Grand Rounds Magazine Fall 2010

8/6/2019 Grand Rounds Magazine Fall 2010

1/13


2/13

A GrowingCommunity Newconstruction projects

enhance the sense of

community on the Medi-

cal Center campus. |page 6

Ethics in ActionNew director of health care

ethics stresses clinical skill

development|page 12

Their Living LegaciesThe School of Medicine loses

leaders in medical education

| page 16

Poised for DiscoveryA fetal surgeon and a cancer

researcher make headlines and

raise hope| page 18

Vital Signs|page 2

Alumni Pulseand Living the Mission|page 20

Prole ofPhilanthropy|back cove

For more information about

the magazine or to submit story

suggestions, please contact

314| 977-8335 [email protected].

GrandRoundsVol. 8 No. 2 Saint Louis University School of MedicineFall 2010

Grand Rounds is

published biannually by

Saint Louis University

Medical Center

Development and

Alumni Relations.

Grand Rounds is mailed

to alumni and friends of the

School of Medicine.

Philip O. Alderson, M.D.

Dean| Saint Louis UniversitySchool of Medicine

Vice President| Health SciencesSchwitalla Hall M268

1402 S. Grand Blvd.

St. Louis, MO 63104-1028

GA S EAL BA

Philip O. Alderson, M.D.

Edward J. OBrien Jr., M.D. 67

Thomas J. Olsen, M.D. 79

CA A wE

Marie Dilg| SW 94

ESGE

Dana Hinterleitner

CBS

Laura Geiser| A&S 90| Grad 92Nancy Solomon

Carrie Bebermeyer| Grad 06Sara Savat| Grad 04

P CES

Steve Dolan| 18Kevin Lowder| 3

Chad Williams| 4Jim Visser| 11-15, 19 and back cover

Lawrence Group| 6-7

2010, Saint Louis University

All rights reserved

m the Dean |The ABCs of medical education are chang- include new and often mysterious terms such as AHECs (Area

Education Centers), EHRs (Electronic Health Records), RHIOs

nal Health Information Organizations), IPE (Interprofessional

ion) and ACOs (Accountable Care Organizations). Not only are

erms important and current, but a number of them (ACOs in

lar) are concepts in a state of rapid evolution. As the practice

ucture of American medicine change rapidly, medical education

ust change to keep pace. A modern curriculum must include

ew aspects of health care along with traditional core subject

. Dr. Stuart Slavin, our associate dean for curriculum, and the

lum Management Committee strive constantly to create the

balance between old and new subject matter and old and new

ches to teaching. Traditional lecture-based teaching approaches

ng replaced by interactive learning, community learning and

-based/case-based approaches.

of particular interest that this current era of rapid change and

ss in medical education comes precisely 100 years after the

ark Flexner Report. In 1910 Abraham Flexner published a report

urvey that had been recommended by the American Medical

ation Council on Medical Education and sponsored by the Carn-

undation. The repor t advocated higher standards in admissions

rformance in medical schools and placed science at the core of

al education. Science remains a core platform for the profession

ars later, but the details of that science have changed dramati-

ollectively speaking, medical education also has changed

tically and is likely to continue changing in this dawning era of

care reform. To keep pace, we will continue to evaluate and

e the balance of the subject matter we teach, the organization of

ching programs and the methods we use to measure the suc-

student outcomes.

new Education Union Building described in some detail in this

ofGrand Rounds is one manifestation of the way that SLU

ues to move forward. The building will contain state-of-the-art

nics to deliver information to our students in the most modern

here will be relaxation space, simulation learning space, and

ding will become the focus of the SLU Medical Center. It will

ogether students from varying health sciences backgrounds

that we believe will promote mutual understanding, accep-

nd respect. We believe that Abraham Flexner would nd these

es to be pleasing, and we hope that you will, too. Please visit the

s soon and see rst-hand how the School of Medicine at SLU is

ng and getting better.

. Alderson, M..

Saint Louis University School of Medicine

esident | Health Sciences

standing outside the

Doisy Research Center

On the coverThe School of Medicine is at theforefront of interprofessional edu-cation, which promotes team careand better patient outcomes. Theschools revised curriculum allowsmedical students to share classesand philosophies with other healthcare profession students on andoff campus. Seepage 8

SchoolofPublicHealth

St.LouisCollegeofPharmacy

SchoolofNursing

SchoolofSocialWork

D i

C l l f H l h S i


3/13

VitalSignsTackling this problem

far below the level of tissueand organs, molecular

biologists looked deep insidethe structure, examiningthrombins amino acids tonote how they behave andinteract with each other.

Using protein engineering,researchers producedmutations in the enzymesamino acid sequence,

carefully taking out piecesand replacing them, a fewat a time, to nd the exactlocations that inuencethe function of thrombin.

Once they found these hotspots, researchers wenteven further trying eachof the 20 natural amino

acids to see which mutationwould allow them to turn onand off the pro-coagulant,pro-thrombotic and anti-coagulant functions.

We asked the question,What if we can take thisenzyme and dissociate thefunctions, allowing only thefunction we want? Di Cera

said.In earlier research,

Di Ceras team did justthat. They engineered

thrombin to promote activitytoward protein C theanticoagulant target protein and minimize activitytoward brinogen and PAR1

the pro-coagulant andpro-thrombotic targets.

In 2000, we engineered athrombin mutant with potentanti-coagulant properties

both in vitro and in vivo, andwe are moving this mutant toa phase I trial, Di Cera said.In this study, however, we

pressed further. We wantedto optimize this mutant tocompletely abrogate activitytoward brinogen and PAR1.

With this research weoptimized the mutant so thatthere is no clotting at all.

Furthermore, we generateda new mutant with exclusiveprothrombotic activity,thereby demonstrating that

the individual functions ofthrombin can be dissociatedby replacing a single aminoacid in the protein.

Once clinical trials are

performed, researchershope to have developed analternative to heparin.

New Research Centerto Target DrugDiscoverySaint Louis University has

launched a new researchcenter that will be staffed byex-Pzer scientists to targetmedical problems that arecommon in the developing

world, as well as other unmetmedical needs.

The new researchinitiative, called the Center forWorld Health and Medicine,

is another demonstrationof SLUs investment in theregion, said UniversityPresident Lawrence Biondi,

S.J. Our decision reects notonly SLUs commitment tokeep talented and productivescientists in St. Louis, butthe Universitys commitment

to pursue initiatives that areconsistent with our Jesuit,Catholic mission.

Pzer decided last year torefocus and consolidate its

research efforts, a decisionthat displaces approximately600 pharmaceutical scientists,representing a signicant loss

for the region.While this event

represents a major challengefor the St. Louis region, it alsorepresents an opportunity

to add a cohort of highlyskilled scientists dedicated toresearch in areas consonant

with the University mission,added Raymond Tait, Ph.D.,

vice president for research.These are people who

have expertise in movingscientic discoveries fromthe laboratory to the clinic.

They also demonstrate anentrepreneurial spirit, Taitsaid. Of course we wantedto nd a home for them.

The new research centerhired about a dozen ex-Pzerscientists in July.

The center is part ofa regional push to keep

scientic talent in the area, amajor priority of the RegionalChamber and GrowthAssociation and Coalition ofPlant and Life Scientists, Tait

added.As Father Biondi has

indicated, the center dovetailswith SLUs Jesuit mission of

service to others because itfocuses on improving thehealth of those most in need,including people who live inthe developing world where

health care is lagging, Taitsaid.

To thatend, the

center willinitially focuson medicalconditionsassociated with

high mortalityin developing world countries,such as childhood diarrhea.

Finally, the scientists inthe center are expected to

bring unique skills that canyield synergies with researchstrengths already present atthe University.

While it is too early toassess the impact of thisinitiative, Tait said, I fullyexpect that the impact will bepositive for the University, the

region and, ultimately, for thecountries of the developingworld.

Research HarnessesEnzymes Anti-Blood-Clotting AbilitiesSLU molecular biologistshave discovered a wayto harness the enzyme

thrombins anti-blood clottingproperties. The nding opensthe door to new medicationsthat will treat diseases relatedto thrombosis, which is

responsible for nearly a thirdof all deaths in the UnitedStates.

Thrombosis is one of themost prevalent causes of fatal

disease, said lead researcherEnrico Di Cera, M.D.,chair of the department ofbiochemistry and molecular

biology. If we coulddevelop an anti-thromboticdrug that didnt carry a riskof hemorrhage, it wouldrevolutionize the treatment

of cardiovascular disease, theleading cause of death in theUnited States. This researchcarries us closer to that goal.

Funded by the NIH, and

published in the June 18,2010, edition ofThe Journal of

Biological Chemistry (Vol. 285.No. 25), researchers zeroed

in on thrombin, a vitamin-K-dependent enzyme key toblood coagulation.

An unusual enzyme,thrombin performs distinct

and even opposing functions,acting as a pro-coagulant

and pro-thrombotic but alsoas an anti-coagulant factordepending on which target

protein brinogen, PAR1or protein C becomesactivated in the blood.Researchers studied thrombin

to decipher the structure-function code that enablesthis protein to do so manydifferent things.

William SlyRecognized forLifetimeAchievementWilliam Sly, M.D., the SLUbiochemist for whomthe genetic disease Sly

Syndrome is named,has received a prestigiousinternational award forhis lifetime contributionin researching a group of

inherited and life-threateningconditions known as themucopolysaccharidoses(MPS).

The Life for MPS awardwas given in June at the 11thInternational Symposiumon Mucopolysaccharide and

Related Diseases in Adelaide,Australia.

I was thrilled andhumbled by the award. Itwas an acknowledgmentfrom colleagues, patients and

their families that our workwas pivotal in improvingthe course of these diseases,which is really satisfying, Sly

said. While there is no cure,some MPS conditions can betreated, which is a cause formore optimism about theserare but life-threatening and

crippling conditions.Sly holds the James B.

and Joan C. Peter EndowedChair and is a professor of

biochemistry and molecularbiology at SLU. Since his1969 discovery of MPSVII, or Sly Syndrome, Slyhas spent his entire research

career investigating causes

and possible treatments ofMPS-related disorders.Slys research into the

disease has paved the way

for an effective treatment enzyme therapy thatdramatically changes theprogression of other, more

common MPS disorders.

Radiologists HonorDean AldersonPhilip O. Alderson, M.D., vice

president for health sciencesand dean of the School ofMedicine, has received theAmerican Roentgen RaySocietys highest award, the

Gold Medal for DistinguishedService to Radiology.

A radiologist and nuclearmedicine physician, Alderson

has been active in manyprofessional organizationsthroughout his career. Inaddition to being a pastpresident of the American

Roentgen Ray Society,Alderson has served aspresident of the American

Board of Radiology; theAssociation of UniversityRadiologists; the Associationof Program Directors inRadiology; the Academyof Radiology Research; the

Fleischner Society; the Societyof Chairmen of AcademicRadiology Departments; theNew York State RadiologicalSociety; and the New York

(City) Roentgen Society.Aldersons work has been

printed in more than 200publications, including four

books, 40 book chaptersand more than 150 journalarticles. He has receivedthe Gold Medal of theAssociation of University

Radiologists and theAchievement Award of boththe Association of ProgramDirectors in Radiology andthe New York Roentgen

Society.

Before becoming dean ofthe SLU School of Medicinein 2008, Alderson had been

chair of the department ofradiology at the College ofPhysicians and Surgeons ofColumbia University anddirector of radiology service

at New York-PresbyterianHospital/Columbia.

ait

3 Grand RoundsSaint Louis University School of Medicin

White Coat Ceremony Welcomes First-Year StMembers of the Class of 2014 slipped on their white coats in front of

and friends in August at the annual White Coat ceremony in St. Franc

College Church.

Michael T. Railey, M.D., associate professor of family and commu

cine and associate dean of multicultural affairs, delivered the keynot

and offered a piece of advice.

Your path will be smoother and all the more complete the more c

you are as a person, Railey said. We will set the bar high for academ

complishment, but you must not forget your personal and spiritual de

The concept of men and women serving men and women should be

that keeps you going on those lonely and fatigued evenings and early

certain to come before major testing. If you develop academically an

spiritual, personal belief system and communication skills until later,

victimize yourself as a total human being.

CLASS OF 2014 STATS:

Overall GPA: 3.8

Average MCAT: 32.4

Number of colleges represented: 82

Number of states represented: 33

Number of countries represented: 5


4/13

talSigns

Health DisparitiesAmong Black andLatino Kidney DonorsBlack and Latino kidney

donors are signicantly morelikely than white donorsto develop hypertension,diabetes and chronic kidney

disease, according to SLUresearch published in theAug. 19 issue of the New

England Journal of Medicine.Weve long known that

diabetes and hypertensiondisproportionately affectblacks and Latinos. Ourresearch found that these

racial disparities also existamong living kidney donors,

As the baby boomers

turn 65, its extraordinarilyimportant that we continueto increase awareness of thedifferences in treating older

people, he said. Its notenough that we teach doctors.It takes a village of trainedprofessionals to providequality elder care.

Among other initiatives,the division of geriatricmedicine will use grantfunds to create educationalprograms for health

professionals that focuson falls, a commonproblem among the elderlywith potentially deadly

implications.The most serious

consequence of falling,Morley said, is breaking a hip.About 80 percent of those

elderly adults who fracture ahip dont completely recover,and about 30 percent diewithin the rst year of injury.

Falls also take a toll onthose who are lucky enoughto escape serious injuries.Once older adults fall, manybecome afraid that they might

fall again. This makes themreluctant to move, whichdecreases the physical activitythat is so important forthem to stay healthy. It also

can trigger a cycle of socialisolation.

Fear of falling cutsdown on social interactions,

Morley said. People refuseto go out, and they becomedisconnected from others andlonely, which leads to a host

of other problems.The good news iseducational programs onpreventing falls for socialworkers, physical therapists,nurses, doctors and other

health care professionalscan markedly decrease theproblem, said Nina Tumosa,

to the current two-year

mandated tracking, so that wecan capture and monitor theoutcomes of donors from allsociodemographic groups.

According to Lentine,more studies are needed tounderstand the consequencesof post-donation diabetesand hypertension on the

overall health of the donors.In the general population,hypertension and diabetesare typically associated withincreased risk of end-organ

complications. However,because kidney donors oftenreceive closer surveillanceand early intervention, the

implications may be milder inthis group.

Even if the risk ofserious end-organ damage issmall with good care, better

understanding of the risk forhypertension and diabetes isrelevant to counseling donorson possible nancial risks

from future prescriptions,medical treatment andassociated insurancepremiums.

$2 Million GrantFunds Anti-FallingEducationalCampaignSLU will receive more than$2.1 million for the next veyears from the federal HealthResources and Services

Administration (HRSA) tofund educational programsabout falling and other topicsof interest to health care

professionals who work withthe elderly.For more than two

decades, the division ofgeriatric medicine at SaintLouis University has been

a leader in the Midwestin educating health careprofessionals about the issuesthat touch the lives of older

adults, said John Morley,M.D., director of geriatricsat SLU.

post donation, said KristaLentine, M.D., associateprofessor of internal

medicine and lead researcher.Increased attention tohealth outcomes amongdemographically diversekidney donors is needed.

Researchers say that whilethese ndings should not beused to discourage anyonefrom donating on the basis

of race and ethnicity alone,these factors should be takeninto consideration whencounseling potential donorsabout their future health risks.

The need for live kidneydonors is greatest amongblacks, who are signicantlymore likely to developend-stage renal disease, yet

have less access to kidneytransplants. Researchers say

Ph.D., professor of geriatric

medicine at Saint LouisUniversity and co-principalinvestigator of SLUs Centerfor Aging Successfully.

Falls are verycomplicated. We need to lookat the whole person notjust the activity of falling to get to the root cause of

falls. Health professionalsfrom different elds mustbring their expertise toaddress the problem,

Tumosa said. Geriatrics is aninterprofessional team sport.If we dont work together, wedont win the game, which isto help older people maintain

their quality of life.Saint Louis University

also will use grant fundsto create a certicate ingerontology for working

health professionals who carefor older adults.

School of PublicHealth Names NewDeanSaint Louis University haschosen Edwin Trevathan,

M.D., M.P.H., as its nextdean of the School of PublicHealth.

Before joining SLUin September, Trevathan

directed the National Centeron Birth Defects andDevelopmental Disabilitiesat the Centers for DiseaseControl and Prevention

(CDC) in Atlanta.Last year, when H1N1

inuenza loomed as a threatto public health, Trevathan

took the lead in planning theCDCs strategic responseto protect the health ofchildren. He also workedas an epidemic intelligence

ofcer at the CDC from 1987to 1989.

that blacks are less likely to

identify a potential donor,and their potential donorsare more likely to have healthconditions at evaluation that

limit their ability to donate.Researchers used

insurance claims from aprivate insurance provider,linked with identiers from

the Organ Procurement andTransplantation Network, toexamine variations in the riskof post-donation medical

diagnoses according to race.All potential kidney

donors undergo an evaluationthat focuses on excludingpatients with medical

abnormalities at the timeof assessment. After kidney

donation, researchers foundthat in comparison to whitedonors, black donors were

52 percent more likely to bediagnosed with hypertension.Latino donors also were36 percent more likely

than white donors to bediagnosed with hypertension.Additionally, black and Latinodonors were more thantwo times as likely as white

donors to be diagnosed withchronic kidney disease and tohave drug-treated diabetes.The pattern of diseaseamong donors is similar to

what is found in the generalpopulation.

While normal pre-donation medical evaluation

increases the overalllikelihood of long-termgood health for donors,Lentine says these screenings

alone cannot be expectedto eliminate the impact ofepidemiologic risk factorsfor disease over time, such asaging and race.

We are not proposing

any change to donor selectionpolicy based on these data,Lentine said. However, thesendings show that we need

a national policy for longerdonor follow up, as opposed

Trevathan is no stranger

to St. Louis. He was onthe faculty at WashingtonUniversity School ofMedicine from 1998 until

2007, rst as an associateprofessor, thenas professorof neurologyand pediatrics.

He served asWashingtonUniversitysdirector of

the division of pediatric anddevelopmental neurologyfrom 2004 to 2007 and wasthe neurologist-in-chief at St.Louis Childrens Hospital.

Trevathan also has hadconnections to the School

of Public Health since 2002,with appointments rst as anadjunct associate professor of

community health, then as anadjunct professor.

Trevathan succeedsHomer Schmitz, Ph.D.,

who had served as interimdean of the School ofPublic Health for two yearsand will continue to be onfaculty as professor of health

management and policy.

Vitamin E HelpsThose with FattyLiver DiseaseAn NIH-funded studypublished in theNew EnglandJournal of Medicinefound thatdaily vitamin E improved the

livers of patients who have atype of liver disease known asnonalcoholic steatohepatitis(NASH). The study results

are welcome ndings becausethere are currently noapproved treatments for thedisease, said a SLU researcheron the project.

Increasingly common,NASH is characterized byexcessive fat that causesinammation and damage in

the liver.

Fatty liver disease is

a growing problem in theUnited States, and we haveno approved medicationto offer patients, said

Brent Tetri, M.D., directorof gastroenterology andhepatology and studyresearcher. With this study,were pleased to nd that

vitamin E should help someof our patients.

During 96 weeks oftreatment, patients with

NASH were given 800 IUdaily of the natural formof vitamin E or a placebo.Researchers found that 43percent of those treated with

vitamin E showed signicanimprovement of the liver;

only 19 percent of those whreceived a placebo improved

Separately, researchers

also studied the effects of adrug, pioglitazone, in treatinNASH. It, too, improvedthe condition of patients

livers, although its use wasassociated with weight gain.

Researchers caution thatneither treatment improvedliver disease in all patients,

and that diabetic patientswere not included in thisstudy. Diabetes is commonin NASH patients, andfurther research is needed

to determine if vitaminE or pioglitazone will beappropriate treatments fordiabetic patients.

5 Grand Rounds Saint Louis University School of Medicin

revathan

r. Adrian i Bisceglie, ean Philip Alderson and r. Steven Bander

re Focusedrian Di Bisceglie, M.D., received a standing ovation as he was formally

ed in August as the inaugural holder of the Badeeh A. and Catherine V.

r Endowed Chair in Internal Medicine.

is ceremony is not about me, said Di Bisceglie, chair of the department

rnal medicine. Its about this gift to Saint Louis University. It secures the

of the leadership of the department and will keep on giving to the Univer-

years to come.

e chair was made possible through a gif t from Steven J. Bander, M.D., and

e, Patricia A. Bander, who named the chair in honor of Banders parents.

y parents stressed constantly the need for education and to do whats

y yourself and others, Bander said at the ceremony. These are very

rules that I think have allowed me to achieve some of my success.

nder graduated from SLU in 1975 with a degree in biology. Generous

rters of the University, the Banders also donated $3 million in 2006

blish the Bander Center for Medical Business Ethics, which promotes

business practices in medical care and research through the develop-

of training and investigation opportunities for medical students, residents

hysicians. Bander has a private practice and is a clinical professor in the

ment of nephrology.


5/13

6

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

The new nucleus of t he Medical Center will be the HealthSciences Education Union located behind the School of Nurs-ing in the former orthopaedic treatment clinic. The vacantbuilding is being remodeled and expanded to create a modern,30,000-square-foot union with a glass and steel atrium and a

sleek clock tower a tting entrance for a campus that pro-vides cutting-edge education for health care professionals.

The rst oor of the Health Sciences Education Union willhold a 225-seat auditorium. An entire wall of the auditorium will

be covered with 25 high-denition video screens that can displaya single image or be divided into quadrants, giving educatorsexibility in presenting material. The high resolution images areso crisp the lights do not need to be dimmed during presenta-tions.

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

The rst oor will also include: a caf-style restaurant,student lounges, digital signage to alert faculty, students andstaff of upcoming events, and the interprofessional education

ofce, which is pioneering education for future health careprofessionals. (See the story on page 8.)

The second oor of the Education Union will be dedicatedto the School of Medicines standardized patient simulation edu-

cation program. The program, which the school was among the

rst to pilot approximately three decades ago, offers studentslearning opportunities to practice new diagnostic and commu-nication skills. The labs are outtted with state-of-the-art videocameras and software that will improve the overall teaching and

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

Land east of the Hickory East Parking Garage is being lev-eled to make way for a new recreation complex that will servethe needs of the Medical Center, club sports, intramurals andBilliken athletics. The complex will include an NCAA-regulatio

soccer eld and an eight-lane track. The track will be the newhome for SLUs Division I track team, and also will be availablefor exercise use by faculty, staff and students. The soccer eldwill provide new playing opportunities for growing club sportsand intramural teams. Construction is expected to be completed

by spring.These two projects are made possible, in part, by donations

from alumni and friends of the University, who support thegrowth of the Medical Center. More support is needed. Thereare many ways alumni can be a part of these projects, including

designating gifts for the Education Union and recreation com-plex. There also are ways for donors to be permanently con-nected to the projects through naming gifts. For more informa-tion about supporting these important Medical Center projects,

please call Matthew White, executive director of Medical Centedevelopment, at 314-977-3287.

Grand Rounds 7

Having these central congregating places will cement the se

community among students, faculty and staff at the Medica

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

community

a growing

right | 1. An addition to theeast side of Health Sciences

Education Union. 2. A rendering

of the recreation complex.

3. The building at the entrance

to the recreation complex.

belo |A rendering of the HealthSciences Education Union.

PP O. AsO, M.., Dean, Saint Louis University School of Medicine andVice President, Health Sciences

Construction projectsenergize the Medical Center.

1 2 3


6/13

When Philip O. Alderson, M.D., dean of the School

of Medicine and vice president for health sciences,

welcomed the Class of 2014 at the annual White Coat

ceremony in August his address emphasized the word

team. He told students that their future patients would

benet from a team approach to care and that their

ability to work as members of a team will make them not

only better physicians, but more satised people.

Alderson wasnt just setting the tone for the Class of 2014,he was promoting a cultural shift within the medical school.After several years of meetin gs and pilot projects, the school has

embedded within its curriculum a required course on interpro-fessional patient care. Beginning this academic year, third-yearmedical students are required to take an Interprofessional TeamSeminar with students from SLUs School of Nursing, DoisyCollege of Health Sciences, School of Public Health, School of

Social Work and the St. Louis College of Pharmacy.Complex and chronic health problems can surpass the

scope of any one profession, Alderson said. Rather than plac-ing the entire focus on the physician, we can learn to utilize the

complementary skills of a group of health care professionalsin a more efcient way and in doing so we can enhance patientcare.

SLUs School of Medicine is one of the rst medical schoolsin the country to require an integrated course in interprofes-

sional education (IPE), and plans are in the works to weave thecollaborative care concept throughout all four years of medicalschool and into residency.

Medical students learn there is strength in

numbers when it comes to patient care.

Taking the InitiativeThe goal of IPE is to teach students from different healthprofessions how to work together effectively. Through lectures,simulated experiences and clinical activities, students work to-

ward a better understanding of the roles and responsibilities ofthe other professionals. Advocates say IPE can maximize ef-ciencies, modify negative attitudes and perceptions, and remedyfailures in communication.

The Institute of Medicine has suggested that this team ap-

proach improves health care quality outcomes. The institute hasissued a number of reports during the last few years demon-strating that patients are more likely to receive safe, quality carewhen health professionals work together and communicate we

As a concept, IPE has been around since the 1960s but didnot gain much traction nationwide, in part because the reim-bursement system did not support it. The idea, however, tookhold at SLUs Medical Center for a couple of reasons. Becausethe campus has a wide array of health science schools in close

proximity to one another, collaboration is easier. In addition,the collaborative care model is patient centered and communityoriented a good t with the Universitys Jesuit mission. Themedical centers early IPE endeavors remain models for todaysprograms (see sidebar on page 11).

Building on SuccessThe recent health care reform debate breathed new life intoSLUs interprofessional programs. In 2006, the School of Nurs

ing and the Doisy College of Health Sciences became the rstin the country to embed IPE into their undergraduate core cur-ricula. Nursing and Doisy students are required to take ve IPEcourses, including an interprofessional practicum, in order to

graduate and earn a certicate in interprofessional practice.Irma Ruebling, P.T., assistant professor of phys ical therapy

at Doisy College and director of interprofessional education foSLU Health Sciences, believes that the skills required for inter-professional practice soon will be recognized as essential in the

preparation of health professionals. Ruebling has written aboutIPE and has spoken at national forums about SLUs interprofessional initiatives.

Grand Rounds 9

TeamPlayers

Health Sciences

Pharmacy

Medicine

SocialWork

PublicHealth


7/13

10 Grand Rounds

The new building also expands teaching space for theschools standardized patient simulation education program. Thestandardized patient simulation clinic will allow for individualmedical students to interact with standardized patients and to

participate in team-based simulation training.The new building is being wired as a high-tech facility that

will allow for team learning via video and Internet connections.This will help overcome one of the major logistical obsta cles

of IPE scheduling. The medical school, nursing schoo l andallied health programs all have different academic calendars andclinical training schedules. Finding ways to teach teamwork andhave collaborative, experiential learning in the same space is es-sential to success.

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

A lot of biases about other professions can be brokendown just by giving students a place to hang out, talk and studytogether in a non-classroom setting, Pole said.

Out in the Real WorldStudents are not the only ones learning about the collaborative

approach to patient care. Faculty members at the School ofMedicine are being taught how to teach from a collaborativecare perspective.

Going from large didactic to small group facilitation towork through cases and problems requires a different set of

educational skills, Pole said. And nding ways to incorporatecollaborative concepts into established course material can be achallenge. Thats why were working on a faculty developmentcomponent and continuing education programs to facilitate thatchangeover.

The Medical Home Working Group also recognizes thatwhile training students in the knowledge, attitudes and skills tothink and function as part of a team, the collaborative practiceenvironment does not yet exist in most health care settings. Thegroup, therefore, is developing continuing education programs

in team care for practicing health professionals.The idea is to teach them what the students are learning

about IPE and collaborative care and, hopefully, theyll incorpo-rate it into their practice, Ruebling said.

The ultimate success of the interprofessional care model willdepend upon how the government health care reforms pay forservices. If studies demonstrate that collaborative care is costeffective and improves patient outcomes, funding will follow.Ruebling and her colleagues are optimistic.

When I go to conferences I barely get ve sentences out

before someone is asking me how were running our programsand how were developing our culture of interprofessional care,she said. Health care professionals know that navigating todayscomplex health care environment while assuring the best patient

care is a team effort. Theyre interested in what were doing be-cause our curriculum is cutting edge and the University is beingrecognized as a leader in preparing students for whats to come.

Out in Front Interprofessional education is not new to SLUs Medical Center. In the late 1960s when IPE was initially introduced as a caremodel, Robert M. Heaney, M.D., associate dean for graduate medical education and Veterans Affairs, created interprofessional education oppor-

tunities for students training at City Hospital. He established one of the rst nurse practitioner programs in the country where medical and nursing

students trained side by side.

Goronwy Broun Sr., M.D., former dean of the School of Medicine, and Max P. Pepper, M.D., founder of what is now the department of family and

community medicine, created opportunities in the early 70s. They allowed advanced practice nursing students to work and learn alongside medical

students and physicians in a cardiovascular clinic. They also invited nursing professors to lecture in the medical school on occasion.

In 1995, James Kimmey, M.D., Ph.D., then vice president for health sciences, formed a task force on interprofessional education that led to an

interprofessional rural health outreach demonstration program in Washington County, Mo. That program still exists today as the Great Mines Federally

Qualied Health Center in Potosi.

And in 2002, the SLU Area Health and Education Center program initiated a highly-rated elective course in Interprofessional Care of Medically

Underserved Populations introducing broader issues that have an impact on access to quality health care.

Traditionally, most health care practitioners are educated

in independent silos, Ruebling said. Each profession istrained in its own methods and philosophy. There might bea brief overview course to survey other professions or aninterprofessional seminar, but for the most part, each goes

its own way. Students lack opportunities to study or workwith other professions, so they leave school without the skillsneeded to function as part of an integrated team. We trainour students so that it becomes second nature to ask whatanother team member can bring to this patients care.

The Next LevelThe IPE program was so successful at the undergraduatelevel that Ruebling and her colleagues put together an Inter-

professional Team Seminar for post-baccalaureate studentsstudying medicine, accelerated nursing, social work, publichealth, and as physician assistants.

Students from the different professions came togethertwice a semester to discuss cases. The seminar was offered

in 2007 as an elective for rst-year medical students. Becausethe medical students lacked clinical experience, however, thecollaborative message had limited impact, said David Pole,M.P.H., deputy director of the Area Health and Education

Center in the department of family and community medicineand assistant director of interprofessional education.

Pole and his colleagues, including Stuart J. Slavin, M.D.(83), M.Ed., associate dean for curriculum, revised theseminar and piloted it again as an elective for third-year

medical students with an emphasis on improving the qualityand safety of patient care and outcomes. Having studentsengaged in the clinical stage of their training increased therelevance of the content and the success of the seminar.

Student engagement in the course increased dramati-

cally once they realized this wasnt just a seminar abouttalking nice to one another, Pole said. It was about how

their patients could suffer bad outcomes or die if health careproviders dont communicate well.

Appreciating and utilizing the talents that other profes-sions can bring to improving patient care really got their at-

tention. Through the case-based discussions, students cometo understand that being able to work collaboratively is nota value-added piece. It is a change in the care process that isbecoming recognized as an essential skill in practice.

A Seat at the TableTwo years ago, to further coordinate interprofessionalinitiatives, Alderson assembled the Medical Home WorkingGroup, a committee to explore the best ways to integrate

IPE into all health sciences curricula. The group, whichmeets monthly, is comprised of representa tives and deansfrom the schools of medicine, nursing, Doisy College, publichealth, social work and the St. Louis College of Pharmacy,

located in the Central West End. Also in the group is anaward-winning quality care expert from the SSM HealthCare system and the executive director of the SLU Centerfor Outcomes Research to help evaluate the effectiveness of

SLUs initiatives.We have to engage in outcome-based research, Alder-

son said. No matter how much we believe we have a greatmodel, we still have to demonstrate in a scientic way thata collaborative care environment can be more efcient and

effective.

Room to GrowFurther testament to the Universitys commitment to IPE isthe construction of the new Education Union north of the

School of Nursing (see renderings on page 6). The formerorthopaedic rehabilitation facility is being renovated to housea 225-seat auditorium for large lecture classes.

We realized that if we were going to teach

interprofeional care, then we need to prainterprofeional care.

GA sPs, M..,assistant professor of family andcommunity medicine and medical director of the Medical Hom

right | Charlotte Burnside gets her questions answered

during a Medical Home luncheon on diabetes.

Theres No Place Like HomeCharlotte Burnside pulls a glucose monitoring device out o

purse and begins a series of questions.

I bought this monitor six months ago and havent had

in new batteries yet. Does that seem right? My mother had

new batteries in her monitor all the time. How do I know w

time to get new batteries? Do low batteries have an impact

results?

Then she pulls out the lancet holder she uses to prick h

nger.

And Im not sure about this. I think all the needles sho

used up by now but I cant tell. How can I tell when its tim

a new one? Can you show me?

Normally patients might feel too rushed or too intimid

ask their physicians as many questions as Burnside has, b

no ordinary patient. She is a patient in SLUCares Medical

a program launched in January exclusively for SLU employ

their dependents. The Medical Home brings together a tea

SLU health care experts from different disciplines to work t

to keep patients healthy.

If a physician prescribes a new medication, a pharmac

there to answer questions. If a patient is advised to chang

habits, a dietician is available for consultation. If a patient

gling with transportation to clinic appointments, a social w

connects the patient to resources.

In addition to this personal care, patients can take par

weekly group education sessions, such as the one Burnsid

attended on diabetes. Any and all questions are answered

members of the Medical Home team.

Some of the faculty members who teach IPE courses

participate in the Medical Home team. They experience rs

the advantages of coordinated patient care and use of res

Stephens said. When they are in the classroom, they can

their experience to students.


8/13

theyre not likely to get off those machines, but we still go down

that road. Its as though were on a conveyor belt. We try to keep

the patient alive only to nd out the patient may perceive it as a

life worse than death. We dont stop to think about the unforeseen

consequences of our actions. Sure, we all like the new technology,

but maybe using it leads to things we hadnt anticipated.

Bishop, an internist with a doctorate in philosophy, wasappointed this summer as the Tenet Endowed Chair in Health

Care Ethics and director of the Albert Gnaegi Center for

Science always interested Jeffrey P. Bishop, M.D., Ph.D., but

during premed studies at the University of Texas, he foundhimself equally fascinated by the theological and philosophicalquestions raised by medicine. When should breathing machinesor feeding tubes be started or stopped? Who decides whichpatient gets what care? What if a patient refuses medical treat-

ment? When is enough enough?

JB:Theres so much we do in medicine that we assume is good,

and yet we keep being reminded that maybe its not. We have

patients in the ICU connected to machines. Medically we know

Health Care Ethics at Saint Louis University. Previously, Bishopdirected Vanderbilt Universitys Clinical Ethics Education andConsultation Services program. He also served as associateprofessor of medicine and biomedical ethics, associate professor

of theo logical ethics and was an active hospitalist at Vanderbilt.Prior to Vanderbilt, Bishop spent time in the United Kingdomteaching health care ethics.

He succeeds James DuBois, Ph.D., D.Sc., the Mder Pro-fessor of Health Care Ethics, who directed the center for ve

years. DuBois will continue to direct SLUs Bander Center forMedical Business Ethics, where he will expand the social scienceresearch group of the Gnaegi Center.

Bishops research focuses on the historical and political

conditions that come to structure medical practices. He recentlycompleted a book titled Otherness, Death, and Medicine. The book,a philosophical history of the care of the dying from ICU careto palliative care, will be published by the University of NotreDame Press in the spring.

Bishop practiced medicine and was on the faculty at theUniversity of Texas Southwester n Medical Center for nearly adecade. He said he hopes his clinical experience complementsthe work already being done at SLU.

JB:Jim DuBois left the Gnaegi Center in a great position. He is well

known in both the clinical and the research ethics worlds. The center

has one of the strongest research ethics program in the country.

What I bring to the table is extensive experience on the clinical ethics

side of health care ethics.

At Vanderbilt, doctors, nurses and social workers would call the

Clinical Ethics Consult Service for help with ethical issues. My job

was to come in and assist in those sticky situations talk with the

attending, the nurses and the family to try to get a feel for where ev-

eryone was. Then we would walk together with the health care team,

the family and the patient through the difcult process of coming to

decisions. Griff (Grifn Trotter, M.D., Ph.D., professor in the Gnaegi

Center) has been doing some of that kind of work. We need to see ou

ethical consulting services grow.

With this balance between research and clinical ethics, I think the

Universitys health care ethics programs will be leaders in the eld.

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

Some are philosophical centers, where the professors are all phi-

losophers like me, and some are empirical research centers, where

the professors only do one thing. Were able to have dialogue across

both the philosophical and empirical, and the clinical and research

arenas.

Whats at the top of your to-do list?I want to create more opportunities for our Ph.D. students t

get hands-on clinical ethics consultation experience. We alreadydo a great job of teaching them to be scholarly inquirers. Forthose interested in clinical ethics, we need to give them the tools

to actually go into clinical settings and apply that knowledge.Rather than having books as primary dialogue partners, we needto get real people as dialogue partners. The American Societyfor Bioethics and Humanities is very likely to require that clinic

12 Grand Rounds 13

Ethics

ActionNew director of health care ethics stresses clinical skill development


9/13

ethicists have specialized clinical training, and clinical ethicistswill need to be credentialed. I want our students ready beforethat change comes. I want them to get used to going into hos-pitals. I want them to learn the language on the oor, to learn

to think the way doctors think, the way nurses think and theway social workers think. They need to be able to talk to thoseprofessionals and to families about what their loved ones wouldhave wanted.

Id also like to expose undergraduate students to more issuesin health care ethics. There is so much information in medicalschool. The curriculum is packed. You dont have much timeto reect. While youre an undergraduate you have a little moretime to breathe, and thats a good time to approach these issues.

What plans do you have for medical school students?Right now we have a few contact hours in the rst year, but

students really dont encounter ethical problems until their thirdand fourth years, when theyre in the clinics and hospitals. So,Griff and I will explore ways to engage students in a dialogue

about ethical and moral questions in their third and fourth years when the rubber hits the road.

What differences do you nd between working in a

secular institution, such as Vanderbilt, and a Jesuit

institution, such as Saint Louis University?I believe the discussions might be richer here because in a

religious institution everything is open to debate. What mightgo unchallenged in a secular university often will become an

important topic of discussion at an institution with a religiousafliation. If a certain controversial speaker is invited to campusor a controversial play is produced, no one bats an eye in asecular institution. But at Saint Louis University or Notre Damesomeone might say, Should we be doing this? It seems to me

that people debate the ideas, and thats a good thing. Theresmore opportunity for open discussion more open thought.

Have the reforms made ethical dilemmas more

challenging?Not really. Every system of health care has its failings. No

matter what system you choose, something will fail in time. Ourcurrent system needed to change. There isnt much debate onthat question. The question was what to change. The current

system is unsustainable. Technology is driving costs throughthe roof. Health care is plentiful, but high-tech health care isvery expensive. Technology will continue to drive up costs. Aneconomist at Notre Dame, Williams Evans, noted that this wasthe side of health care reform that we should have addressed

rst. Yet everyone wanted to focus on nancing rather than onthe costs of what we were nancing. And that is where the ethi-cal, rather than the economic question, comes into relief.

Were so uncomfortable with our mortality that if theres anyinkling of hope, we take it even if it means nding ourselves

in the ICU in a state worse than death. The moral question isabout the worth of a human life, but also about when that lifecan become idolatrous. Catholic moral teaching holds that theultimate end of human life lies with God. As Pope John Paul

II noted, life on earth is not an ultimate but a penultimatereality. Life and sustaining it are strict moral imperatives; yet lifeat all costs can become idolatrous. If there s something otherthan this life, then there comes a time when we need to resignourselves to the fact that were mortal. Even if the technology is

there, we dont always have to use it.In a way then, hidden beneath the economic question and

beneath the technological imperative, there is a fundamentalmoral question about human life that has always been and willalways lurk beneath the systems. So whatever system is used to

nance health care, the nancing of health care will never reallychange the fundamental moral and ethical question.

14 Grand Rounds 15

PREVIOUS

Vanderbilt University 2Associate professor o

and biomeddirector of clinical ethics

and consultatio

Peninsula College of Medicine anUnited Kingdom, 2

Principal lecturer, associatein medical ethic

University of Texas Southwestern Medical Center Associate professor of interna

interim director of thin Ethics in Science an

University of D

M.A.,

University of D

Internal medicine residenUniversity of Texas, Southwestern Medical School

University of Texas Medical School, Hou

B.SInstitute for Christian Studies, Au

BUniversity of Texas, A

Bishop moved to St. Louis with his wwho teaches English com

Chaminade College Preparatand their three daughters: Madeleine, 13;

and Lydia, 6. They live in B

I imagine the health care debate has been interesting for

you as an ethicist. Some argue that the most ethical

health care system is a government-run health care

system. Others think the system must control costs or

eliminate prots or ration care to those most in need

and that is the most ethical thing to do. What are your

thoughts?My job is to show the pitfalls in any system. I believe its

foolish to think that because we now have health care reform inplace that all of our issues, ethical and otherwise, are going to goaway. Every move presents a whole set of ethica l issues. I taughtin England, where they have the National Health Service. Ev-

erybody has access to care. Thats a good thing, right? But thatsystem has its own problems. If you have peripheral vasculardisease and you smoke, they wont even consider performing an-gioplasty or bypass surgery until you stop smoking, and they canget militant about it. If they discover you continued to smoke,

you will be told you wont get the procedure, or youll be put onthe bottom of the list. Is that wrong? Is that Big Brother? On

the one hand, it appears to impinge on freedoms. On the otherhand, if soc iety is paying for it, shouldnt society have some-thing to say about those who engage in risky behavior? That is

precisely the question that weve been dealing with.We joke now about death panels. I dislike that phrase, but the

truth of the matter is someone has to make these decisions, andthe person paying for the care has always had some say in these

decisions. Even before President Obamas health care reformcame about, there was literature out there that demonstratedpalliative care saves money. I dont believe President Obama isgoing to put his people on committees to make sure we savemoney by letting people die; thats a little hysterical. But at the

same time its true that the people who are paying for care willwant to decide what theyll pay for.

Our current system needed to change.

There isnt much debate on that question.

The question was what to change.


10/13

Frank R. Burton, M.D.,professor of internal medi-cine and a leading researcher

of pancreatic disease, died inAugust at the age of 58.

Among his many profes-sional accomplishments, Dr.Burtons NIH-funded research

nding that chronic pancreati-tis is strongly associated withsmoking and not solely tied toalcohol use leaves an impor-

tant legacy. His ndings helpeddispel the widely held assump-tion that at times led patientsto be labeled incorrectly asproblem drinkers.

Frank chose a verychallenging professionalcareer. Pancreatic disease isan extremely difcult diseaseto take care of, and he was

a very caring physician, saidBrent Tetri, M.D., interimdirector of gastroenterologyand hepatology. As moreresults from his research are

published in the upcomingyears, his legacy of helpingthose with pancreatic diseasewill continue.

Dr. Burton joined SLUin June 1985 and developedthe hepatobiliary and pan-creas therapeutic endoscopyprogram. He served as the

medical pancreatologist for thepancreas transplant programand director of the gastroen-terology physiology labora-tory at SSM St. Marys Health

Center.A founding member

of PancreasFest, a yearly

conference aimed understanding theDr. Burton was knenthusiasm in sharabout the eld.

When it cameFrank had the patsaint, said Charle

M.D., professor omedicine who worBurton for more tHe really gave stu

to learn.Patients loved

He would always gmile to make surewell taken care of.

very generous hea

John J. Collins Jr., M.D., the School of Me dicines2002 Alumni Merit Award recipient, died in March atthe age of 76.

Dr. Collins was professor of surgery emeritus of theHarvard Medical School. From 1987 until his retire-ment in 1999, he served as vice chairman of the surgerydepartment at Brigham and Womens Hospital. He waschief of the division of cardiac surgery from 1970 until

1987.

In 1984, Dr. Collins and a surgical team fromBrigham and Womens Hospital performed the rstheart transplant in New England. Although relativelycommon today, such transplantation was rare at thetime.

We were out there alone, Dr. Collins explained ina 1999 interview, but with the introduction of the im-munosuppressant drug cyclosporine we were condent

in our teams capability.Dr. Collins proved heart transplantation was a vi-

able treatment alternative and inaugurated one of themost respected organ transplantation programs in thecountry.

Dr. Collins received numerous honors afor his extensive contributions to cardiac trtion, the treatment of coronary artery diseartery bypass surgery and valve surgery.

C. Rollins Hanlon, M.D., renowned surg

former chairman of the School of Medicindepartment, trained Dr. Collins and was his

If there had been no Dr. C. Rollins Hawould have been no Dr. John Collins Jr., s

Hogan Collins, M.D. (68), whom Collins mposed to on their rst date. Dr. Hanlon mdeal to our family.

John and Mary Collins had four childrenmarried 41 years. The family has extended t

Louis University 17 members of the Coearned degrees from SLU.

To honor Dr. Collins contributions as aleader, husband and father, the Collins fam

lished the John J. Collins Jr., M.D., MemoriScholarship in the School of Medicine.

Carol R. Archer, M.D., former professor of radiology and neurology, died in June at the age of 79.Dr. Archer was the chief of neuroradiology at SLU Hospital until her retirement in 1998. During

her career, she published more than 50 research publications and won a gold medal for her research on thestaging of carcinoma of the larynx. She was a member of numerous professional organizations and pastpresident of the St. Louis chapter of the American Medical Womens Association.

Jo Ann Shipp, Dr. Archers former assistant, remembered her both as an accomplished doctor andresearcher and a genuinely nice person.

Dr. Archer was a very compassionate and dedicated person. She truly cared about her employees and

was known as a good teacher, Shipp said.

Coy Fitch, M.D., the physician

who helped lead SLUs departmentof internal medicine to prominence,died in May at the age of 75.

Formerly chairman of the de-partment of internal medicine, Dr.

Fitch most recently was a professorof internal medicine at SLU andchief of the medicine service at theSt. Louis VA Medical Center.

Dr. Fitch was a triple threat anexceptional educator, clinician andresearcher, said Robert Heaney,M.D., senior associate dean of theSchool of Medicine, who rst met

Dr. Fitch during his residency ininternal medicine at SLU.

He was a real mentor and wasone of the best people Ive workedfor. He was determined and

committed to excellence in medicalstudent and resident education.In addition, he was a tremendousrecruiter who helped build thedepartment of internal medicine to aposition of prominence regionally,

nationally and internationally while

always maintaining his own researchin his area of specialty malaria,Heaney said.

Dr. Fitch, an endocrinologist,joined SLU in 1967 as associate

professor of internal medicine andbiochemistry. He was chief of themedical service for SLU Hospitalfrom 1976 to 1977 and from 1983

to 2000. He was director of the di-vision of endocrinology from 1977to 1985. He was acting chairman ofthe department of internal medicinefrom 1985 until 1988, and served

as department chairman from 1988to 2000.

During his time as internalmedicine chair, Dr. Fitch recruitedseveral division directors who have

helped to bring international rec-ognition to the School of Medicine Bruce Bacon, M.D., gastroenterol-ogy; Kevin Martin, M.D., nephrol-

ogy; John Morley, M.D., geriatrics;and Robert Belshe, M.D., infectiousdiseases.

He was a straight shooter and

always kept his promises.Once hecommitted to a project, he wouldsee it through, said Belshe, whobrought his Center for VaccineDevelopment to SLU when hejoined the faculty in 1988.

Dr. Fitch loved to describehimself as an Arkansas countryboy, Heaney said. He became aphysician in part because of thegenerosity of someone who helped

him buy textbooks when he was inmedical school at the University ofArkansas.

That person never let Coy Fitch

pay him back. I believe Coy wasalways paying back that rst personby paying it forward, Heaney said.You can look around and see alot of Coy Fitch here. Thats the

biggest legacy anyone can hope for.He helped bring people to SaintLouis University to make it a betterplace.

Legacies

LivingTheir

COFITCH,

M.D.1934-2010

FRAN R.BURTON, M.D.

1951-2010

JOHNCOLLINS,M.D. (57)

1934-2010

CAROARCH1931-2

16 Grand Rounds 17

2011 marks the 100th anniversary of the School of Medicines department of internal medicine.An upcoming issue of Grand Rounds will celebrate this milestone with a feature story, photos and your memories.Please share your stories [email protected] you have photos you think might be useful, we would appreciatethe opportunity to scan and return them.


11/13

Grand Rounds 1918

sive and metastatic cancercells. Chinn adurai proposed aconcept that E1A, in addition

to causing cancer, also sup-presses cancer. While search-ing for cellular proteins thatare involved in controlling thetumor-suppressive activity of

E1A, his group identied thecellular protein CtBP and twoother protein complexes thatplay important roles in thespread of cancer cells. His

group also showed that thetumor-suppressive activity ofE1A is shared by a proteincoded by certain benign hu-

man papilloma viruses.Chinnadurai has edited a

book on CtBP and is con-

sidered the nations leadingexpert on the protein. His

group is working to designagents that interfere withthe functions of CtBP andother protein complexes thatinteract with E1A to disrupt

tumor growth and spread.During their work on the

adenovirus gene E1B-19K,Chinnadurai and his team

discovered important celldeath regulatory genes knownas BH3-only members, whichare essential for cell death.

Chemotherapy drugs

cant kill some cancer cellsbecause the cells express highlevels of anti-cell death pro-

we can reassure the mom andfamily that their babys futureis good and help them under-

stand the resources that theywill need, Yang said. But weare also here to provide highrisk fetal operations for life-threatening problems. The

satisfaction of saving a baby,of building a family, is whatthe Fetal Care Institute is allabout.

GovindaswamyChinnadurai, Ph.D., hasspent the last 35 years explor-ing why cancer cells do not

follow the rules of normalcell proliferation and whythey are able to evade defense

mechanisms within the body.His ndings are helping scien-

tists and clinicians at SLU andthroughout the world developdrugs to ght the more than100 types of cancers diag-

nosed today.By studying two ad-

enovirus genes, E1A andE1B-19K, Chinnadurai hasdiscovered several cellular

genes that are implicated inthe development of cancerand cell death regulation. Heand his team found that a

mutation in the distal half ofE1A, in cooperation with acellular cancer gene known asRas, induces highly aggres-

tein, he said. If we under-

stand E1B-19K, we can learnhow these genes protect cellsfrom death.

Two of the BH3-only

members discovered byChinnadurais group are inac-tivated in a number of humancancers. Several anti-cancerdrugs activate expression of

these genes, causing deathof cancer cells. Chinnaduraihopes a new generation ofdrugs that efciently activatesthese genes would lead to

more effective anti-cancer

Edmund Yang, M.D.,Ph.D.,gives hope to expect-ing parents facing unthinkable sometimes fatal diag-noses. As co-director of theFetal Care Institute at SSM

Cardinal Glennon ChildrensMedical Center, Yang helpsdiagnose the full spectrum ofthe problem, giving parents aclear picture of the prognosis,and he helps them develop a

plan for care.The Fetal Care Institute

is the only comprehensivefacility for fetal therapy in the

Midwest. For babies facinglife-threatening conditionsin the womb, the Fetal CareInstitute offers a range ofinterventions including:

open surgery, the most riskyprocedure and reserved onlyfor conditions that threatenthe life of the baby; mini-mally invasive surgery, which

uses slender scopes guidedthrough tiny incisions toreduce the risk for prematuredelivery; and exit procedures,

where the baby is partially

delivered through a Caesareansection and remains attachedto the placenta through theumbilical cord during the

procedure.Since 2009, Yang has

treated fetal complicationssuch as sacrococcygeal

teratomas, the most com-mon type of tumors found innewborns; twin-twin transfu-

agents than are available n

The National InstitutesHealth has funded Chinnarais groundbreaking reseafor more than three decad

All of the genes and protehe has discovered are drugtherapy targets.

An important rule inresearch is to stick with on

or two intellectual problemand see where they take yohe said. Thats what Ivedone, and its taken us closthan ever to nding a cure

cancer.

G R A N T S at a Glance

nrico i Cera, M.., chair of the department of biochemistry and molecular biol-

ogy, received a $1.8 million grant from the National Heart, Lung and Blood Institute

for the project, Studies in Thrombin Allostery.

Alireza ezaie, Ph.., professor in the department of biochemistry and molecular

biology, received a $1.5 million grant from the National Institutes of Health for the

project, Protease Activated Receptor Signaling by Coagulation Proteases.

William sly, M.., the James B. and J oan C. Peter Endowed Chair and professor in

the department of biochemistry and molecular biology, received a $1.4 million grant

from the National Institute of General Medical Sciences for the project, Receptor-

Mediated Transport of Lysosomal Enzymes (A1 Application).

he department of pharmacological and phyiological cience has received a

$1.1 million grant from the National Institute of General Medical Science to train 30

pre-doctoral students during the next ve years. This is the fourth time the grant has

been renewed. The SLU School of Medicine is the only medical school in Missouri to

receive the grant for its training program in the pharmacological sciences.

sion syndrome, a frequentlyfatal disorder where onetwin receives too little of theshared blood supply while

the other twin receives toomuch; and amniotic bands,which restrict blood owand can result in amputationor severe deformity of the

affected limb.Recently, Yang became

the rst doctor in the worldto perform a tracheal occlu-sion surgery, which essential-

ly causes the lungs to stretchlike a balloon and expandthroughout the pregnancy,using a dissolvable gel sub-

stance similar to gelatin. Thebaby had a condition calledCongenital DiaphragmaticHernia (CDH), where a holein the diaphragm caused the

intestines to grow into thechest cavity and obstructnormal development of thelungs. By using a dissolvable

substance rather than a tradi-tional balloon, Yang elimi-nated the need for a secondfetal surgery to remove thetracheal occlusion before the

baby was born.What makes the Fetal

Care Institute unique is thatwe bring together neonataland pediatric surgical special-

ists with obstetricians whospecialize in high-risk preg-nancy to evaluate the momand her future baby and offer

alternatives. Its great when

Edmund Y. Yang, M.D., Ph.D.Associate Professor of Surgery

Division of Pediatric Surgery

Joined SLU in 2009

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

indeed one of the top research universities in the nation. In this issue of Grand Roundswe prole a physician who specializes in treat-

ing babies yet to be born and a scientist who has discovered how cancer cells are able to evade the bodys defense mechanisms.

Poised for DiscoveryGovindaswamy Chinnadurai, P

Professor of Molecular V

Institute for Molecular V

Joined SLU in


12/13

Alumni Pulse

Living the MissionCall of the WildIf being retired means doingwhat you want, when youwant and with whom you

want, then Harry Owens Jr.,M.D. (66), gures he retiredat the age of 35.

Thats when Owens closedhis family medicine practice

in Palmer, Alaska, and begantraveling the world with non-prot health care agencies.

Initially, Owens worked

for Project Hope on a hos-pital ship in northeast Brazil.He soon was recruited by Es-perana, a relief agency witha boat that plied the Amazon

River and its tributaries to

bring health care to remotevillages.

One of his most memo-rable stops was in a village

deep inside the jungle in thelate 1970s. Owens came upona mother who had been in la-bor for three days because her

From Your New AlumniAssociation PresidentEdward J. OBrien, M.D.(67)I am pleased to assume the

role as president of ourMedical Alumni Association.My rst order of business isto thank retiring president,Dr. Tom Olsen, for his many

years of service and contri-butions. Toms outstandingtalent and time commitmentwill continue to be noticed inthe department of inter-

nal medicine, in importantclinical outreachefforts and onthe School of

Medicine Ex-ecutive AdvisoryBoard.

I will buildon his efforts

to improve alumni outreachand connectivity. I ask ourloyal alumni to remain faithfuland ask those who may feelless connected to become

engaged. The medical schooland the alumni associationhave improved online webaccess and ease by updating

links and by adding the rela-tively new communication,Dialogue with the Dean,which allows alumni to com-ment on important medical

topics that have an impact onour school. In addition, mailcommunication will continueto improve, includingGrandRoundsmagazine, and alumniclass and reunion informa-tion. To assist in this out-

reach, please send any new orupdated e-mail addresses to

the alumni association ofce.Watch for announcements

of medical school and alumnievents and receptions, somerelated to major medical orga-

nization meetings in some ofthe larger metropolitan areasof the country. All are invited.

baby was poorly positioned.He considered a C-section,but Owens knew she wouldnot receive adequate follow-

up care. He then remem-bered a lecture he heard atthe School of Medicine. Hereached inside her, reposi-tioned the baby in the birth

canal, and she was able to de-liver the baby safely. Motherand child survived, and thegrateful mother named theboy Haroldo dEsperana

in honor of Owens. WhenOwens returned to the villagea decade later, the boy waswaiting to greet him at the

rivers edge.I still get choked up

thinking about it, Owens

said.Owens loved the jungle,

but he missed rural Alaska.He came back to the Statesand worked in Nome for anon-prot organization thatserved Eskimos in outlying

Lastly, I invite you to sharewith us any memories or per-tinent stories of your time atthe medical school or in one

of our residency programs.As we have recently lost sev-eral outstanding and legend-ary physicians and teachers,

any tale or event related toyour time with one of theseicons would be appreciated.We are particularly interestedin your stories about the de-

partment of internal medicinebecause we are celebratingthe departments 100th an-niversary in the next issue ofGrand Rounds.

To assist in this outreach,please send any new or updat-ed postal or e-mail addresses

to [email protected].

In memoriamJohn Soucy, M.D. (29)

Cornelius Kline, M.D. (34)

Edward Nixon, M.D. (37)

Herschel Cohen, M.D. (41)

Michael LaHood, M.D. (41)

Ellis Lipsitz, M.D. (43)

James Myers, M.D. (43)

villages. He also spent time inthe Aleutian Islands caring forthe Aleut people.

In between making housecalls in his Jeep, Owens earneda masters degree in inter-national management andbegan consulting for private

enterprises, higher educationinstitutions, the African De-velopment Bank and healthcare organizations in Guinea-

Bissau, Mozambique andBrazil. He took breaks fromhis practice to volunteer withthe Flying Medical Service inTanzania, working with the

Maasai people in the Seren-geti Plains. More recently,he volunteered with SudanMedical Relief in southern

Sudan but had to make anemergency exit due to inter-tribal warfare near the clinic.

In 2006, a colleaguesuggested Owens would be

a good t for lead physicianat the McMurdo Station, aNational Science Foundationresearch center located on theshore of McMurdo Sound in

Antarctica. Each year Owensbundles up and spends sevenmonths caring for the sta-tions 1,100 scientists and

support staff at a three-bedhospital and clinic.

Ralph Miller, M.D. (43)

Amadeo Saeli, M.D. (43)

Arthur Friskel, M.D. (44)

Cyrus Pachter, M.D. (44)

Harvey Itano, M.D. (45)

Gerald Blanchard, M.D. (46)

Stanley Lutz, M.D. (46)

Gilbert Wilhelmus, M.D. (46)

Vincent Marecki, M.D. (47)

Glenn West, M.D. (47)

Richard Nelson, M.D. (48)

George Tenoever, M.D. (48)

Belmont Rodney Thiele, M.D. (48)

W. Atkinson, M.D. (49)

Francis Jacobs, M.D. (49)

John Justus, M.D. (49)

Edwin Schmidt, M.D. (49)

Claire Cotton, M.D. (50)

Robert Doisy, M.D. (50)

Russell Welsh, M.D. (50)

Stephen Buckley, M.D. (52)

Joseph Connolly, M.D. (52)Charles Galbraith, M.D. (52)

Robert Healey, M.D. (52)

Robert Lyden, M.D. (52)

Harold Rowland, M.D. (53)

William I. Stryker, M.D. (53)

John McCue, M.D. (54)

Joseph Dewitte, M.D. (55)

Norman Rose, M.D. (55)

Joseph Traynor, M.D. (55)

John McLychok, M.D. (56)

Edward Rongone, M.D. (56)

I have the perfect tem-perament for it, Owens said.I love the outdoors, Im notscared to stray two feet off

the pavement, and I love tak-ing care of people.

When not practicing inMcMurdo, or Africa or the

Amazon jungle, Owens isat home in a little cabin onthe McKenzie River in BlueRiver, Oregon, 50 miles eastof Eugene. Owens uses

what little money he makesto cover his basic needs. Therest goes to charity.

He said he learned to ap-preciate the simple life as a

young boy working summerson his aunt and uncles sheepranch in Arizona.

Survival wasnt a chal-lenge, he said. It was a wayof lif e. You dont need muchto get by. This approach helpsme feel at home no matterwhere I go. Whether Im in

the jungle or the mountainsor the polar regions, Im notdaunted by the remoteness ofan area. Im invigorated by it.

Every so often Owens

likes to stop the world andget off. Since 1987 he hastaken periodic retreats at aTrappist Monastery to make

any necessary course correc-tions. He shares his insightsand experiences in a book ofshort stories titled, A HealersCall.

For a copy of the bookor to learn more aboutOwens work, contact him [email protected].

Peter Citrone, M.D. (57)

Elmer St. George, M.D. (57)

Theodore Scharf, M.D. (59)

Robert Ratliff, M.D. (60)

Daniel McLaughlin, M.D. (6

Merle Walker, M.D. (61)

James Beckner, M.D. (62)

John Cicconi, M.D. (65)

Peter Farley, M.D. (65)

Bruce Heyl, M.D. (65)

Marshall Kessler, M.D. (65)

Daniel Brennan, M.D. (67)

Narendar Datta, M.D. (68)

Frances Ficker, M.D. (69)

Joel Ruffman, M.D. (70)

Theodore Munns, M.D. (71

Moustafa Naguib, M.D. (71

Cullie Funderburk, M.D. (75

Robert McConnell, M.D. (75

Stephen Surtshin, M.D. (79

Edward Parrish, M.D. (80)

John Fennig, M.D. (81)Karen Knox, M.D. (81)

Robert Yowell, M.D. (81)

Sataya Satayaviboon, M.D.

Lynda Lombardo, M.D. (86)

Kathleen Barcia, M.D. (89)

Michael Mecinski, M.D. (90

Raemma Luck, M.D. (95)

Eugene Averbuch, M.D. (98

ens

Show your school colors

www.clubcolors.com/sluTravel with alumni

www.slu.edu/alumni/travel

markyo

urcalendar School of Medicine Alumni Events

Feb. 4 American Academy of Dermatology - New Orleans

Feb. 15 - 19 San Diego-area Alumni Reception/American Academy of Orthopaedic S

March 18 - 22 San Francisco-area Alumni Reception/American Academy of AsthmaAllergy and Immunology

April 8 10 Missouri State Medical Convention - Kansas City

April 30 - May 3 Denver-area Alumni Reception/Pediatric Academic Societies

May 7 - 10 Chicago-area Alumni Reception/Digestive Disease Week

Continuing Medical Education Programs

Jan. 12-15 Rheumatology Winter Clinical Symposium-Hawaii

Jan. 27-29 Fourth Annual Cervical Spine Research Society Hands-On Cadaver C Feb. 3-6 Fourth World Congress on Cerebral Revascularization and 11th Annu

Hands-On Workshop: ECIC Bypass and Microanastomosis Technique

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

For information on the CME programs, please call the SLU School ofcontinuing medical education ofce at 314-977-7401. See updatedetails about Practical Anatomy and Surgical Education Workshop ppa.slu.edu.

For any other events, please contact the Alumni Relations Ofce at314-977-8335or visit medschool.slu.edu/alumni/.

Some people ask me how Ido it how can I travel sooften and so far from moderncomforts. I tell themmy way o lie is more o a

reward than a sacrifce.OWENS

20 Grand Rounds Saint Louis University School of Medicine

left | A few ofOwens friends greet

him at the airport

at McMurdo Station.

Brien


13/13

One N. Grand Blvd., SON 539

St. Louis, MO 63103

Address Service Requested

Non-Proft

U.S. Posta

PAIDSt. Louis, M

Permit No.

Paul H. Young, M.D. (75), was only 10 when he began tagging along

with his father on weekends to the anatomy lab at the School of Medi-

cine. Paul A. Young, Ph.D. (53), would prepare cadaver brains for his

upcoming neuroanatomy lab and answer any questions his son had.

I didnt take my rst class with him until I was in medical school,

but he was teaching me well before then, said Paul H. Young. To tell

you the truth, Im still learning from him today, as are many medical

students.

Paul A. Young, who has been teaching at the medical school for more

than 50 years, has as heavy a course load today as he had two decades

ago. For his animated lectures, famous two-handed illustrations and

dedication to students, Young has received nearly every teaching awardthe School of Medicine grants. In addition to educating his son, Paul

A. Young has taught four of his grandchildren: Julie Young, M.D. (99);

Jason Young, M.D. (05); Nicholas Rottler, a medical school senior; and

Christopher Young, a medical school sophomore.

Teaching always was and is his passion, said Paul H. Young, or

PHY as his colleagues call him

to avoid getting him confused

with his father. He does it bet-

ter than anyone Ive ever seen.

It was only tting then that

PHY recently led an effort to

donate to the School of Medicine

the historical St Louis Metropolitan Medical Society Building a build-

ing dedicated to the education of medical professionals and to name

it in honor of his father.

Paul A. Young Hall at 3839 Lindell Blvd. houses SLUs Practical

Anatomy and Surgical Education programs, which PHY founded in the

early 1980s to offer physicians high-tech surgical training. The programs

began in the School of Medicine histology lab with four courses a year

offered on weekends and during academic breaks.

The demand for training became so great, however, that in 1990

the programs moved to their own facility at the St. Louis Metropolitan

Medical Society Building, now Paul A. Young Hall. Today, the world-class

facility hosts more than 50 workshops a year for surgeons, nurses, physi-cians and other medical professionals, as well as workshops for middle

and high school students who are interested in medicine.

How appropriate to dedicate this building to my father, said PHY.

I cant think of a better way to honor him and to thank him for what

he has given to the thousands of students whove had the privilege of

sitting in his classroom.

To learn more about Practical

Anatomy and Surgical Education

programs administered by the

School of Medicines Center for

Anatomical Science and Educa-

tion, send an e-mail message [email protected].

P R O F I L E O F P H I L A N T H R O P Y

T O L E A R N M O R E about giving opportunities and tax benets that may be associated with your gift,

contact the ofce of development at the School of Medicine at (314) 977-3287 or Matt White at [email protected].

r. Paul A. Young

and r. Paul . Young

Documents

Grand Rounds Magazine Fall 2010