a partnership to enhance the research capacity of minority nursing students and faculty. Since then, Yale has brought 34 undergraduate nursing students from Howard to New Haven for summer research internships. Today, more than half of those students have completed or are completing graduate work, increasing research in health disparities at both universities.

Beth A. Jones, M.P.H. ’86, Ph.D. ’93, associate professor of epidemiology, studied disparities in the mammography process: do African-American women receive the same benefit from mammography? She found disparities in three areas: adherence to guidelines for frequency of mammography, differences in follow-up care for abnormal screenings, and communication and understanding of the results.

“We know that even at the same stage of diagnosis, the mortality rate among African-American women is greater,” said Jones. “We’ve made huge progress in terms of treatment and early detection, but it’s time to start thinking about strategies to ensure that all groups benefit from these advances, so that we can eliminate the disparities in outcomes.

When it comes to cardiovascular diseases, said Harlan M. Krumholz, M.D., the Harold H. Hines Jr. Professor of Medicine, professor of epidemiology and public health and co-director of the Robert Wood Johnson Clinical Scholars Program, studies have shown that African-Americans undergo disproportionately fewer procedures—cardiac catheterization, angioplasty and bypass surgery—than whites. There is no evidence, however, that these procedures improve outcomes.

“When you find something like this disparity, you have to decide. Is it a difference without a consequence? Is it a difference with a consequence? Then we can call it a disparity. Is it a difference with a consequence that we cannot attribute to anything else but pure bias against a certain group?” he said.

The final panelist was Curtis L. Patton, Ph.D., professor of epidemiology (microbiology) and director of international medical studies, who retired in July after 36 years. Patton, who is African-American, spoke about the ability of African-Americans to survive.

“We know that when we look at the medical literature published in the 19th century, experts predicted that nobody who looks like me is supposed to be here. We were supposed to have disappeared a long time ago, and at several points in history—from tuberculosis, syphilis, starvation—you name it,” he said. “In some ways, people who look like us are monuments, not just to slavery, but to survival and exceptional competency.”

Race, ethnicity and genetics

As work on the human genome shifts from sequencing to understanding how DNA affects health, the roles of race and ethnicity also come into play, said Vence Bonham Jr., J.D., the National Human Genome Research Institute’s senior advisor to the director on the societal implications of genomics.

“This conversation is not ending,” Bonham said in his special address to public health alumni. “It is only beginning and that is why it is so important to public health professionals.”

Acknowledging that race and ethnicity are social and political constructs, he discussed the complexities of race-based medicine. And he cited BiDil, a drug that was approved by the FDA in 2005 to treat congestive heart failure. A retrospective study found that the drug, which was first tested in the 1980s and 1990s, seemed to benefit blacks more than whites. In 2005 the fine print on the label noted that the drug was indicated for use by “self-identified blacks.”

“It is the first drug in the history of the United States to be approved for only one racial group,” Bonham said. “Who is a self-identified black? What does that mean?”

The implications of race and ethnicity for public health and health care practitioners center on how research studies are designed, as well as how the results of such research are interpreted, according to Bonham. “Race and ethnicity are important components of health in our society, but we have to be careful about how we use them.”

Awards and the state of EPH

This year’s Distinguished Alumni Award went to Irene Trowell-Harris, Ed.D., M.P.H. ’73, director of the Northeast Regional Office of Healthcare Inspections, Office of the Inspector General, Department of Veterans Affairs.

The Eric W. Mood Award was given to Elisabeth Schauer, M.P.H. ’96, director of vivo international, a foundation that deals with mental health issues in communities affected by violence and conflict.

Katrina Clark, M.P.H. ’71, executive director of the Fair Haven Community Health Center in New Haven, received the Emerging Majority Affairs Committee’s (EMAC) Health Equity Award for her leadership in promoting community health in New Haven. EMAC, a committee of the Association of Yale Alumni in Public Health, strives to increase the representation of African-Americans, Latinos and other under-represented groups in the student body.

Curtis L. Patton, Ph.D., received the 2006 Award for Excellence for his service to the department and to the university (see Curtis Patton Retires from Research and International Health).

Matthew Lopes, M.P.H. ’77, director of AIDS Care for New Haven’s health department, and Judith Stavisky, M.Ed., M.P.H. ’80, who developed public health programs for low-income populations in Pennsylvania, were inducted into the 2006 Alumni Public Service Honor Roll.

Brian P. Leaderer, M.P.H. ’71, Ph.D. ’75, the Susan Dwight Bliss Professor of Epidemiology, who served for 18 months as interim dean, gave a brief report on the state of the school. Recent accomplishments included the implementation of a five-year joint program with Yale College that will allow undergraduates to take public health courses during and after their undergraduate education and earn an M.P.H. one year following receipt of their undergraduate degree. Five new faculty members will start in September, Leaderer said, in biostatistics, environmental health, health policy and social and behavioral science. The school is also undergoing a self-study as part of the accreditation process, he said.

Leaderer introduced the new dean of public health, Paul D. Cleary, Ph.D., whom he called “the best of all applicants.”

Cleary said he hopes to create “the best possible educational experience” in the department. “I am hoping I can rely on your advice and counsel as I try to do that over the next several years,” he told alumni.