When doctors and students t ake
athletes at a Boston high school under
their wing, everybody w ins
Home
by b r u c e m o r g a n
p h oto g r a p h s by a lo n s o n i c h o l s
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Catherine Logan
(standing, arms folded)
drove the partnership
with Cathedral.
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football player lay face down on the turf, not
moving. Spectators in the stadium held their collective
breath, the way they always do at such moments, unsure
whether they should be preparing to applaud or grieve.
A physician raced out from the sidelines and crouched down to examine the young
man. It turned out the player had just had the wind knocked out of him. The game
resumed, and Jeremie Axe, a third-year orthopedics resident at Tufts Medical Center,
reclaimed his seat on the sidelines, where he kept an attentive eye on the proceedings,
ever watchful for how his young men were faring in the gridiron battle.
In the past year, a small cohort of Tufts
students, residents and faculty members
have volunteered their time and expertise
to the athletics program at nearby Cathedral
High School, improving safety for the student-athletes, advising and mentoring the
players while reassuring their coaches, and
seeking an ever-deeper community involvement that benefits everyone concerned. It’s a
rare, perhaps unique initiative in the Boston
area that’s been driven by a mix of abiding
passion for sports and love for the kids. It’s
also good medicine.
Catherine Logan, M.D./M.B.A., ’12, came
up with the idea. A few years ago she worked
as a physical therapist in New York City, where
more than once she had accompanied a sports
medicine team from the Hospital for Special
Surgery that visited the city’s high schools
offering clinics on physical fitness and injury
prevention. The model stayed with her, even
after arriving at Tufts. She wondered how
the medical school might reach out to a high
school in the vicinity—or, to turn it around,
how some local kids might better connect
with the resources of the medical school. She
consulted with her mentor in orthopedics at
Tufts Medical Center, Elizabeth Matzkin,
an assistant professor at the medical school,
who gave her community outreach notion an
enthusiastic thumbs-up.
People in orthopedic medicine tend to be
hard-core about physical fitness and sports.
A high percentage of the doctors in the field
have sports backgrounds and continue to
race from one thing to another like sprinters
long after they’ve donned their white coats.
“It’s the most physical specialty there is,” Axe
contends. “Orthopedics is a full-day sport.”
After scouting out Boston schools that
might gain from some intervention, Logan’s
pick was Cathedral High School, a small
co-ed, private Catholic school with meager resources located about a mile down
Washington Street from the medical school,
where Jimmy Lynch sat behind a steel desk
in his small, nondescript office off the lobby
of the gym, awaiting her call. Cathedral has
an active sports program, and its boys’ varsity basketball team has won state championships in their division three of the past
five years. But there’s not a lot of cash to
fuel the enterprise, or safeguard its players.
“Our school runs on donations and generous acts,” one coach says with a shrug.
Cathedral’s 250-member student body is
98 percent minority. Ninety percent of students come from families living at or below
the poverty line.
Lynch, 25, is nearing the end of his second year as athletics director. Like almost
everyone who’s part of this story, he’s a jock
at heart, with a lanky, easy movement when
he walks and an indelible belief in the power
of sports to instill structure and discipline in
the lives of those who need it most. Growing
up in working-class Philadelphia, he saw this
happen firsthand amid his circle of friends.
The playground was both their convenient
gathering spot and the fulcrum for their
lives. So when Catherine Logan showed up
last year with her idea of putting the weight
of Tufts behind the Cathedral athletics program to make it safer for the kids involved,
well, she didn’t have to say it twice. “Safety is
priority one for us,” Lynch affirms.
Safety is a widespread problem in high
school athletics in the best of times, and it’s
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At left, the team relaxes courtside. Above,
Elizabeth Matzkin confers with Logan.
Matzkin has brought her three young daughters
to cheer at basketball games here.
among the first things to go when money
gets tight. According to a 2006 survey by the
Centers for Disease Control of nine major
sports, “high school athletes account for
an estimated two million injuries, 500,000
doctor visits and 30,000 hospitalizations
annually.” Boys’ football was by far the
most injury-prone, followed in order by
boys’ wrestling, boys’ soccer, girls’ soccer,
girls’ basketball and boys’ basketball.
What role do coaches play in a typical
from a concussion just a few years ago.
medical emergency? Not much of any, in fact.
Massachusetts law requires that each
Cathedral’s assistant football coach, Collin
high school have an EMT/athletic trainer
Johnson, reports that he, like all coaches, got
on site for football and ice hockey games,
some basic first-aid training—“they gave us
and Cathedral took pains to comply in the
a crash course in ankle-taping,” he says—
days before Tufts arrived. But arguably the
that leaves them all wondering what to do in
greatest value that Tufts has brought to
many situations they commonly encounter
the school has to do with how much more
on the field. “An ankle sprain, we can handle
than the basics—that is to say, the legally
that, but a neck injury or a dislocation, no,”
required minimum staffing, or its medical
he says, his voice trailing off.
equivalent—they have delivered. For one
Concussions pose a special risk.
Players who are temporarily dazed
or “get their bell rung” fall largely
“our school runs
under the average coach’s radar,
even as experts estimate that 10
on
percent of high school athletes in
contact sports suffer a concussion
each season and the severity of
—Cathedral High School Coach
these blows is steadily more appreciated. For Americans between
the ages of 15 and 24, sports are
second only to car crashes as a cause of trauthing, Lynch contends there’s been a shift
matic brain injury. The concern is nothing
in attitude that’s tangible to the athletes.
abstract for the kids at Cathedral. One of
“The EMTs who could cover our games last
the football team’s away games this year was
year would show up at the field and leave
played on the same field where an opposing
at the last whistle,” he explains. “That’s
player had crumpled to the ground and died
not the case now, when Jeremie [Axe] and
donations and
generous acts.”
Logan and Jeremie Axe watch the action.
Since working together with his father at
high school wrestling tournaments, A xe has
always been involved in athletics.
Catherine [Logan] and the others will commonly show up before the game to see the
kids, and then travel on the bus with them
to the football field.”
Other, more obvious gaps have been
filled as well. Working together, Lynch, Axe
and Logan have created a small training
room in what used to be part of
the school gymnasium lobby. The
space features three long, thin
training tables donated by Logan’s
former physical therapy employer
in Wellesley, Mass., and its cabinets have been stocked with new
braces, bandages and liniments.
Lynch came in on weekends to
help knock the space together. “I
remember one time I looked out
and saw Jeremie unloading material from
the trunk of his car,” Lynch says as he shows
off the freshly painted room. “He had driven
down to Delaware over the weekend to get
a bunch of free stuff given us by his father,
who has an orthopedics practice there.”
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Fr ayed Social N e t
The symbol of change in an athletics program can be as simple as a roll of tape.
Sage Philippe, a sophomore on the football
team, still can’t believe the excellent job of
ankle-wrapping that Axe gave him one day
last season. “I injured my ankle a bit in the
first game, and the doctor, he taped it up,”
says Philippe, with a rising inf lection of
surprise on the last three words. “He did
it really good, too,” he continues. “Before
Dr. Axe came along, the coach used to do
it, but he would always do it too tight. I’m
a linebacker, and I need to be able to move
around some. It was way better when Dr.
Axe did it.”
Is it reassuring to look over to the sideline
and see Axe waiting there with his expertise? “Tsss, definitely,” answers Philippe with
a hiss of disbelief. “ ’Cause this is football.
There’s no telling what’s gonna happen.”
nature of Tufts’ commitment to her school.
Nicole Webbe can appreciate the feeling.
“They really care,” she comments, making
As a player on the girls’ volleyball, basketball
that last word ring like a chime, “because
and softball teams, she has drawn her share
they’ll come in and say, ‘Hey, Nicole, how’s
of game-day injuries, including hip and
it going?’ When I see Dr. Axe, I think it
knee bruises. “I had a lot of injuries, playing
would be cool to be like him. He’s always
volleyball,” she says cheerfully. Now, whether
helping people.”
the medical staffer on hand for a given day
Most kids at Cathedral come from relais Logan, Matzkin, Axe or one of the other
tively poor backgrounds, a fact that lies
residents who show up as their schedules
just below the surface of much of what
permit, they can offer Webbe individual
they have to say. Unlike kids from more
attention. “They are able to talk to me, calm
affluent backgrounds, they are not used to
me down, give me ice and get me back to
having resources of any kind lavished on
volleyball,” she says. “It’s like having your
them. Their medical routines are differown doctor there, right away.”
Before, she explains, she would
have gone to the coach with her
“When i see dr. axe,
complaint. “They want to help
you,” Webbe says collectively of her
coaches, in an understanding tone,
“but they have all the other kids to
think about.” Johnson, the foothe’s alWays
ball coach, makes a similar point
helping people.”
from the coach’s perspective when
he remarks that having someone
—Nicole Webbe
like Axe on the sidelines keeps an
injury-related distraction at arm’s
length. “It relieves a lot of pressure.
So instead of me worrying is this kid OK or
ent as well. When one student-athlete at
not, I can be coaching the game,” he says.
Cathedral is asked what his family would
The students suggest there’s a lot more
do about getting him to a doctor’s office to
than good time management on display. In
have an injury looked at, he says, well, that
a way similar to Philippe, Webbe detects
would take some time to be arranged, with
something special and unexpected in the
the implicit message that it might never
i think it Would
be cool to be like
him.
Axe greets an old friend. “This is our high
school,” he says unabashedly. “We love it.”
At right, some physical therapy for an athlete.
happen. Another student, quizzed about
her family’s schedule of medical visits, is
more direct. “My parents are kind of lazy,”
she says bluntly. “They don’t always get
around to things like that.”
A frayed social net has obvious implications when you’re talking about raising the
standard of medical care for high school
students. Medicine costs money, and a doctor’s bill represents another drag on the
family budget. “Say you go down with a
sprained ankle,” suggests Lynch,
the athletics director. “Some of
these kids would have to wait like
a month to see their doctor.” In
the meantime, a twisted knee or
muscle sprain could well turn into
something more serious.
Another effect of not having
ready access to doctors is that players may be naturally tempted to
conceal injuries from the coaching staff if they know the consequence is they will remain on the
bench until they are cleared by
a physician. “This way they’re not holding
back,” Lynch offers. “I know what that’s like,
because I’ve been an athlete who was dying
to get back in the game.” Under the emerging
Tufts partnership, any injuries that occur can
be identified and treated promptly.
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That partnership had its big inaugural event last August when Matzkin and a
handful of medical students and residents
from Tufts Medical Center put on a “Sports
Physical” night for student-athletes in the
school gym. The gym contained tables set up
as medical “stations” where students could
stop by and be examined. Complete musculoskeletal and cardiopulmonary examinations were provided free of charge to 50 kids,
most of whom had signed up for fall sports
and were able to get their clearances to play
on the spot. Doctors at the event also had a
chance to advise students—and in some cases
their parents—about good health habits and
injury prevention. There was more. Soon after
the school year began, Tufts opened a free
walk-in clinic on Thursday afternoons at the
school, in the newly created training room.
Here, an individual athlete might need to
be fitted for an ankle brace, or just want to
discuss some personal aspect of his or her
life in sports. “It gives them an avenue,” says
Axe, who staffs the clinic as often as he can.
B e yoN d tH e du N k
Rock music is laying down a hard, sizzling
beat. The gym is filling up with fans, and
there’s a feeling of excitement as the boys’
sneakers squeak repeatedly on the gleaming
hardwood floor and the basketball team’s
practice shots clang off the rim. This is not
a bad place to shoot hoops. Cathedral High,
founded in 1926, has a two-story original
main building that holds classrooms and
offices and looks a bit sanded down by the
years. The newer adjacent gym, in contrast,
is a cube of glass that invites a certain flash.
Tonight’s opponent is Bishop Fenwick,
a school that’s three times the size of
Cathedral. The game has been scheduled
as a fair contest, Lynch explains, because of
the smaller school’s winning record. And
so the game begins. You certainly wouldn’t
know Cathedral was a top competitor
from watching them. They are sloppy and
listless-looking, like a team of sleepwalkers, or slack-jawed commuters lingering
at a bus-stop. Where’s the talent? Fenwick
offers the counterpoint, moving crisply up
and down the floor and draining shot after
shot in a predictable minuet of swishing
sounds. After 10 or 15 minutes, the visitors
are dominating, 25–18.
“Just wait,” Axe says under his breath.
He is seated on a folding chair at courtside,
having raced cross-town to Cathedral and
arrived minutes before, following a long day
of performing multiple surgeries at NewtonWellesley Hospital. Leaning forward eagerly
in his seat outside the training room, watching the home team’s players move in a pack
around the floor with a keen eye, he is in his
element. If the game were a meal, he would be
eating it with a knife and fork. “That number
32, serious air,” he says appreciatively.
The kids in the gym are stamping their feet
and cheering in unison. Everyone is on edge,
hungry for the dunk that will ignite the home
team. Then it happens: a Cathedral player
goes up to get a routine-looking rebound off
the rim, grabs the ball with both hands in
mid-air and slams it through the net. Whoa!
People rise from their seats. A roar fills the
gym. “Here we go,” Axe and Lynch (standing
beside Axe) murmur in unison.
Cathedral wakes up big-time. The pace
on the floor quickens, and the team’s shots
start to drop like nickels and dimes through
a coin slot. They are suddenly completely
in control of the game as Fenwick seems to
recede before our eyes. Axe whoops happily
and unselfconsciously when a play is sublime,
which is often now. (The final score is 83–63
in Cathedral’s favor, a drubbing). Whether
he’s bent down tending a fallen athlete or yelling with abandon at courtside, Axe doesn’t
look at all like an outsider, or someone who
has shown up out of curiosity; he’s more like
a man who has always been here in spirit and
simply took a while to find the address.
“I’ve asked around, and there are not
that many ortho programs that have their
own high school—and this is our high
school. We love it,” Axe says unabashedly.
“We didn’t fall into it, we didn’t inherit it,
we began it.” The relationship is still young,
of course. Plans are in the works for Tufts
to expand its health coverage for Cathedral
by hosting public seminars for students and
their parents on topics such as sports nutrition, injury prevention and more. Some
changes will reach into the classroom. Loni
Rogers, ’14, has volunteered to work with
Lynch on devising an elective course for the
high school seniors on how to make better
food choices in their daily lives. The new
curriculum should be ready by the fall.
Matzkin, who has brought her trio of
young daughters (ages three, six and nine)
to sit in the bleachers and cheer at basketball games, has her own personal and professional reasons for wanting the budding
Tufts/Cathedral partnership to thrive longterm. “For those of my residents interested
in sports medicine, this is an incredible
opportunity to take on responsibility,” she
remarks. “My hope is that they will take
ownership of this and pass it down from
year to year.”
Time will tell. Right now the program’s
only certain gain takes the form of a junior
varsity basketball player who approaches
Axe shyly at halftime to say he was scratched
on his cheek by an opposing player in a
game earlier in the day, and is there anything he should do to treat the scratch? Axe
responds quickly and respectfully to the
request, fetching a small vial of antiseptic
cream and a gauze pad from the training
room. “Here you go,” he tells the young
man. “Put some of this on before you go to
bed. It should be fine.” tM
Bruce Morgan, the editor of this magazine,
can be reached at [email protected].
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The Man
Who Did the
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i l lu s t r at i o n by c h r i
in this modern, secular world, we place great faith in the
scientific method. That might be why when we hear about a study that says we
should take more of a particular vitamin, eat this fruit or take that drug, we pay
close attention. “Studies have shown…” is a common refrain in news reports,
lending a certain seal of approval.
But then another study comes out, and it turns out that the vitamin we’re
taking is causing more problems than it’s solving; the fruit we’re consuming in
the quest for a long life isn’t doing anything of the sort, and that prescription
we’ve been dutifully downing every day is not solving one health problem, but
causing another.
To cite two outsize examples: a decade ago post-menopausal women were told,
based on existing studies, they should be on hormone replacement therapy—until
it was shown years later that HRT can increase the risk of breast cancer, heart disease and stroke. Vioxx was widely prescribed as a safe medication for acute pain,
with many studies giving it the nod—until it proved to cause an increased rate of
heart attacks and was swiftly removed from the market.
Why is it that so many research studies don’t survive later efforts to replicate
the initial results—a standard practice for validating research—and what can be
done about it? Those questions have concerned John Ioannidis for the better part
of two decades, and now dominate his academic life.
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So what is
ailing medical
research?
In dozens of papers, Ioannidis and his collaborators have found
that small sample sizes, poorly designed protocols and lax statistical standards have produced a miasma of unsubstantiated and
misleading research. And while the research studies undergo peer
review before being accepted for publication in professional journals, the standards that the profession uses to judge research have
not been stringent enough, Ioannidis says, leading to systemic
problems.
A longtime adjunct professor at Tufts University School of
Medicine, Ioannidis made the point sharply in the title of his
widely cited 2005 paper, “Why Most Published Findings Are False,”
which appeared in the journal PloS Medicine.
Not everyone agrees, of course. PLoS published a response to
the article by two researchers who questioned the mathematical
models Ioannidis used to support his claims. But even they agreed
“that many medical research findings are less definitive than readers suspect … [and] that bias of various forms is widespread.”
There’s obviously plenty of downside to any flawed study. Bad
research on medical interventions has the potential to expose large
numbers of people to ineffective, harmful and expensive treatments. Basic scientists run the risk of wasting millions of federal
research dollars in their pursuit of science based on misleading
findings. For example, there are still numerous researchers who
continue work “based entirely on the premise that beta-carotene
is an effective chemo-preventive agent for cancer, despite repeated
refutations by large trials,” Ioannidis says. “That money could
have been invested elsewhere.”
What Ioannidis really wants, though, is not to castigate scientists. Instead, he wants them to develop ways to make their
research better. He’s making his case in respected journals, such
as Lancet and the Journal of the American Medical Association, and
regularly speaks at scientific conferences. The Atlantic magazine
recently carried a long article about Ioannidis, calling him “one of
the world’s foremost experts on the credibility of medical research.”
And he was quoted at length by the science writer Jonah Lehrer
in a January New Yorker article that explored problems with the
scientific method.
“I think he has come across something that has not been recognized before. It is potentially extremely important,” says Jerome
Kassirer, a Distinguished Professor at Tufts Medical School and
the former editor of the New England Journal of Medicine. “I think
that it is something that needs to be followed up. If it’s true, then
every study is going to have to be evaluated based on what is already
published and what the new observations are,” he says.
Staying in Motion
As a high school student, Ioannidis’ first passion was mathematics,
but he eventually followed his physician parents into the “family
business,” graduating first in his class at the University of Athens
Medical School. He says he was intrigued by the “evidence-based
medicine” movement that was gaining traction in the early 1990s:
it sought to base treatments on proven techniques. But Ioannidis
thought that many studies on which the evidence relied seemed
sloppy, based on small sample sizes and poor science. He started
to apply meticulous statistical analyses to the studies—and found
them wanting.
He first came to Tufts School of Medicine in 1993 on a fellowship and started working on just these questions. He has been an
adjunct faculty member since 1996, and now holds the rank of professor. In 2008 he also was named director of the genetics/genomics
component of the Tufts Clinical and Translational Science Institute
(www.tuftsctsi.org) and of the Center for Genetic Epidemiology
and Modeling in the Institute for Clinical Research and Health
Policy Studies at Tufts Medical Center. He works closely with his
medical school colleague, Joseph Lau, whose research focus is on
evidence-based medicine and meta-analysis, in particular developing tools to conduct systemic reviews of scientific studies.
Ioannidis (pronounced yo-NEE-dees) is nothing if not peripatetic: for the last dozen years or so, he’s also held an appointment as professor and chair of the Department of Hygiene and
Epidemiology at the University of Ioannina School of Medicine in
Greece, and late last year was named the C.F. Rehnborg Professor
in Disease Prevention at the Stanford School of Medicine.
Earlier this year he was again back at Tufts Medical School,
working with Johanna Seddon, a professor of ophthalmology, on
a large-scale meta-analysis of genome-wide association studies for
age-related macular degeneration, and Peter Castaldi, an assistant
professor of medicine, on an evaluation of validation practices,
among others. “We have video conferences between Greece and
Tufts every couple of weeks with presentations on our research,”
adds Ioannidis. “It’s a small world.”
ProbleMS in the Mix
The crux is this, according to Ioannidis, who has analyzed thousands of research studies: those that garner media attention—and
thus public notice—often have tiny sample sizes, and the smaller
they are, the less likely they are to be true. Take vitamin D. Early
and enthusiastic small studies touting its many health benefits,
from preventing cancer to protecting children from allergies, are
now being tempered by larger and better-designed studies that
haven’t found nearly the results the earlier investigations claimed.
This is a typical and recurring pattern.
Vitamin D fit the mold. In late November 2010, the Institute
of Medicine issued a report urging caution before loading up on
vitamin D. Ioannidis was not surprised. “We’ve had tons of observational data on various vitamins, such as vitamin E and vitamin
C and beta-carotene, suggesting that you can see huge health benefits,” he says, from improved cardiovascular health to lower incidence of cancer. “Then others do further research, running very
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large randomized studies, and they showed no benefit most of the
time, and sometimes even showed harm.”
And the more that money or politics is involved in the research,
the less likely the results are to be valid, he says. Think of big
pharmaceutical companies reporting on drug tests: there’s a huge
incentive to play up positive results, however weak, and downplay
negative ones.
In discussing ways to counter loose methodology, Ioannidis
talks often about the “gold standard” for research: large, doubleblind, randomized trials. In those scenarios, participants are randomly assigned to test and control groups, and participants and
researchers are unaware who is receiving the drug or device being
tested until the study ends. Yet even that supposedly ideal metric
isn’t perfect. Ioannidis and his colleagues found that a quarter of
all double-blind, randomized studies were flawed, and even the
large ones, which offer more protection from error, were wrong 10
percent of the time.
For example, he says, “claims that vitamin E can decrease cardiovascular events and death by half were supported not just by
smaller, observational studies, but also by at least one large randomized trial of 2,002 patients.” But subsequent studies disproved
those results. Likewise, the claim that magnesium can markedly
decrease mortality in patients with acute myocardial infarction
was supported by a large randomized trial with more than 2,000
patients, but was later found to be in error.
research. “I think that there has been quite a lot of progress in the
way that research is designed and reported,” he says, but adds a
quick qualifier: it depends on the field. One discipline that has
made clear progress, he says, is genetic epidemiology, the study of
how genetic factors influence health. “I think it is one where within
a short period of time, we have seen dramatic improvement in the
standards of research,” he says.
Even relatively recently there were plenty of papers published
in genetic epidemiology that used only a handful of cases and controls and employed very lenient statistical significance rules—“this
gene caused that disease, at least in the 24 people studied” was a
standard approach. “Pretty much anything generated from that
type of study was not replicated in follow-up studies up to 95 to 98
percent of the time,” Ioannidis says.
But in the last five years, in response to criticism from Ioannidis
and others, genetic epidemiologists have raised the bar. To determine the validity of findings, they use a measurement called a
probability value, or p value. It refers to the likelihood that the
thing being tested has an effect versus having no effect. In the
past—and still today in many fields—a finding would be considered statistically significant with a p value of 0.05, meaning there
is a less than a one in 20 chance that the thing being tested doesn’t
have an effect.
The goal should be a p value of less than 0.000000005, Ioannidis
says, the type of standard used in studies of genetic causes of disease because it heightens the probability for accuracy.
Along with more stringent statistical criteria, large consortia of up to 30
teams of investigators often are “joining forces with common protocols,
definitions, stringent quality control,
sharing of all the data and a common analysis plan,” he says. Genetics
research is a good example, with
international groups of researchers
sifting through vast amounts of data
to identify the genes that cause different types of cancer.
— Joh n Ioa n n i dis
The new standards have led to a
realization that many genetic factors
don’t increase the risk of, say, having
There’s also the issue of selective reporting. While drug com- diabetes or a heart attack or Parkinson’s disease two-fold or threepanies have to register with the FDA for clinical trials in advance, fold, as previously thought. Instead, those risks work out to 1.1there is no obligation to report the results. “They run hundreds of
fold or 1.15-fold. “These are far more tempered and conservative
trials and report only those that get the most promising results,” discoveries, but they are genuine,” he says.
Ioannidis says. The public never learns about the others.
With all the talk of flawed research, could Ioannidis be wrong
He cites trials of antidepressants. Only about half of the hun- about being wrong? “Absolutely,” he says. “I think that this is just
dreds of studies done by drug companies were positive, but “when
part of the scientific process: everything needs to be replicated and
you look at the literature, almost everything that has been pub- reexamined by other investigators, and needs to be transparent
lished has positive results.”
enough so that it can be replicated or refuted.” tM
It’s not all bad news, though. “It would be tragic,” Ioannidis
Taylor McNeil, the senior news editor in Tufts’ Office of Publications,
says, if things had not gotten better since he and other scientists
can be reached at [email protected].
started working on improving the statistical validity of biomedical
“I think that there has
been quite a lot of
progress in the way
that research is
designed and reported.”
photo: kelvin ma
27943p24-27.indd 27
s p r i n g 2 011 tufts me dicine 27
4/28/11 3:26:02 PM
on campus
medical school news
Translating
‘Doctor Speak’
A new movement is helping health-care professionals
communicate better and improve outcomes by Helene Ragovin
hen some tufts dental students were learning how to
communicate better with their patients, one repeatedly used
the term “caries” to describe a common oral health problem.
The teacher kept correcting him.
“Who uses the term ‘caries’ for ‘cavity’? No one. Only dentists,” said the
instructor, Sabrina Kurtz-Rossi. “They were so involved in their own field and
their own learning that they had forgotten how people outside the field talk.”
The use of discipline-specific language isn’t limited to dentistry. For healthcare students and practitioners, there is too often a gap between what the provider
is intending to say and how their patients interpret and act on that information.
Bridging that terminology gap is one goal of the field of health literacy, a movement designed to increase communication and understanding in health care.
28 t u f t s m e d i c i n e s p r i n g 2 0 1 1
27943p28-32.indd 28
“You’d think it would be so obvious, but
health literacy has only recently been recognized on a national level by the surgeon
general and the Institute of Medicine,” says
Kurtz-Rossi, an adjunct clinical instructor
who teaches a seminar on health literacy
as part of the School of Medicine’s health
communication program. The course, one
of only a handful on the topic taught at
medical schools across the country, draws
students from the medical and dental
schools, the Friedman School of Nutrition
Science and Policy and other public health
students at Tufts.
The U.S. Department of Health and
Human Services defines “health literacy”
as the ability to read, understand and act on
health information. “Within the field, we see
it as much broader than that,” Kurtz-Rossi
says. “Health literacy is a two-way street.
It’s not only the skills the patient brings to
the clinical encounter, but the skills of the
health-care provider and ability of the system
to communicate health-care information.”
T he c on s e quenc e s of p o or c ommunication go far beyond confusion.
“Miscommunication is one of the top
causes of medical errors,” Kurtz-Rossi
says. Patients who don’t understand hospital discharge instructions for home care
or dosing instructions for their medication are more likely to be re-admitted.
Within the past two decades, assessments
of adult literacy in the U.S. have revealed
that nearly 50 percent of the population has
basic or “below-basic” literacy skills, according to the National Institute for Literacy.
“That was a wake-up call to the health field,”
Kurtz-Rossi says. “If millions of people have
limited literacy, that raises questions about
the ability of a large part of our population
to navigate the health-care system and our
ability to reduce health-care disparities.”
At the same time, researchers have documented the mismatch between written health
information that is being disseminated and
the reading skills of patients. “We’ve built
a lot of evidence documenting that we’re
not doing such a great job communicating
illustration: alex nabaum
4/27/11 3:26:19 PM
health information with patients and the
larger community,” Kurtz-Rossi says.
The patients at greatest risk for not
understanding what is being communicated include the elderly, those who haven’t
completed high school, the poor and those
for whom English is not the first language,
Kurtz-Rossi says.
But they are not the only ones. “If you
have a Ph.D. but know nothing about
heart disease, and your doctor starts talking about angioplasty, you may not understand,” she says.
That leads to a not her element of
expanding health literacy: promoting a
shame-free environment when communicating with patients. “You don’t know who
doesn’t understand and who may be too
to almost unlearn what they’ve learned”
when they talk to their patients.
“In medical school, you communicate
with your students and colleagues in one
way,” she says. “When you’re working with
patients, you need to speak about health in
‘living room language,’ also known as plain
language.” It isn’t as simple as it sounds. “Sit
down and try to write in everyday language
about a health-care topic—it’s not so easy,”
Kurtz-Rossi says.
For example, she says, “think about communicating risk. It’s a fairly complex concept. When you’re counseling patients about
cancer treatment or other treatments, we
expect people to understand the concept of
risk and make life decisions based upon the
information provided to them.”
Culture also has
a bearing on health
literacy, Kurtz-Rossi
says, and there are
times when healthcare concepts and
vocabulary literally
don’t translate. “For
example, in Navajo
there is no word
for chemotherapy,”
she says. “If you’re
work ing w ith an
— Sa br i na Ku rt z-Ro s si
interpreter, not only
the word, but the
embarrassed to say so,” Kurtz-Rossi says.
whole concept has to be explained.”
“We talk about establishing an atmosphere
Kurtz-Rossi teaches her students about
of helpfulness, encouraging questions and
working with interpreters, stressing the
engaging all staff.”
importance of using professional interpreters instead of a patient’s family members.
Living Room L anguag e
A guest speaker in one of Kurtz-Rossi’s
During the past decade, more medical
classes was a “cultural broker” from Maine
schools and schools of public health have
Medical Center in Portland who helps memrecognized health literacy as a core combers of Maine’s growing Somali immigrant
petency for students. That wasn’t always
community navigate the health-care system
the case. “One physician told me that 20
and helps the providers better understand
years ago when he was in training, he got
Somali culture and health-care needs.
marked down for using common language
rather than medical terminology” when
Helene Ragovin, a senior health sciences
talking to a patient, Kurtz-Rossi says.
writer in Tufts’ Office of Publications, can be
“That’s changing now, but doctors need
reached at [email protected].
“If millions of people have
limited literacy, that raises
questions about the ability of a
large part of our population to
navigate the health-care system
and our ability to reduce
health-care disparities.”
photo: kelvin ma
27943p28-32.indd 29
The ArT
of Medicine
Last November 15, a reception was
held on campus to dedicate the art
donation of Nada Farhat, M.D./M.P.H.,
’11. Inspired by cell tissue, her painting,
which she titled “Cell-Abration!,” is
displayed in the lobby of the Biomedical
Research and
Public H ealth
Building on
Harrison Avenue.
A microscope
set up at the
reception
enabled guests
to v iew c ell
tissue firsthand.
“Th ough
often seen
as s eparate
disciplines, a rt a nd science naturally
complement e ach other,” r emarked
Harris B erman, d ean ad interim.
“Here at t he medical school we s trive
towards educating doctors, scientists
and public health professionals w ho
are creative problem-solvers, a nd t his
creativity i s b eautifully c aptured in
Nada’s w ork of art.”
Originally from Saudi Arabia, Farhat
spent much of her childhood in the
United States. U pon her return to her
native c ountry, s he s tudied art a s a n
outlet for self-expression. Her work
is inspired by a s upple mix o f Middle
Eastern architecture, I slamic p atterns
and science. A s elf-taught artist, Farhat
held her first s olo exhibition in Saudi
Arabia at a ge 21 and has participated
in several shows s ince t hen. N ow based
in Boston, s he divides her time between
her appointment a s a c linical associate
in pathology a nd her art.
s p r i n g 2 011 tufts me dicine 29
4/27/11 3:26:20 PM
on campus
Have vaccine, Will Travel
In a boon to poorer countries, researchers create new ways to store and deliver
life-saving inoculations by Jacqueline Mitchell
S
ince the advent of vaccines,
childhood mortality has declined
dramatically in industrialized
nations, but that is not the case in
many other parts of the world. That’s because
traditional vaccines require constant refrigeration to keep them potent, clean needles
and trained health-care professionals to
administer them and money
or medical insurance to pay for
them. In developing nations,
these requirements are significant roadblocks to protecting
children from some of the most
common infectious diseases,
including measles and polio.
At Tufts, a team of researchers led by Abraham “Linc”
Sonenshein, professor and
interim chair of molecular
biology and microbiology at
the School of Medicine, and
Saul Tzipori, a Distinguished
Professor of Microbiolog y
and Infectious Diseases at
t he Cu m m i ng s S c ho ol of
Veterinary Medicine, are developing a new vaccine delivery
system to overcome those barriers. They have published two
studies outlining their achievements in successfully inoculating mice against tetanus and
rotavirus, which causes severe
dia rrhea, by using genet ically engineered bacteria to
deliver the vaccine. If this method works in
humans, it could open the door to inexpensive, heat-stable, needle-free vaccines.
“It’s an alternative approach to vaccination
that may be more effective in some parts of
the world than existing vaccines,” says John
E. Herrmann, a researcher in the Infectious
Diseases Division at the Cummings School.
Vaccines protect us from illness by introducing little bits of pathogens—not enough
to make us sick, but enough to provoke the
30 t u f t s m e d i c i n e s p r i n g 2 0 1 1
27943p28-32.indd 30
immune system. The immune system reacts
by developing antibodies, disease-specific
proteins that will identify and attack the
pathogen the next time it enters the body.
Antibodies recognize a pathogen by specific proteins—the molecular calling cards
known as antigens—it wears on its surface.
But high temperatures can damage those
antigen proteins, meaning vaccines must
be kept refrigerated to remain effective. In
much of the developing world, where a constant supply of electricity isn’t a given, that’s
not always possible.
To overcome that challenge, the Tufts
researchers have genetically altered a common bacterial species, Bacillus subtilis,
to manufacture antigen proteins. When
introduced into the body, this harmless
bacterium will stimulate the immune
system to develop antibodies.
B. subtilis is a ubiquitous bacterium commonly found in soil. Under environmental
stress, the bacterium goes dormant, taking
the form of a tough spore capable of withstanding extreme heat, acidity and salinity.
It’s well-studied, easy to genetically manipulate and grows quickly in the lab.
“This would be a very lowcost vaccine,” says Sonenshein.
“We expect it wouldn’t cost
more than pennies per dose.”
In a study published in the
journal Vaccine in August 2010,
the scientists describe how they
genetically engineered B. subtilis
to express a fragment of tetanus
toxin protein either on the surface of the spore or inside the cell
in its active, non-spore form.
Both forms of the engineered bacteria, when delivered
by nasal drops, proved to be
highly effective in protecting
mice against the tetanus toxin.
Moreover, after being freezedried, both forms of the bacterial vaccine remained potent
for 12 months at more than 100
degrees Fahrenheit. The vaccine appeared to be as safe as it
was effective, with the scientists
finding no side effects or any
evidence of B. subtilis infecting
any other tissues in the mice.
In another groundbreaking
experiment, the team engineered B. subtilis
to express a rotavirus antigen. Rotavirus is
the leading cause of severe diarrhea in infants
and young children worldwide, killing an
estimated 500,000 children each year.
While the non-spore form of the engineered bacteria failed to induce protective
immunity against rotavirus in mice, the
spore form proved to be effective when combined with an additive that enhanced the
immune system’s response.
illustration: mario wagner
4/27/11 3:26:21 PM
“We were the f irst ones to induce
immunity against a virus this way,” says
Herrmann, the senior author of the second
study, published in the November 2010
issue of the journal Clinical and Vaccine
Immunology.
if aT fiRST You
Don ’T SucceeD
The findings came just five years after
the Tufts team, collaborating with scientists from Boston University and Tulane
University, began work on the project supported by a $4 million grant from the Bill
and Melinda Gates Foundation.
Things as complicated as vaccine development don’t always work as planned,
though. Back in 2005, the researchers envisioned engineering B. subtilis to express the
antigen on the surface of the cell in its nonspore form and then inducing the bacteria
to take its spore form in the laboratory. That
heat-stable spore could have been stored
indefinitely and shipped around the world.
When mixed with a liquid and consumed,
the researchers hypothesized, the spore
would germinate in the gastrointestinal
tract, releasing active cells, which would
express the antigen protein into the body.
“Almost every aspect of that plan turned
out not to work,” says Sonenshein, who notes
the spores didn’t germinate well in the digestive tract.
So the scientists eliminated that step
in the process by designing the bacteria
to express the antibody on the surface of
the spore itself. Since the bacterial spore
is administered via nasal drops instead of
orally, the cell avoids the digestive tract,
allowing the antigen to make immediate
contact with the immune system.
Having demonstrated the delivery method’s efficacy, now the team is ready to partner with new funders and manufacturers to
prove the tetanus and rotavirus vaccines are
not toxic in animals other than mice.
“Everything about vaccines is unpredictable,” says Sonenshein. “But generally, if it
works in two animals, the chances are very
good it will work well in humans. We’re very
hopeful that our approach will generate
many inexpensive vaccines that don’t need
refrigeration, needles or trained personnel
for delivery.”
Tufts Medical Center
CEO to Retire
ellen Zane, who stepped
into her role as president
and chief executive of tufts
medical Center seven years
ago to help rescue the
hospital from red balance
sheets, will retire at the
end of september.
with her decisive
personal style, Zane is
widely credited with having
turned the hospital around.
losses were greater than
$18 million annually when
she took the reins in 2004.
last year the hospital earned
$6.9 million. “her heel
print is very deep on the
Ellen Zane
massachusetts health-care
landscape,” lynn nicholas,
chief executive of the massachusetts hospital association, told the
Boston Globe. “she is not a ‘yes’ person and is willing to challenge the
status quo.”
tufts university president lawrence s. bacow is emphatic in his
praise of Zane, calling his recruitment of her “one of my greatest
accomplishments” as president. “i have worked with many great leaders
during my 34-year career in higher education,” he wrote in an email to
university staff and faculty, “but i don’t think i have ever worked with
anyone quite like ellen. she is a force of nature—smart, focused, strategic, creative, articulate, thoughtful and tough when she needs to be.
if she is not the best hospital Ceo in the nation, i would like to meet the
person who is.”
bacow also applauded Zane for her cultivation of a closer, more
fruitful relationship between tufts medical Center and tufts medical
school, noting “the ‘tufts model’ is now the envy of many other institutions and represents a new paradigm for academic medicine, one in which
the hospital and medical school constantly collaborate for mutual gain.”
For her part, Zane noted the pressing challenges that lie ahead for
hospitals striving to stay competitive in a time of shrinking resources,
both statewide and nationally. one of her winning strategies at tufts
medical Center was to partner with a number of community hospitals
and reach out to the hospital’s neighbors in boston’s Chinatown, which
helped expand the patient base. “as i prepare to retire this fall,” Zane
wrote in her message to the hospital community, “i do so with great
confidence in the future of this organization.”
in retirement she will serve as vice chair of the board of trustees and
as a paid consultant to tufts medical Center for a year to assist with the
transition in leadership. the hospital’s board has put together a search
committee and hopes to find Zane’s successor by september 30.
s p r i n g 2 011 tufts me dicine 31
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on campus
no easy answers
An ethics seminar for second-year students tackles
medical ambiguity by Bruce Morgan
S
uppose a two-week old infant
has been born with no clear sex,
showing elements of both male
a nd fema le genita lia. W hat
should the child’s gender be, and who
should decide the question?
The 35 students seated around the
table in a Sackler Center classroom don’t
take long to start chiming in. First, Dr.
Sanjay Bansal, a pediatric endocrinologist at Tufts, brief ly introduces the case
at the front of the room, using a slide or
two to illustrate the rare but real condition
known as congenital adrenal hypoplasia,
or CAH. “You are presented with this
situation, and it’s a challenge,” offers Alon
Above, students
ponder the complexity
of a case under review.
At right, Dr. Bansal
(standing) fields
a question.
Neidich, ’13, one of the student organizers
of the new monthly medical ethics seminars, as a bridge to the general discussion.
“How should this child be introduced to
the grandparents—as a boy or girl?”
Dr. Steven Ralston, who co-directs the
medical ethics course for first-year students, speaks up. “Imagine yourself not
only as the doctor, but also as the parent,”
he says. Ralston, an associate professor of
obstetrics and gynecology, is one of several
faculty members in attendance and a key
advisor to the student group, steering them
to faculty members who are likely to yield
thought-provoking cases from their respective disciplines. Each meeting offers two
such cases for consideration in
a richly branching hour.
A female student strikes
a practical note for the case
under review. “If you decide on
a gender assignment,” she asks,
“which of the treatments are
reversible?” This prompts Dr.
Richard Siegel, another endocrinologist on hand, to give
some quick cultural history.
“It used to be that whether
you became a boy or a girl was
determined by whatever the
physician thought best,” he points out.
“But more recently patients have voiced
their consternation about this.”
“Is it OK to let the patient grow up and
decide?” a student at the far end of the table
wants to know. “Excellent question,” Bansal
responds. “But bear in mind that where
there’s an adrenal insufficiency, you have
to treat that medically [without delay].”
“Would there be fully functioning genitalia in either case?” another student asks,
“and if so would the person have sexual
pleasure?” Without responding directly,
Bansal extends the complexity. “Say we
made this into male genitalia,” he says,
indicating a small nub on the medical
slide. “What’s going to happen with fertility? We’re not sure. The aim is to give
the patient a chance to have a family. One
question that parents of children with this
disorder often ask is: Will our child have a
same-sex orientation? The answer to that
is no—not any more so than members of
the general population.”
Another student wonders if the mother
should be treated with steroids during any
future pregnancies to head off a recurrence of CAH. “That’s a very controversial
issue,” Bansal notes, “whether to treat the
mother with steroids or not.” Ralston has
a related thought: “We’ve been so concentrated on the genitalia, but there are other
issues here,” he says. “We would be treating the mother with very strong steroids
for seven or eight months. We don’t know
what the effect of this might be on her, 10
or 20 years out.”
The questions keep coming. “Can we
wait until patients are four or five years
old to let them decide for themselves?” a
female student wants to know. A bearded
male student is troubled by this, saying,
“We’ve got to be careful about giving kids
too much autonomy. Also, we’ve got to
respect the preference of the parents. I
think it may be too much, having a fouryear-old make decisions that leave us perplexed as medical students.”
This last exchange, with its lack of resolution, is typical of today’s meeting. “What
we’re looking at is a venue where medicine
meets the soul,” Neidich noted in an earlier
interview. “There is so much more to being
a doctor than just knowing the x’s and o’s.”
photos: alonso niChols
27943p28-32.indd 32
4/27/11 3:26:23 PM
university news
the wider world of tufts
the political dimensions of economic policymaking “has been eye-opening,” something that academic economists don’t
always pay enough attention to, he says.
“That’s a very important aspect to how
policy gets done, both domestic politics
and international politics.”
He was offered the job by his current
boss, Lael Brainerd, the undersecretary
for international affairs at Treasury, who
reports to Geithner. Klein got the call
because of his policy-oriented research on
topics such as exchange rates.
On leave from Tufts,
Michael Klein is the chief
economist in the U.S.
Treasury’s Office of
International Affairs.
tufts at treasury
The Fletcher School’s Michael Klein gets up close and
personal with the global economy by Taylor McNeil
T
he view from michael klein’s office window is a bit different
from his usual one at the Fletcher School at Tufts, where he’s
a professor of international economic affairs. Now he sees the
White House.
Since June, Klein has been on leave from Fletcher, serving as the chief
economist in the U.S. Treasury’s Office of International Affairs. He’s leading
research and writing policy briefs on current economic topics. Working in
the main Treasury building on Pennsylvania Avenue, he finds the view isn’t
the only thing that’s changed. While the articles he writes for academic journals might be years in gestation, now if he takes more than a week to draft a
policy brief, it will be stale—yesterday’s news.
Klein and his colleagues, permanent staffers at Treasury and interns
from schools like Fletcher, provide the background for Treasury Secretary
Tim Geithner to formulate U.S. international economic policy. The goal of
the international office, says Klein, is to help foster sustained growth and
economic stability in the United States and encourage policies that do the
same in other countries, since in a global system all parts are linked.
“It’s been interesting—and a real learning experience,” Klein says. Seeing
photo: toby jorrin
27943p33.indd 33
H ef t an d deptH
International economics is more important
than ever. “The crisis that we’ve had over the
last few years has demonstrated the way in
which events in one country can affect what
happens in other countries,” Klein says. “So
in the Office of International Affairs, there
is a real focus on how international events
affect the U.S., and how the U.S. affects the
world.” That has meant, for example, dealing with debt challenges in Europe, which
threatened to stall the U.S. economic recovery last spring, and controversy over U.S.
monetary policy, which led to “cries of currency wars from some in emerging market
countries in the fall,” he says.
His role, Klein says, “is to provide intellectual heft and depth to what’s going on
in the international affairs division.” In
meetings and policy briefs, he draws on
his knowledge of—and contributions
to—scholarly research on topics to provide background about current concerns
for top-level policymakers at Treasury.
“It’s providing a context and framework
for thinking about issues,” he says.
Serving in the Treasury has also given
him a greater appreciation for public
service. “The people working here are
really top-notch,” says Klein, the William
L. Clayton Professor of International
Economic Affairs at the Fletcher School.
“It’s very inspiring to see people really
working very hard for the public good.”
“The Fletcher School has always been
an institution that values both scholarly
research and practice,” says Dean Stephen
Bosworth. “Michael will now be even better able to help prepare his students for
public service.
s p r i n g 2 011 tufts me dicine 33
4/22/11 10:39:40 AM
beyond bounda r i e s
providing the means for excellence
Partners in Discovery
Russo grants encourage researchers from different disciplines to explore
tough medical problems by Mark Sullivan
sk sackler school dean naomi rosenberg how the russo
grants have benefited medical research at Tufts, and her response
is quite succinct: “This support brings talented people together
and allows them to try new things.”
Since a gift from the Russo Family Charitable Foundation Trust established
the grant program six years ago, 20 research teams, in most cases scientists
from different disciplines, have received early support for novel investigations
in genetics, neuroscience and other areas. The grants, ranging from $10,000
to $20,000, enable researchers to conduct pilot tests that lay a good foundation
34 t u f t s m e d i c i n e s p r i n g 2 0 1 1
27943p34-35.indd 34
for their work to move forward on track.
“The Russo grant gave us the stepping
stone to start a really big collaborative project,” says the Tufts immunologist Brigitte
Huber, a professor of pathology. She and
her colleague, Ronald Lechan, a neuroendocrinologist and professor of medicine,
received a Russo award in March 2010 for
their studies of a molecule called DPP-2.
Mice lacking this molecule in the hypothalamus have glucose intolerance, insulin
resistance and other conditions that predispose them to type 2 diabetes. The findings have potential applications in the war
on obesity.
Huber said the initial work made possible by the Russo award paved the way for
an interdisciplinary partnership with two
other scientists, from the Scripps Research
Institute and University of Massachusetts
Medical School. The four now are applying for a $300,000 grant from the National
Institutes of Health to continue their work.
“NIH isn’t going to write a check for just
a good idea,” Rosenberg says. “You have to
show your idea is worthy of investment.”
Encouraging academic collaboration
was the idea behind the initial $250,000
gift made through the Russo Trust by
Devette Russo, M11P, a School of Medicine
overseer who had a distinguished career in
biomedical technology before she retired.
“Solving the toughest problems always
requires a multidisciplinary approach,”
she says. “We wanted to do something that
would help build the kind of culture that
can deliver truly innovative research.”
This seed money for pilot research has
been very important, Rosenberg says. “It
brings people together to try new things.
There is an understanding that not everything will pan out. We would like every project to be a home run, but not every project is
going to be. That said, there are lots of good,
illustration: brad yeo/theispot.com
4/27/11 1:39:14 PM
strong, exciting ideas, and if the attempt
doesn’t pan out, it may lead to something
else. People are excited about these grants.
They have brought about a huge influx of
new ideas. Scientists thrive on this.”
U n r aveling
Down Syn Drom e
Diana Bianchi, Donna Slonim and Philip
Haydon received a Russo grant in August
2010 to study the basic biology of Down
syndrome. The research draws on the scientists’ special areas of expertise—genetics, neonatology, pathology, computer
science and neuroscience—to attack a
poorly understood genetic condition in
which a person has an extra chromosome
(47 instead of 46). Their work will explore
potential therapies to mitigate its effects,
possibly leading to a better understanding
of other disorders with origins in altered
neurological development.
Using mice that have a chromosomal
abnormality similar to human Down
syndrome, the researchers hope to determine if pregnant females that receive
FDA-approved antioxidants produce pups
with a higher level of mental development,
says Bianchi, the executive director of the
Mother Infant Research Institute at Tufts
Medical Center and the Natalie V. Zucker
Professor of Pediatrics, Obstetrics and
Gynecology at Tufts School of Medicine.
and Rajendra Kumarhypothesized that if we
Singh, associate procould negate the oxidafessor of ophthalmoltive stress, it might have
og y—is seek i ng to
a beneficial effect on
develop methods for
brain development in
treating such injuries.
the womb,” she says.
The trio used its
Bianchi notes that
Russo grant to explore
the Russo funding “has
whether silk proteins
jump-started a threecould be used to repair
way col laborat ion”
Ganglion on the posterior nerve
damage to the mass
across two campuses:
root of the spinal cord.
of nerve cell bodies
her lab at Tufts Medical
known as the dorsal
Center and Haydon’s
root ganglia, says Kaplan, the director of
in the medical school’s Department of
Tufts’ Bioengineering and Biotechnology
Neuroscience on the Boston health sciCenter who has spent more than two
ences campus and Slonim’s laboratory in
decades researching medical applications
the Department of Computer Science at the
of silk (see “Common Threads,” Tufts
School of Engineering on Tufts’ Medford/
Medicine, Winter 2011). Because silk is
Somerville campus. With the Russo grant
biocompatible—it doesn’t disturb the
they’ve purchased the mice with the model
immune system—its potential in medicine
form of Down syndrome and have begun
is boundless.
giving some of them the various supple“A major goal of the research concernments to determine if there is a difference
ing spinal cord injury is to restore the pathbetween the study and control group of
way of information carried by ascending
mice, she says.
and descending fibers at the site of injury
SPinal CorD rePair
in the spinal cord,” Kaplan says. “Spinal
In another two-school collaboration
cord injuries are devastating because most
launched with a Russo grant, a biomedical
damaged nerve fibers in the central nervous
engineer, a physiologist and an ophthalsystem do not re-grow to reestablish funcmologist are investigating possibilities for
tional connections.
restoring sensory function after devastating
“The results of the study provided insight
spinal cord injuries.
into biomaterial design needs and options
“We would like every project to be a home run,
but not every project is going to be. That said, there are
lots of good, strong, exciting ideas, and if the attempt
doesn’t pan out, it may lead to something else.” — Naom i Ro se n be rg
“Down syndrome is one of the most
common genetic causes of developmental
delay,” Bianchi says. “Currently there are
no prenatal or postnatal treatments for the
neurocognitive abnormalities that occur
in this condition.”
In previous genetics research, Bianchi’s
laboratory found that oxidative stress—cell
damage caused by the free radicals that form
naturally whenever the body metabolizes
oxygen—is one of the biggest problems in
human fetuses with Down syndrome. “We
photo: bsip/photo researchers inc.
27943p34-35.indd 35
The inability of damaged nerve fibers to
reestablish functional connections poses a
major challenge to the development of an
effective treatment. The challenge is even
greater in injuries in which the dorsal
root—the more posterior of the two nerve
fiber bundles that carry sensory information to the central nervous system—is
severed.
The research team—Eric Frank, professor
and chair of physiology; David Kaplan, professor and chair of biomedical engineering;
to move forward towards nerve-related
repairs,” says Kaplan, who is also the Stern
Family Professor of Engineering at Tufts.
“The results also triggered our interest in
the use of the biomaterials in brain-related
repairs,” he says, “and thus, the Russo seed
has propelled our studies into nerve-related
needs on many fronts.”
Mark Sullivan, a writer and editor in the
Advancement Communications office, can be
reached at [email protected].
s p r i n g 2 011 tufts me dicine 35
4/27/11 1:39:14 PM
alumni news
staying connected
Changes in the Wind
at last spring has arrived, and the tough,
snowy winter has become a distant memory.
There was a great deal to show our alumni as they
arrived on campus to celebrate their reunions in
early May.
Our medical school has undergone a significant
transformation to its campus, curriculum and strategic plan since the days when you and I were students here. As one example, the revised curriculum
is based upon a recently introduced translational
learning process, which helps our students retain
what they have learned longer. The results have made an indelible impact on
our students and better prepared them for productive careers.
As alumni, creating scholarships is our first fund-raising priority. Your
support for the Fund for Tufts Medicine is helping make it possible for remarkable, bright and deserving students to pursue their professional dreams. Some
20 percent of our alums have given more than $1 million this year to the Fund
for Tufts Medicine. Our goal is $2 million, a number which could help more
than 125 students reduce their medical school indebtedness.
Every donation helps us improve the mix and quality of students able to
attend our school. Alumni generosity is making a difference. Enrollment of
underrepresented minorities at Tufts has
more than doubled, from 6 percent of the
entering class in 2009 to 13 percent this
year. This growth has been supported by
an increasing number of scholarships for
economically disadvantaged students.
Tufts Medical School is dedicated to
making a positive difference both locally
and around the world. Of course there
is always more to be done. We all need to
pitch in and do our part.
david s. rosenthal, ’63
president, tufts medical
alumni association
[email protected]
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36 t u f t s m e d i c i n e s p r i n g 2 0 1 1
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class notes
47
John Jenusaitis of
Middlebury, Conn.,
who has been retired from his
practice as a family physician for
20 years, writes to say that even
though he never won any special
awards or prizes for his work,
he is proud to have served his
patients to the best of his ability
for 45 years. “My patients, I
believe, like and respect me,”
he suggests. He enclosed a
recent picture of him and his
wife, Joyce, that says everything
about a life well lived.
53
Edward Nalebuff, A49,
of Newton Centre,
Mass., is the recipient of a
Pioneer in Hand Surgery award
given by the International
Federation of Hand Surgical
Societies. The honor was
presented last October at a
conference in Seoul, South
Korea. Nalebuff is former chief
of surgery at New England
Baptist Hospital and a clinical
professor of orthopedic surgery
at the medical school.
61
Richard Circeo of
Williamsburg, Va., who
retired as a radiologist in 2001,
has fond memories of his days
in medical school. He cites
anatomy with Dr. Benjamin
Spector (“a great inspiration”),
physical diagnosis with Dr. Mark
Aisner (“my first exposure to
clinical medicine”) and house
calls in the company of Dr. Count
Gibson (“that made me really
feel like a doctor”) as especially
memorable. “Since completely
retiring 10 years ago,” he
writes, “I now spend my days
doing those things for which I
did not have the time—daily
physical fitness, attending
lifelong learning classes at the
nearby College of William and
Mary, social outreach for my
church and community, library
time and daily reading, frequent
walks through the historic area
of town, and enjoying my six
grandchildren.”
Stanley Cortell of New York
City is chief of the Division
of Nephrology at St. Luke’sRoosevelt Hospital and a
professor of clinical medicine at
Columbia University. He spends
what spare time he has listening
to music, reading and attending
theater events.
Richard Curran, J86P, of
Wolfeboro, N.H., a graduate
of the Massachusetts Maritime
Academy by the time he arrived
at Tufts, also got married young.
Those two factors put a special
slant on his time in medical
school. “Between marriage,
kids and working on the
waterfront, there was no time
for hobbies,” he says. He and his
wife, Suzanne, have five children,
Patrick, 52; Sheila, 50; Joan,
49; Nancy 47; and Laura, 46.
He is a retired psychiatrist.
George Gardiner of
Philadelphia is still a practicing
psychiatrist. He writes that he
would have liked to see “more
(or some) grass” on campus
when he was in school. He
remembers enjoying the
collegiality of dorm life and
gaining a “solid knowledge
foundation” on which to build
his career. He and his wife,
Margarita, a rheumatologist,
have three children and four
grandchildren.
Eugene Glick of York, Maine,
has an adult psychiatry practice
in York. In his spare time he
stays busy by serving on multiple
social service and town boards,
participating in reading groups
and working as a volunteer at the
library. He and his wife, Susan,
have three children and five
grandchildren.
Harold Goldfarb of Allentown,
Pa., retired in February after 43
years of mostly solo practice
as an ophthalmologist. Looking
back, he takes some pride,
he says, in “rendering honest,
ethical, non-commercial,
personal, top-quality care to my
patients.” He credits Tufts with
having taught him “the craft and
the art” of medicine. He and
his wife, Sandra, enjoy reading,
travel, charitable endeavors,
family time and cooking.
Kermit Kenler, A84P, of
East Longmeadow, Mass., is a
clinical professor of obstetrics
and gynecology at Baystate
Medical Center. He and his wife,
Ruth, a college counselor, have
three children, Elizabeth, Andrew
and Deborah.
Manny Myerson, D95P, of
Boynton Beach, Fla., retired from
practice in 1999. He had been
an otolaryngologist in Hartford,
Conn., for many years. These
days he reports that he enjoys
nature photography, exercise,
family time and playing with his
computer.
John Ostheimer of Hingham,
Mass., remembers a classmate
coming into his room on the
eve of the biochemistry exam
and asking, “What’s this Krebs
cycle thing?” It all worked out,
apparently. Now employed as
an associate clinical professor
of radiology at Tufts Medical
Center and Good Samaritan
Medical Center in Brockton,
Mass., he enjoys taking care of
his antique house and barn in
Hingham in his spare time.
Victor Popeo of Marco Island,
Fla., got something from of his
medical school experience that
has never quite left him. As he
recounts, “There were many
great people, but especially the
late Dean [Joseph] Hayman,
who guided every aspect of my
career. His words to me were,
‘Remember, Victor, you can’t take
good care of patients unless you
care about them—never forget
this.’ I haven’t.” Popeo cites
“the privilege of caring for
children and their families”
as his proudest professional
accomplishment. Popeo was
an assistant clinical professor
of pediatrics at Tufts, chief of
pediatrics at Norwood Hospital,
physician-in-chief at Kennedy
Memorial Hospital and president
of the Floating Hospital Alumni
Association, among other roles.
Now retired and dividing his
time between homes in Florida
and Yarmouth Port, Mass., he
hasn’t lost a step. He enjoys
playing trumpet, golfing, playing
tennis, running, woodworking,
attending medical seminars and
spending time with his children
and grandchildren. He and his
wife, Annette, a retired special
education teacher, have three
children, Joan, 51; Denise, 48;
and Marlene, 47; and three
grandchildren, Nicolle, 21; Ryan,
15; and Andrew, 12.
David Quigley of Seekonk,
Mass., is an orthopedic surgeon
who works at the VA Hospital in
Providence, R.I., and who for
the past decade has specialized
in non-operative orthopedics.
He and his wife, Eileen, have five
children and nine grandchildren.
He says he enjoys walking,
biking, skiing and traveling with
his family.
Kenneth Reamy of Venice,
Fla., is retired from his dual
career as an obstetrician/
gynecologist in the U.S. Army
Medical Corps (1962–82,
posted in Germany, Arizona and
Washington), and a professor
at the West Virginia School
s p r i n g 2 011 tufts me dicine 37
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4/27/11 1:39:48 PM
alumni news
of Medicine (1982–2000).
Reviewing his career, he says he
is proudest of having worked to
raise public awareness of sexual
assault and abuse and “helping
to establish military medical
center-based sexual assault
protocol for the empathic and
orderly evaluation, examination
and treatment of victims.” He and
his wife, Eileen, a psychologist/
gerontologist, have five children
and 11 grandchildren.
69
Omer Thibodeau,
A02P, M06P, MG12P,
of Kennebunkport, Maine,
recently retired from his full-time
practice of general surgery at
Southern Maine Medical Center.
Not wanting to go “cold turkey,”
he continues to enjoy providing
occasional call coverage at a
few Maine hospitals. Thibodeau
and his wife, Maxine, have five
children. He had the honor of
walking his daughter, Evangeline
Thibodeau, ’06, down the aisle in
September 2010 at her marriage
to Michael Bartner. She is an
infectious diseases fellow at
Tufts Medical Center.
70
David Osler, A66, of
Cambridge, Mass.,
has been appointed senior
vice president for ambulatory
services at the Cambridge Health
Alliance, a Harvard-affiliated
public health-care system that
serves Cambridge, Somerville
and Boston’s metro-north
region. Osler was the first
board-certified pediatrician in
Somerville and was instrumental
in formulating a screening
module for children entering
kindergarten. He established
the Cambridge Health Alliance
Somerville Teen Connection
health center at Somerville High
School. His efforts on behalf
of children earned him the first
Extraordinary Service Award from
the Massachusetts Division of
Medical Assistance. A former
chairman of the Somerville
Board of Health, Osler was also
involved in issues such as city
ordinances to restrict access to
tobacco, enforcing smoke-free
restaurants and workplaces,
bioterrorism preparedness and
the administration of city-wide
health assessments.
73
John Leventhal of New
Haven, Conn., has won
the 2010 Ray E. Helfer, M.D.,
Award, given in honor of the
late Ray Helfer, considered the
“father” of children’s trust and
prevention funds because of his
belief that special funds could be
used to ensure that our nation’s
children grow up nurtured, safe
and free from harm. Leventhal
is a professor of pediatrics at
Yale School of Medicine and
medical director of child abuse
prevention programs at YaleNew Haven Children’s Hospital.
Leventhal is recognized nationally
for his research in the area of
child maltreatment, where he
has focused on the epidemiology
of child maltreatment and the
perinatal risk factors for abuse
and neglect. He has published
more than 140 articles and
book chapters and has lectured
throughout the U.S. and in
England.
Ridgewood, N.J., works as an
orthopedist in Fair Lawn, N.J.,
specializing in foot and ankle
injuries. He reports that he fondly
remembers evenings spent with
classmates at the Hong Kong
Restaurant in Harvard Square.
Max Rosen of Weston,
Mass., is executive vice chairman
of radiology at Beth Israel
Deaconess Medical Center and
associate professor of radiology
at Harvard Medical School. He
and his wife, Jeanne, also a
radiologist, have three children,
Samuel, Claudia and Andrew.
Steven Smith, A82, of
Chestnut Hill, Mass., has
built a solo private practice in
dermatology in recent years.
He is past president of the
Massachusetts Academy of
Dermatology.
Frederick Stockton of
Ottawa Hills, Ohio, is an
interventional cardiologist with
an office in Toledo. He and his
wife, classmate Susan Solomon,
’86, a family physician who also
maintains her practice in Toledo,
have two children, Melissa, 20,
and Douglas, 17.
Mark Tedesco, A80, of
Montclair, Va., has been busy
with family medicine and
aerospace medicine since
graduation. He is currently the
chief medical officer for the U.S.
Coast Guard, working as director
of health, safety and work life,
and has held the rank of rear
admiral since 2007. He writes
that he is proud of being able to
serve his country as a medical
officer in uniform. Tedesco’s
message to the Class of 2011
comes from Joseph Campbell:
“We must let go of the life we
planned, so as to accept the life
that is waiting for us.” He and his
wife, Patty, whom he met on the
first day of his third-year surgical
rotation at Tufts–New England
Medical Center, have two sons
and two daughters.
Bryan Stone, A82, of
Haverhill, Mass., collects and
restores antique fountain pens
when he’s not occupied with
his career as an allergist and
immunologist in Lawrence, Mass.
06
Evangeline Thibodeau,
see ’69.
we want to hear from you!
Fill us in on your news. Have you been getting together with
classmates? Have a new job? Have you moved?
86
Wade Goolishian of
Sandwich, Mass., an
anesthesiologist, is a partner in
Cape Cod Anesthesia Associates,
based in Hyannis, and also vice
president of De Novo Labs, a
Massachusetts-based company
that creates, develops and
manufactures medical products
for use in hospitals, operating
rooms and other patient-care
settings around the world. He is
married to Tracy, an archaelogist.
Kenneth Levitsky of
CHECK HERE IF ADDRESS IS NEW.
Send to: Tufts M edical Alumni Relations
136 Harrison Avenue,Boston, M A 0 2111
email: [email protected]
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Street
State
City
Zip
Email address
class notes deadline for next issue is July 15
38 t u f t s m e d i c i n e s p r i n g 2 0 1 1
27943p36-ibc.indd 38
4/27/11 1:39:48 PM
Sherm and Betty GleaSon, wed to medicine
CHARLES “SHERM” GLEASON, ’45, M78P, A78P, J80P, M85P, AND HIS
wife, Elizabeth “Betty” Gleason, J43, M46, M78P, A78P, J80P,
M85P, of Wareham, Mass., who enjoyed a long, rewarding
life together and were married for 63 years, died within eight
days of each other this spring. Sherm died on March 4, 2011,
at age 90, and Betty followed him on March 12. She was 89.
They had practiced as pediatrician and general practitioner,
respectively, out of their Wareham home for many years and
were well known for their extraordinary contributions to the
life of the town.
Sherm Gleason was born in
Wareham, a small town in southeastern Massachusetts, and attended Harvard College before entering
medical school. During residency at
Newton-Wellesley Hospital, he met
his future wife, Elizabeth Hooper.
They were wed in Tufts’ Goddard
Chapel in 1947. In 1950 Sherm
and Betty opened their combined
practices in Wareham in the house
where Sherm had grown up. Besides
his regular practice, Sherm conducted well-child clinics locally and
served as school physician for the
Wareham Public Schools.
As the sole pediatrician in the
region, Gleason was an old-school
doctor known for his respectful, sympathetic care and for being available
to his patients at all hours. Together with his wife, he provided
sex education to adolescents in his home because the town’s
schools would not. From the 1950s until the late 1990s, he
flew to Nantucket twice a year to treat children and perform
checkups because there was no pediatrician on the island.
Following his retirement in 2004, Sherm Gleason, always
active and energetic, stayed eagerly involved in civic life. For
decades until his death, he served on the Wareham Board of
Health. He and his wife attended nearly all town meetings.
He was a member of the Wareham Community Associates
and of the Wareham Land Trust. Realizing that his hometown
had little to offer young people in their spare time, he conceived the idea of creating a YMCA in Wareham and
donated the land to make it happen. Opened in 2004 and
since expanded with his help, the Gleason Family YMCA has
been a great success, with more than 7,000 members.
PHOTO: RICHARD HOWARD
27943p36-ibc.indd 39
Betty Hooper Gleason was born in Boston in 1921. Her
grandfather, William Lesley Hooper, was a professor at Tufts
and acting president of the university from 1912 to 1914. As a
child she lived all over the world—including stops in Wyoming,
Persia, Argentina, France and England—because of travels
required by the work of her father, a civil engineer. After her
father’s death, she and her family moved to Newton, Mass.,
to live with an aunt and uncle who were both doctors. Gleason
graduated from Tufts’ Jackson College in 1943 before entering
medical school, where she was one
of four women in her class.
Once in practice, she earned
wide respect for her patient, caring
manner. She raised five children
and tended to their needs while
maintaining a demanding professional schedule. “She was there
for the birthday parties and dance
recitals and the sports games,”
said Amy Weigandt, J80, M85,
who followed in her mother’s steps.
“She still did all the day-to-day
activities. She was always there sitting at the table for dinner.”
Betty Gleason was responsible
for establishing several new clinics and agencies that were years
ahead of their time. She started
local clinics devoted to women’s
health and mental health in the
late 1960s, long before such clinics were common. On the latter score, Gleason was frustrated because her patients would
often tell her of problems that went beyond physical ailments,
and there was nowhere to send them. She also created a
pioneering volunteer hospice that eventually became federally
funded as Wareham Hospice.
Sherm and Betty Gleason were longtime supporters of the
medical school. Gifts from their estate will fund the Gleason
Family Endowed Scholarship Fund at Tufts, helping to defray
the expense of attending medical school for deserving students in need. “We understand that the cost of higher education makes it difficult for many families,” Sherm said in 2000,
“and we wanted to do something to help them out.”
In addition to Amy Weigandt, the Gleasons are survived by
William, Pamela Gleason Swearingen, ’78, Susan and Robert,
A78, nine grandchildren and two great-grandchildren.
s p r i n g 2 011 tufts me dicine 39
4/27/11 1:39:50 PM
alumni news
obituaries
IN M EMORIAM
natalie Zucker,
GenerouS donor and Friend
THE PSYCHOLOGIST NATALIE V. ZUCKER, OF LAGUNA, CALIF., WIDOW OF MILTON
O. Zucker, ’30, died on March 15, 2011, at age 93. She was a longtime
ardent supporter of the medical school whose passion was encouraging
young women scientists at Tufts in any way she could.
In 2000 she established the Natalie V. Zucker Research Center for
Women Scholars, designed to offer women junior faculty members at the
school a measure of financial support and recognition at a critical stage
in their careers. In 2002 she also established a professorship for an outstanding woman scholar willing to be a role
model and mentor for women at the medical
school. Diana Bianchi, a pediatrician and
geneticist at Tufts Medical Center, is the first
Natalie V. Zucker Professor.
Born in St. Paul, Minn., in 1917, Zucker
was discouraged from becoming a doctor by
her traditional physician father. “If I had been
born a boy, this center wouldn’t be happening,” she told Tufts Medicine at the time
of the Zucker Research Center’s creation.
Rebuffed on her first choice, she became a
psychologist. During World War II she was a psychologist for the U.S. Navy,
based in San Francisco. Later she maintained a private practice in southern California for more than 50 years.
As a couple, Zucker and her husband, Milton, have given generously to
the medical school since 1985. Following Milton’s death in 1995, Zucker
deepened the commitment on her own behalf through the establishment
of annual faculty awards for outstanding research and clinical teaching.
In 1998 she completed funding an endowed professorship in rheumatology and immunology, now occupied by Timothy McAlindon, a professor of
medicine at Tufts Medical Center.
The Zucker Research Center awarded grants to five women in its inaugural year. Since then, it has helped dozens of women at Tufts in timely,
practical ways by giving them money to cover travel expenses to scientific conferences, for example, or to purchase additional lab equipment,
thereby improving the quality and recognition of their research.
She brought something lively and personal to all her endeavors. This
comes through clearly in a moving personal letter sent to the Zucker family at the time of Natalie’s death, signed by 27 recipients of the Zucker
Faculty Research Prize. “We cherish the times we were able to meet with
her, often over lunch, and share with her the stories of her life and ours,”
they wrote. “Natalie always showed an amazing ability to follow the complex scientific stories we told and to share in the pleasure we derive from
advancing knowledge.”
Zucker is survived by her daughter, Judith, also a psychologist, her
son-in-law, Doug, and two grandchildren, Mathew and Jonathan.
Donald E. B owen, A 35, M 39, of Weston,
Mass., died on April 1, 2011, at age 98.
He was an Army Air Corps flight surgeon
during World War II, and before that, he
was the only physician for 18 lumber camps
in New Hampshire and Maine. He practiced
psychiatry for 35 years, serving as chief of
psychiatry and president of the medical
staff at Newton–Wellesley Hospital.
Elizabeth French, ’44, of Fairfax, Va.,
died on January 7, 2011, at age 93. She was
a pediatrician before becoming an anesthesiologist and emergency room physician.
Alfred Donovan, ’46, of Lynnfield, Mass.,
died on March 21, 2011, at age 90.
W. W arren Millis, ’48, of Santa Rosa, Calif.,
died on December 10, 2010, at age 86.
He specialized in internal medicine and
hematology.
Robert Rossi, A 49, G5 0, M 54, J 83P, M 87P,
of Leominster, Mass., a pediatrician,
died on December 4, 2010, at age 82.
Philip J. D ean, ’ 55, of Holyoke, Mass.,
and Naples, Fla., died on November 9, 2010,
at age 80. He practiced family and internal
medicine.
Francis S cholan, ’ 55, M 85P, of Fairfield,
Conn., died on January 9, 2011. He was a
pediatrician in private practice for 38 years.
William Clark II, ’ 58, of Sedona, Ariz.,
died on March 4, 2011. He was a staff
pathologist at Hartford Hospital in Hartford,
Conn., for 30 years.
Stanley S abin, ’ 63, of Wellesley, Mass.,
died on March 30, 2011.
Joel Rappeport, ’ 65, of Marblehead, Mass.,
died on January 16, 201l. He was a professor of medicine and pediatrics at Yale School
of Medicine.
Leo A mrhein Jr., ’ 70, of Brookline, Mass.,
a psychiatrist, died on March 16, 2011.
40 t u f t s m e d i c i n e s p r i n g 2 0 1 1
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