medicine
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Fall 1999
From
E.R.
to E.D.
The Michigan Medical
School Gets Its First New
Department in 15 years
A
P UBL I CAT I O N O F TH E
U N IV ERSI TY
OF
M I CHI GAN M EDI CAL S C HOOL
SENIOR “SWING-OUT”: 1914
Medical School graduates participate in the
parade across campus that was a popular
graduation activity from 1894 to 1934.
“On this day
I knew more
about medicine
than at any other
day in my life.”
From “College Days,” the personal photo album of University of
Michigan Medical School graduate R. A. Barlow (M.D. 1914). The
album is now a part of the permanent collections of the Bentley
Historical Library.
Sesqui
Clothing
Don Sesqui Wear
and Celebrate the University of Michigan
Medical School Sesquicentennial!
All of the items pictured
here can be ordered by
calling the M Den at
(800) 462-5836. Orders
can also be faxed to the
M Den at (734) 662-8251.
Prices listed do not
include six percent sales
tax for Michigan residents
or shipping and handling
charges.
Oarsman
Jacket
(S, M, L, XL, XXL) #MS
000150-1 $74.95
Gear Polar Fleece
Summit (S,M,L,XL,XXL) Covered
zipper; raglan sleeve; kangaroo
pockets; elastic waist
#MS 000150-2 $62.95
Cross Creek Polo (S,M,L,XL)
100% cotton pique; maize #MS
000150-8 $35.95
Gear Big Cotton
Sweatshirt (S,M,L,XL,XXL)
80-20 cotton/poly #MS 000150-7
$44.95
Gear Houndstooth Polo (S,M,L,XL) 100% cotton
double-knit jacquard in subtle navy and khaki pattern.
#MS 000150-6 $44.95
Gear Denim Shirt (S,M,L,XL) 100%
cotton; button-down collar. #MS 000150-4 $55
T-Shirt (S,M,L,XL,XXL)
100% cotton preshrunk
#MS 000150-3 $14.95
Gear ‘Finally Friday’ Pullover
(S,M,L,XL) Navy lightweight terry fleece; self-fabric neck.
#MS 000150-5 $44.95
medicine
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UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
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PA I D
Ann Arbor, MI
Permit No. 144
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and Development Office
301 E. Liberty
Ann Arbor, MI 48104-2251
Executive Officers of the U-M Health System:
Gilbert S. Omenn, U-M Executive Vice President for
Medical Affairs, and CEO, U-M Health System;
Allen S. Lichter, Dean, U-M Medical School; Larry
Warren, Executive Director, U-M Hospitals and Health
Centers
The Regents of the University of Michigan:
David A. Brandon, Ann Arbor; Laurence B. Deitch,
Bloomfield Hills; Daniel D. Horning, Grand Haven;
Olivia P. Maynard, Goodrich; Rebecca McGowan,
Ann Arbor; Andrea Fischer Newman, Ann Arbor;
S. Martin Taylor, Grosse Pointe Farms; Katherine E.
White, Ann Arbor; Lee C. Bollinger, ex officio
The University of Michigan, as an equal opportunity/
affirmative action employer, complies with all applicable
federal and state laws regarding nondiscrimination and
affirmation action, including Title IX of the Education
Amendments of 1972 and Section 504 of the Rehabilitation
Act of 1973. The University of Michigan is committed to
a policy of nondiscrimination and equal opportunity for
all persons regardless of race, sex, color, religion, creed,
national origin or ancestry, age, marital status, sexual
orientation, disability, or Vietnam-era veteran status in
employment, educational programs and activities, and
admissions. Inquiries or complaints may be addressed to
the University's Director of Affirmative Action and Title
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C
CELEBRATING 150 YEARS OF MEDICINE AT MICHIGAN
Sesqui-sensational:
14
cover story
The Emergence
31
of Emergency
Medicine:
Part II of the Sesqui timeline
centerfold (1900-1925):
The Flexner Report, World War I, the
arrival of beloved anatomy teacher
Elizabeth Crosby, the Cabot years
and more
The University of Michigan Medical School
gains its first new department in 15 years
contents
Volume 1, Number 2, Fall 1999
Is “Virtual” a Virtue?
At the University of Michigan Medical School, both faculty and
students are fast grasping the extraordinary potential of technology—
from “virtual” microscopic images to “virtual” trauma victims—
to make medical education more than it’s ever been before.
Does realer-than-real mean better and better? In a word: yes.
24
1
Letter from the Dean
4
Above the Huron
37 Professors Emeriti
50 Class Notes
52 Alumni Happenings
30
A History
of the Deans
Part one in a three-part series on the deans
of the University of Michigan Medical School
and the important role they have played in
defining the School’s missions in medical
education, research and clinical care.
Also, on page 5, a biography of new Dean
Allen S. Lichter, (M.D. 1972).
Aiming High with Viral Vectors
34
DEPARTMENTS
If a determined Jeffrey Chamberlain has his way, a cure for
muscular dystrophy will be found. Packing a cold virus with a
gene that produces the vital protein dystrophin may be the key to
eliminating a disease that affects a million people worldwide.
On the Cover
William G. Barsan, M.D., chair of the newly created Department of Emergency Medicine, photographed in University Hospital by D.C. Goings. In the background: Thomas Deegan, M.D., clinical
instructor in emergency medicine and clinical instructor in pediatrics and communicable diseases,
and Reilly Bennett, B.S.N., clinical nurse.
53 CME Calendar
54 In the Limelight
59 In Print
63 Impact of Private Giving
64 Letter from the Executive
Vice President for Medical
Affairs
ALSO...
40 Galens
43 Mott Golf Classic
44 Honors Convocation
46 Graduation Day 1999
60 Graduate Career Fair
62 Surgery goes Sesqui
“Becoming the School's fifteenth dean is a
wonderful honor, one that I will always cherish.”
Dear Alumni/ae and Friends:
It is a pleasure to write to you as the
newly installed dean of the Medical
School. Becoming the School’s 15th
dean is a wonderful honor, one that
I will always cherish.
Even though I was a student here
and have spent the past 15 years on
the faculty, I was astounded to learn
of the depth, breadth, and size of the Medical School.
Our overall budget this coming academic year will be
$560 million. About $200 million is sponsored research
and $220 million represents practice income. A total of
$60 million comes to us from various University
accounts including tuition and indirect cost return on
our grants. A critical component, about $30 million,
comes to us from voluntary support including philanthropy and grant support from foundations and
volunteer organizations such as the American Cancer
Society or the Muscular Dystrophy Association. The
remaining $50 million is made up of income generated
by service to other University units, interest on our
endowments, and vital support that we receive from the
University Hospitals and Health Centers.
These funds are all used to support the three missions
of our School: education, research, and patient care.
These missions are carried out by the six basic science
and 16 clinical departments, along with the Department
of Medical Education and the Unit for Laboratory
Animal Medicine. The full time faculty number over
1,400 with an additional 400 volunteer and adjunct
faculty assisting us. We teach a total of 680 medical
students (170 per class), 850 house officers, 300
graduate students and 400 post-doctoral research
fellows. This past year our faculty managed over 37,000
admissions to the University’s hospitals and saw over 1.3
million outpatient visits. Supporting the faculty and
trainees is a dedicated staff of over 1,800 in the Medical
School as well as 8,500 employees in the hospitals and
health centers.
Being part of the leadership of the School is a thrilling
challenge, but it is made easier with the help of outstanding colleagues, some of whom you will read about
in this issue of Medicine at Michigan. The creation of
the newest academic department in the Medical School,
Emergency Medicine, is an important step that will
enable us to better serve our patients, develop impor-
tant research and train our students in caring for the
critically ill. I think you’ll enjoy learning about how Jeff
Chamberlain is bringing his groundbreaking research
discoveries in muscular dystrophy to important clinical
trials. His work and that of his colleagues should have a
significant impact on the emerging field of gene
therapy. You’ll also want to read the article that explains
how we continue to work to expose our students to the
latest technology in order to prepare them for the new
ways we are practicing medicine and serving our patients.
By any measure, we continue to be regarded as one of
the nation’s top medical institutions. Our hospital was
recently ranked in the top ten in the country. The
Medical School ranks tenth as a school in National
Institutes of Health funding and the University ranks
seventh. We successfully compete for the best students
and faculty with all the major private and public
medical schools. But as accomplished as we are, we
could be better and we are always striving to improve.
The schools ranked above us are not standing still and
those right behind us would like nothing better than to
pass us. To give you an idea of how keen the competition is “at the top”, in 1987 we were awarded a total of
$65 million in National Institutes of Health grants. This
earned us the rank of ninth on the National Institutes
of Health’s list of medical schools. By 1998 we had more
than doubled our National Institutes of Health funding
to a total of $140 million. But this dropped us one spot
in the rankings to tenth. While National Institutes of
Health funding is only one of many measures of a
medical school’s excellence, it is an important factor
and we monitor this and other key indicators closely.
In order to stay competitive with our peer institutions
and to improve our stature and level of accomplishment, we have embarked upon a bold plan for the
future with new buildings planned for both clinical care
and basic research. The Life Sciences Initiative is an
important part of that expansion. It will help tie the
research faculties of the Medical School and the Central
Campus more closely together as we tackle the key
problems in biomedical research in the 21st century.
This critical initiative is discussed by Gil Omenn in his
letter in this issue of Medicine at Michigan. We are
confident that these investments in our future will go a
long way to keeping the University of Michigan Medical
School in the forefront of the world’s great medical
institutions.
Allen S. Lichter, M.D.
Dean
A b o v e
Above the Huron
Medical School Professor Gary Nabel
named Director of National Institutes
of Health Vaccine Research Center
G
ary Nabel, M.D., Ph.D., has been
appointed the first director of the
Vaccine Research Center at the National
Institutes of Health (NIH) in Bethesda,
Maryland. The Center’s initial
focus is to develop vaccines
against HIV. Prior to his
appointment, Nabel was
the Henry Sewall Professor
of Internal Medicine, professor of biological chemistry and a Howard Hughes
Medical Institute Investigator in the University of
Michigan Medical School.
Gary Nabel and David Baltimore, president of
the California Institute of Technology, with
President Bill Clinton at the cornerstone
dedication of the National Institutes of Health
Vaccine Research Center in Bethesda,
Maryland in June.
“Gary Nabel is a superb scientist who has excelled at
the frontiers of virology,
immunology, gene therapy
and molecular biology,” said NIH Director
Harold Varmus, M.D. “As a result of his
experiences with clinical and laboratory
research in academia and extensive interactions with industrial partners, he is
remarkably well prepared to lead the
complex, multidisciplinary and collaborative activities that will be required to
develop an effective HIV vaccine. His
recent work — on novel strategies for
gene therapy for AIDS and for vaccines
against cancer and Ebola virus — illustrates
the imagination and drive he will bring
to the NIH Vaccine Research Center.”
Nabel’s interest in HIV gene therapy
began with basic research and progressed systematically to clinical studies.
He and his colleagues developed Rev
M10, a competitive inhibitor of the HIV
4 Fall 1999
Rev protein, which is required for HIV
replication. The Rev M10 gene, when
introduced into cells, makes a protein
that prevents authentic REV from binding
to the cell, thereby short-circuiting HIV’s
replication cycle.
In 1996, they reported on the first HIV
gene therapy trial, in which three HIVinfected patients had been infused with
their own CD4+ T cells that had been
modified with the Rev M10 antiviral
gene. The scientists found that CD4+ T
cells containing Rev M10 survive longer
in the blood than unmodified cells, with
no adverse side effects. His group continues work to improve this novel therapeutic strategy.
Nabel is also one of the first researchers
to develop a DNA-based therapeutic vaccine against cancer. He and his colleagues
have used direct gene transfer to introduce
therapeutic proteins into patients with
melanoma. Their clinical studies were
among the first to demonstrate the feasibility and safety of this approach. He also
has applied his gene therapy expertise
to the deadly Ebola virus. In late 1997,
Nabel led a group of researchers who
reported on their successful experiments
in guinea pigs showing that a DNA-based
vaccine could generate protective immune
responses to Ebola virus.
t h
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David Gordon, cardiovascular pathologist at Parke-Davis
and adjunct associate professor of pathology, explains
some of the models in the plastination lab to Scotty Greene
(center), a student at West Middle School, and Eric
Chanowski, an Ypsilanti High School student.
A New Dean for the
Medical School:
Allen Lichter, M.D.
A
llen S. Lichter (M.D.
1972) a member of
the faculty of the University of Michigan Medical
School for the past 15
years, was appointed dean
May 1 after serving as
interim dean from December 1, 1998.
Lichter served as chair of
the Medical School’s
Department of Radiation Oncology from
1984 to 1997 and was also director of the
U-M Comprehensive Cancer Center’s Breast
Oncology Program from 1984 to 1991.
Before joining the Medical School, he was
director of the Radiation Therapy Section of
the National Cancer Institute’s Radiation
Oncology Branch in Washington, D.C.
Lichter received his B.S. degree from U-M
in 1968. After receiving his medical degree
from the U-M Medical School in 1972 he
did his internship at St. Joseph Hospital in
Denver and completed his residency in
radiation oncology at the University of California in San Francisco in 1976.
Y
psilanti high school and middle
school students spent their Saturday mornings this spring exploring careers
in health care during a series of workshops
organized by the Health Occupations Partners in Education (HOPE) Program.
“Our Saturday morning workshops feature
presentations, activities and tours by
nurses, sports trainers, paramedics, physicians, dentists, pharmacists, research
scientists and public health directors,”
says Linda Cunningham, HOPE‘s program
HOPE: AN OPTIMISTIC EFFORT TO STEER
KIDS TOWARD SCIENCE AND MEDICINE
director. “We try to provide information
and help students stay focused on what
they need to do now to prepare for a
future career as a health care professional
or technician. But we want the workshops to be fun, too, so we emphasize
hands-on, interactive activities.”
HOPE was created in fall 1998 when the
Medical School, in conjunction with six
other U-M schools and colleges, the U-M
Hospitals and Health Centers, community groups and private industry joined
forces with educators and administrators
in the Ypsilanti Public Schools. Their
common goal is to increase the number
of underrepresented minority students
who pursue health care careers. While the
program is geared to minority students,
all middle and high school students in the
Ypsilanti Public School District are eligible to participate.
Widely known for his research in the treatment of breast cancer, Lichter was an early
advocate of the lumpectomy approach. He
conducted one of the trials that found the use of lumpectomy and radiation therapy to be
as effective as the traditional treatment of mastectomy. This work, along with other
trials, led to a revolution in breast cancer treatment standards. Also, under Lichter’s
leadership, the U-M created a system of 3-dimensional treatment planning and dose
distribution that uses stacked X-ray sliced images of organs or sections of the body to
recreate the patient’s anatomy on the computer, thus allowing doctors to more precisely direct radiation to a tumor. This pioneering work helped redefine the technical
delivery of radiation therapy.
The program is part of a nationwide initiative instituted by the American Association of Medical Colleges.
“The number of Black, Latino and Native
American students interested in healthrelated careers decreases every year
from elementary school on,” says Lisa
A. Tedesco, a professor of dentistry and
co-principal investigator, with Dean Allen
Lichter, for the HOPE program. “HOPE‘s
goal is to develop a successful model
for how to recruit qualified minority students into the health professions and
sustain their participation through the
critical middle school and high school
years,” adds Tedesco, who also is vice
president and secretary of the University.
The HOPE Program is funded by the
Association of American Medical Colleges, the Robert Wood Johnson Foundation and the W.K. Kellogg Foundation
through the Project 3000 by 2000 Health
Professions Partnership initiative, with
matching funding from the U-M partner
schools and Parke-Davis.
For more information about the HOPE
Program, contact Linda Cunningham at
[email protected]
Lichter is past president of the American Society of Clinical Oncology, only the second
radiation oncologist to be elected to the position. He is also a member of the board of
the American Society of Therapeutic Radiology and Oncology. A frequent writer and
editor, he is co-editor of Clinical Oncology, a textbook first published in 1995, with
a second edition to be released this year.
Medicine at Michigan 5
A b o v e
U-M Biochemists Discover How Folic Acid
Lowers Risk of Cardiovascular Disease
U
niversity of Michigan scientists have
solved the mystery behind folic acid’s
ability to reduce amounts of a compound called homocysteine, which is associated with an increased risk of heart attacks,
strokes and birth defects in humans.
A team of U-M researchers led by Rowena G.
Matthews, Ph.D., and Martha L. Ludwig,
Ph.D., discovered the chemical and structural
basis for folic acid’s effectiveness while conducting research on an enzyme called
methylenetetrahydrofolate reductase (MTHFR).
This enzyme catalyzes a critical step in the
biochemical chain reaction within cells that
converts homocysteine to an essential amino
acid called methionine. The U-M study was
published in the April 1, 1999 issue of Nature
Structural Biology.
“This work illustrates why basic scientific
research is so important,” said Matthews, the
G. Robert Greenberg Distinguished University
Professor of Biological Chemistry and chair
of the Biophysics Research Division in the
College of Literature, Science and the Arts.
“Our original goal was simply to learn more
about the biochemistry of MTHFR. We had
no prior indication of any specific healthrelated application for our work, nor did we
imagine that this enzyme would prove to be
so important for human health.”
Since the 1970s researchers have known that
administration of folic acid dramatically protects against the development of birth defects
like spina bifida in humans. More recent evidence has suggested a correlation between
high levels of homocysteine in blood and an
increased risk of cardiovascular disease or
spina bifida. In the mid-1990s, scientists discovered that increased folic acid intake reduced
homocysteine. But no one understood how
folic acid exerted its effect until the U-M study.
Rowena Matthews and Martha Ludwig.
Using X-ray crystallography, Ludwig, Matthews
and colleagues were able to picture the
molecular structure of MTHFR from the bacterium E. coli. “We used E. coli as a surrogate
for human MTHFR, because there is a high
degree of similarity between the two enzymes
and human MTHFR is not yet available for biochemical analysis,” said Ludwig, a professor
of biological chemistry and research biophysicist in the Biophysics Research Division.
Nestled within the barrel-shaped MTHFR
molecule is a vitamin-derived molecule called
flavin adenine dinucleotide or FAD. “The critical discovery in our work was that a common
mutation in MTHFR promotes the loss of FAD
from the enzyme,” Matthews said. “If FAD is
lost, the enzyme can’t do its job. If the enzyme
is inactivated, the conversion to methionine
cannot take place and homocysteine builds
up in blood plasma.”
According to Matthews, about 10 percent of
people have abnormally high levels of homocysteine, because they inherited a genetic mutation from both parents that alters the DNA
specifying their MTHFR enzymes. “Mutated
MTHFR is 11 times more susceptible to loss
of this essential flavin molecule than the normal
enzyme,” Matthews said.
6 Fall 1999
“Increased levels of folates help bind FAD
more tightly to MTHFR—protecting the enzyme
against heat inactivation and allowing the
homocysteine-to-methionine conversion pathway to proceed normally,” Ludwig said. “Our
results suggest that folic acid supplementation
will reduce homocysteine levels for normal
humans as well as those with the mutant
MTHFR.”
Collaborators on the U-M study included Brian
D. Guenther, postdoctoral fellow, graduate
students Christal A. Sheppard from U-M and
Pamela Tran from McGill University, and Rima
Rozen, a professor at Montreal Children’s
Hospital and McGill University.
The research was supported by the National
Institute of General Medical Sciences of the
National Institutes of Health. Rozen received
additional funding from the Medical Research
Council of Canada.
Matthews can be reached at rmatthew@
umich.edu; Ludwig can be reached at
[email protected]
t h
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Jack Dixon Honored
With Russel Lectureship
J
ack Dixon has spent the past 10 years of his career
immersed in protein tyrosine phosphatases. Found
in all living cells, phosphatases are one of the “master
control switches” that regulate virtually all types of cellular activity. Until the late 1980s, little was known about
how these phosphatases work
together with their betterunderstood counterparts—
the kinases. Collectively, the
phosphatases and kinases act
as a set of molecular switches
to turn cells on and off. Much
of our current understanding
of phosphatase function
comes from work by Dixon
and his research associates in
the Department of Biological
Chemistry.
In recognition of the quality and significance of this
work, Dixon was chosen to present the University’s 1999
Henry Russel Lecture in March, which he titled “Playing Tag with Death: A Biochemist’s View of the Plague,
Cancer and Signal Transduction.” The Henry Russel
Lectureship is the highest honor a senior faculty member can receive for distinction in research. A U-M faculty
member since 1991, Dixon is the Minor J. Coon Professor of Biological Chemistry and department chair.
U-M Medical School Again
Ranked In Nation’s Top 10
T
he University of Michigan Medical School is again among the Top 10
research-oriented medical schools in the country, according to a survey
released by U.S. News & World Report. The Medical School tied for the No. 10
spot among the nation’s 124 medical schools in the news-magazine’s annual ranking.
U.S. News & World Report also ranked the U-M in the Top 10 for three medical
specialties – geriatric medicine (eighth), internal medicine (ninth) and women’s
health (tenth).
“It’s always gratifying to be recognized by our peers as one of the top medical
schools in the country,” said Allen S. Lichter, M.D., dean of the Medical School.
“Michigan’s success is based on the strength of all its programs. We’re particularly
proud of the three medical specialties ranked in the top 10 in this survey.”
The overall rankings are based on several criteria, including student selectivity
(average MCAT scores, average undergraduate GPA, and the proportion of applicants
accepted into the program), faculty resources, research activity and reputation.
Medical specialties were ranked on the basis of their reputation among medical
school deans and senior faculty.
The Medical School’s reputation is particularly strong among directors of intern
and residency programs – medical professionals who interview and recruit the
students produced by the nation’s medical schools. Those directors ranked the U-M
fourth nationally.
“We’re especially pleased to receive that high ranking from the residency directors,”
Lichter said, “because they’re the faculty who work with our students and thus
understand their quality. They also compete against us for trainees and young
faculty, so they truly understand the excellence of our institution across the board.”
“Health Minute”
Brings U-M Research to the Public Every Week
W
hat do artificial hearts, teen vegetarians, back pain, alternative
medicine, sinusitis and bone marrow
transplants have in common? They’ve all
been featured on the University of Michigan Health Minute, the new weekly public
health tip being produced by the U-M
Health System Public Relations Department
to educate patients about the latest developments in medical science and encourage people to live healthier lives.
John F. Randolph, Jr., M.D., associate professor of
obstetrics and gynecology and chief of the Division
of Endocrinology and Infertility, being taped for a
Health Minute.
The Health Minute covers health topics
that range from the high-tech to the everyday, putting a familiar face on research and
clinical advances in the U-M Health System.
Videotaped interviews with U-M experts
and their patients are sent to more than
25 television stations and national networks.
A print version of the Health Minute is
also sent to newspapers in Michigan,
northern Ohio and northern Indiana. The
Health Minute is also made available to
more than 125 radio stations in and
around Michigan. The material is also
posted on the University of Michigan Health
system Web site at www.med.umich.edu.
For more information, contact Andrea
McDonnell at [email protected]
Medicine at Michigan 7
A b o v e
t h
RETINOIC ACID PLAYS KEY ROLE IN SUN DAMAGE TO SKIN
“This is a bad situation
because vitamin A is required
for normal skin development and function. Retinoic
acid receptors, when activated by retinoic acid,
transfer genetic instructions from DNA to the cell’s
protein-producing factory
telling it to assemble proteins needed for skin cell
function.
Gary Fisher and John Voorhees.
H
ow does ultraviolet radiation cause so
much damage to human skin? University of Michigan scientists have discovered
an important new piece of the puzzle, which
they describe in an article published in the
March 29, 1999 issue of Nature Medicine.
“We found that ultraviolet irradiation blocks
the ability of skin cells to recognize and respond
to an essential nutrient called retinoic acid,
which skin cells make from vitamin A or retinol,”
said John J. Voorhees, M.D., the Duncan and
Ella Poth Distinguished Professor of Dermatology in the U-M Medical School. “The inability to respond to retinoic acid triggers a cascade of biochemical changes that upsets the
normal balance between healthy and dying
skin cells. In essence, ultraviolet radiation
causes a functional vitamin A deficiency in
human skin.
“We also found that pretreating skin with
retinoic acid—the active form of vitamin A—
before ultraviolet radiation exposure limits the
extent of the harmful biochemical changes.”
According to Gary J. Fisher, Ph.D., associate professor of dermatology and the study’s co-author,
ultraviolet radiation causes a major loss of
retinoic acid receptors found in human skin
cells. “Retinoic acid receptors are the molecular
mediators of the biological actions of vitamin A.
When retinoic acid receptors are lost, it is as
if the skin has no vitamin A,” Fisher explained.
“Eight hours after skin was
exposed to ultraviolet radiation in our study, amounts of
retinoic acid receptor messenger RNA and
protein were as much as 70 percent lower than
control levels. They remained below normal
levels for more than 24 hours after exposure,”
Fisher said.
In addition to Voorhees and Fisher, co-investigators on the U-M study were ZengQuan
Wang, Mohamed Boudjelal and Sewon Kang,
all from the Department of Dermatology. The
research was funded by the Babcock Endowment for Dermatological Research, the Dermatology Foundation and the Johnson &
Johnson Corporation.
You may reach Gary Fisher at
[email protected]
You may reach John Voorhees at
[email protected]
“The inability to
respond to retinoic acid
triggers a cascade of
biological changes...”
When the biochemical retinoic acid receptor pathway is shut down, other dangerous
skin changes—which also occur in response
to ultraviolet radiation exposure—can proceed unchecked. “In this process, ultraviolet
radiation activates a protein complex called
AP-1, which causes production of large
amounts of enzymes called matrix metalloproteinases or MMPs,” Voorhees explained.
“These MMPs break apart and degrade
collagen and elastin, the major structural
materials in skin. Although the broken-down
collagen and elastin are replaced, the repair
process is imperfect. This imperfect repair
results in a tiny defect in the skin. With
repeated ultraviolet radiation exposures, the
defect grows and eventually results in the
wrinkled appearance of sun-damaged skin.
In addition, the biochemical changes associated with activation of AP-1 and production
of MMPs promote skin cancer.”
Although additional research will be needed
to completely understand the complex relationship between the retinoic acid receptor
8 Fall 1999
pathway and the pathway responsible for
producing enzymes that destroy skin collagen,
Voorhees and his colleagues believe the two
may exist in a state of dynamic balance. This
dynamic balance may be necessary to maintain healthy skin.
Postage Stamp
is Inaugurated
W
hen the U.S. Postal Service asked
Americans to select what they considered the most important science and
technology advancement of the 1950s,
respondents chose the polio vaccine
developed by Dr. Jonas Salk. The vaccine, which was tested in a massive
clinical trial directed by the late Thomas
Francis, a professor in the School of
Public Health and a leading epidemiologist, revolutionized the battle against
the deadly polio virus.
e
H u r o n
Listening to Cats Listen May
Help Us Hear Better
N
ext time your pager starts beeping in a crowded room, try this
little experiment in auditory perception. After a few beeps, notice how
everyone starts looking around in all directions trying to hear where the noise is coming
from. Try the same experiment in a room full
of cats and you’ll see the feline version of
aural confusion.
People and cats have no problem localizing natural sounds like a snapping twig or rustling leaves, which include a broad spectrum of sound
frequencies, according to John C. Middlebrooks, Ph.D., an associate
professor of otolaryngology in the University of Michigan Medical School.
But they both lack the ability to pinpoint the location of narrow-band sounds
with just a few frequencies, like a beeping pager.
Middlebrooks and his colleagues at the U-M Kresge Hearing Research
Institute are taking advantage of this inability to localize narrow-band
frequencies in research designed to learn how the brain processes and
perceives sound.
“We know that sound is recorded in the firing pattern of neurons in the
auditory cortex—the part of the brain that processes electrical signals
generated in the inner ear,” Middlebrooks said. “We’re trying to break
the code—to understand the rules the brain uses to translate this neural
activity into what we hear as sound.”
In a paper published in the June 17 issue of Nature, U-M scientists
Middlebrooks and U-M post-doctoral researchers Li Xu, M.D., Ph.D., and
Honoring Salk Vaccine
at Rackham Auditorium
On May 26, the U.S. Postal Service honored the fight against
polio with the release of a commemorative postage stamp:
“Polio Vaccine Developed.” It is one of 15 stamps that are
part of the 1950s edition of the Postal Service’s “Celebrate
the Century” commemorative stamp program. The polio
stamp was unveiled at Rackham Auditorium on the U-M campus, the same site where the announcement of the efficacy
of the polio vaccine was made on April 12, 1955.
Salk was a research scientist with Francis in the School of
Public Health before joining the University of Pittsburgh in
1947 where the polio vaccine was developed. Salk found a
mentor and a research collaborator in Francis, who conducted
the clinical trials of the polio vaccine in 1954. In 1961, Albert
Sabin developed a live attenuated (weakened) oral polio
vaccine.
Shigeto Furukawa, Ph.D., describe how localization errors made
by nerve cells in the brains of cats exposed to filtered sounds
are consistent with errors made by humans in previous experiments.
In earlier experiments, human volunteers stood in a soundproof
room surrounded by many loudspeakers and listened to a random
series of broad-band and narrow-band tones, which sound something like quiet crickets. People turned toward each sound’s origin,
while sensors recorded the orientation of their heads when they
did so. Consistently, volunteers listening to narrow-band sounds
turned toward locations that differed in predictable ways from
the actual loudspeaker.
For experiments described in the Nature paper, U-M scientists
played the same sounds for anesthetized cats with miniature
probes surgically implanted in their auditory cortex. Created at the
U-M Center for Neural Communication Technology, these neural
probes are the size of a grain of pepper and sensitive enough to
record signals from a single nerve cell. Using the microelectrode
probes, U-M researchers recorded electrical activity from individual
neurons in the cat’s auditory cortex as it heard the sounds.
“With the probes, we can record from the neuron directly,” said
Xu. “In effect, the neuron tells us where the cat believes the sound
is coming from.”
“The auditory systems in humans and cats appear to use the
same spectral sound characteristics to determine sound locations,” Middlebrooks said. “We interpret these results as evidence
that the firing pattern we see in cat neurons could be a model
for brain processes that
underlie spatial perception reported by humans
exposed to the same
sounds.”
The research could lead to
applications for the diagnosis and therapy of disease of the temporal lobe
of the brain. Experimental
techniques developed in
these cat studies are
already being applied to
studies of brain responses
Li Xu in the sound chamber.
to new implantable hearing devices designed to stimulate the ear directly.
The U-M research project is funded by the National Institute for
Deafness and Other Communicative Disorders of the National
Institutes of Health. The U-M Center for Neural Communication
Technology is supported by NIH’s National Institute for Research
Resources.
Middlebrooks can be reached at [email protected]; Xu can be
reached at [email protected]
Medicine at Michigan 9
A b o v e
PREVENTING WOMEN’S HEART ATTACKS:
U-M’S LORI MOSCA CHAIRS PANEL WITH
NEW RECOMMENDATIONS
H
eart disease kills more American women each year from their first heart attack. There’s often no opportunity
for a second chance,” Mosca says. “That’s why prevention
than all cancers combined.
is the key.”
New guidelines from the American Heart Association and
the American College of Cardiology were released April 30, The most important recommendations: Women and their
1999 in hopes of reversing what a University of Michigan doctors must be aware of heart attack risk factors that
physician calls this “alarming trend” in women’s risk for are critical to women. Women should avoid or quit smoking, exercise for 30 minutes every day, reduce fat and salt
heart disease.
in their diet, and eat plenty of fruits and vegetables.
Lori Mosca, M.D., Ph.D., assistant professor of internal
medicine and preventative cardiologist, chaired the expert Women also should tackle stress, loneliness and deprespanel for the new guidelines, which she says were created to sion with exercise and socializing rather than food or cigahelp women and their physicians reduce the risk of car- rettes. “Heart disease in women is largely preventable,
diovascular disease and heart attacks. but there are several alarming trends in risk factors for
“Heart disease prevention is particu- heart disease,” Mosca says. “Only 25 percent of American
larly important for women because women get regular sustained physical activity. The rate of
30 to 40 percent of women will die smoking decline is less for women than it is for men.
Nearly half of all women over the age of 45 have high
blood pressure. Forty percent have high cholesterol.
Web Site for
Kellogg Eye Center
T
he University of Michigan Kellogg Eye Center has launched a
new web site at www.kellogg.umich.edu. The new site
meets Americans with Disabilities Act guidelines, and can be
used by people with low vision and limited abilities. The site contains information for clinicians, researchers, and patients.
The University of Michigan Kellogg Eye Center is home to the
Department of Ophthalmology and Visual Sciences and provides
vision care, medical/surgical eye care, professional and public
education, and performs state-of-the-art ophthalmic research,
such as genetic research on macular degeneration, glaucoma,
and other ocular diseases.
UNIVERSITY OF MICHIGAN
Lori Mosca with patient Marilyn Kaestener.
Kellogg Eye Center
Patient Services
Faculty, Staff, Alumni
& Referring MDs
Eye Conditions & Diseases
Education & Training
Research
Welcome from the Chair
Directory | Search | Hot Topics & Events | Support Kellogg | Index | Comments
“There is substantial evidence that women are being
undertreated in terms of their blood pressure and cholesterol, which are major risk factors for heart attack in
women,” Mosca says. “There’s excellent evidence now
showing that if women can achieve these lower levels, we
can reduce their risk of a future heart attack, or a recurrent heart attack if they already have heart disease.” Cholesterol-lowering drugs may be more beneficial to women
than men in reducing the risk of heart attacks, according
to the new guidelines.
For further information on clinical or research programs
for heart disease prevention at the U-M Health System,
please call 734-998-7400.
You may reach Lori Mosca at: [email protected]
U-M Kellogg Eye Center (KEC) Department of Ophthalmology
1-734-763-1415
10 Fall 1999
t h
e
H u r o n
Diagnosing and Treating Depression in
the Primary Care Setting: It Can Be a
Depressing Experience for the Primary
Care Physician
E
pidemiological and clinical research over
the past two decades has shown depression to be a common and highly debilitating
condition. Depression can exact high costs in
terms of work productivity, the success of personal relationships and general satisfaction
with life.
For the family physician in a primary care setting, however, the depressed patient poses
enormous challenges of diagnosis and treatment. A growing body of research, to which
Michael Klinkman, associate professor of
family medicine, Thomas Schwenk, professor
of family medicine and chair of the Department of Family Medicine, and James Coyne,
formerly a member of the family medicine
faculty at Michigan and now at the University
of Pennsylvania, have contributed significantly, suggests a developing awareness of
the shortcomings of the “top-down,” diagnosisdriven approach to mental health care in the
complex world of primary care, but the absence,
as yet, of a clearly articulated “bottom-up”
approach that will provide a more accurate
view of mental health problems as they exist
in primary care. Classic psychiatric instruments for screening depressed patients don’t
seem to work very well in the primary care
setting, but the question of what will work is
still unanswered.
In several recent articles, Schwenk, Klinkman
and Coyne discuss the results of a study they
undertook involving 425 adult patients in the
family practice setting. The study suggests
that there are significant differences in the past
history, severity and impairment of depressed
patients in the primary care setting and those
in a psychiatric setting, that primary care physicians are nevertheless pretty good at
identifying patients who are overtly psychologically distressed, but that they miss significant numbers of depressed patients who
are different from the overtly depressed patients
in psychiatric settings who provided the
basis of their medical training.
Depression, they say, is an important diagnosis but often an elusive one, and for the primary care physician, diagnosis and treatment
of the depressed patient can be downright
daunting. Depression in different patients
doesn’t always look the same or act the same:
some patients get depressed only when
they’re under stress, others are depressed
much of the time. In some ways, Klinkman
and his colleagues have found, depression in
the primary care setting can look and feel a
lot like asthma and diabetes in the sense that
they are all chronic conditions requiring not
only good diagnosis and treatment, but patient
energy and attention as well. “You can tell
asthma patients, ‘You’re breathing at only half
your capacity,’ and suggest they use their
inhalers, but some of them will elect not to
use the inhalers even if their breathing is greatly
reduced. It just isn’t their highest priority,”
Klinkman says.
And there are other reasons depressed patients
may not respond. Not all patients view depression as a legitimate medical problem; they
may think mood disorders are inappropriate
Classic psychiatric
instruments for
screening depressed
patients don’t seem
to work very well in the
primary care setting.
for a doctor’s attention. Some physicians may
be less or more likely to identify depression
in a patient depending on the patient’s gender, age and ethnic derivation. Many physicians feel they just don’t have time to explore
psychosocial issues, no matter what the
patient’s level of depression or gender, age
or ethnic background. Even when the primary
care physician does correctly identify the
depressed patient, the diagnosis may not necessarily lead to an improved outcome for the
patient, since depression is not easily treated.
The complexity of their findings has led
Klinkman and his colleagues to come to at
least three major conclusions:
• A “snapshot” diagnosis doesn’t work with
the depressed patient in the primary care
setting; one has to take into account the
passage of time, how the patient performs
over weeks and months and years, not for
a few minutes in a clinical setting.
• Blaming the physician because the
depressed patient doesn’t improve is missing the big picture; much is still not known
about how best to approach depression in
the primary care setting and the attitudes
and value systems of patients must also
be taken into account.
• How and when the primary care physician
should intervene is a matter of priorities,
of communication and decision-making.
Having the physician engage in a onetime,
stand-alone consultation with a psychiatrist as well as having the patient engage
in brief, diagnostic consultations with a
psychiatrist may be beneficial. (Such consultations, Klinkman suggests, can be as
important for the relief they provide the
physician in sharing the caregiving burden
as for the information they provide.)
“We think we know what doesn’t work very
well,” Klinkman says. “Our next challenge is
to find out what does work.”
For more information, see the following articles:
• “Depression in Primary Care...More Like
Asthma than Appendicitis: The Michigan
Depression Project, Canadian Journal of
Psychiatry, November, 1997
• “Depression in the Family Physician’s
Office: What the Psychiatrist Needs to
Know,” Journal of Clinical Psychiatry
supplement, September, 1998
• “False Positives, False Negatives, and the
Validity of the Diagnosis of Major Depression in Primary Care,” Archives of Family
Medicine, September/October 1998
You may reach Michael Klinkman at
[email protected]
You may reach Thomas Schwenk at
[email protected]
Medicine at Michigan 11
A b o v e
However, given the trust and power already
placed in physicians’ hands, it is imperative
that it be used for the welfare of patients,
and not just to serve physicians’ own (often
financial) interests. “There is some merit
to the old saying ‘A happy physician makes
a happy patient,’ but patient and doctor
interests don’t always automatically overlap,” Goold comments.
Collective
Action, Unions
and Even Strikes
May be Moral
for MDs:
Ethicist Susan
Dorr Goold, M.D.
B
efore they strike, negotiate with insurance companies or lobby Congress,
physicians should make sure they are acting
with their patients—not just themselves—
in mind, according to Susan Dorr Goold,
M.D., assistant professor of internal medicine and a medical ethicist.
“Doctors already act collectively and can do
so morally. But the goal of collective action
must be completely consistent with their
commitment to the patient and respectful
of the trust patients place in them,” says
Goold. “Even a strike could be morally justified if circumstances were bad enough,”
Goold continues, “but there are many
other collective action options available
short of striking. And doctors must also
remember that morality and legality are
not always in line with one another.”
Goold presents her views in a commissioned paper to be published in a special
issue of the Cambridge Quarterly of
Healthcare Ethics, from Cambridge University Press in England to be published next
year. In the paper, she disputes some of
the most common arguments against physician collective action, unionization and
strikes, but puts forth other reasons why
such actions might not stand on solid
moral ground.
12 Fall 1999
For example, some argue that physicians
should not strike because they are professionals. Airline pilots and teachers, Goold
points out, are professionals, too, yet they
are organized and routinely strike. Others
say striking doctors would deprive the
public of essential services and cause hardship or even death. But, she answers, most
health-care services are non-essential, and
physicians could strike without withholding emergency care.
“...doctors must also
remember that morality
and legality are not
always in line with one
another.”
It is the moral argument for or against
striking—or any collective action—that
counts, she concludes. Doctors take on a
moral responsibility for their patients
when they enter medicine because of the
trust patients must place in their doctors’
knowledge, experience and good faith.
Due to this power imbalance, she says,
physicians bear a moral burden to act in
ways that strengthen, not dilute, that trust.
Collective action, says Goold, is a strategy
for increasing power, so it is no surprise that
doctors feel it is necessary as they perceive
their professional autonomy diminishing.
“The more the process or outcome of collective action will harm patients, or undermine patient trust, the more difficult it
becomes to morally justify it,” she writes.
“This is why it is so difficult to morally
justify a strike: withholding care from
patients ostensibly to benefit them rarely
adds up.”
In fact, she says, doctors already act collectively, whether through professional
organizations lobbying elected officials or
educating the public about issues, groups
of physicians in private practice joining
together as a large clinic or group, or residents protesting long hours or low pay.
About 42,000 practicing physicians are
already in unions, including the house
officers at the University of Michigan.
In general, she concludes, issues where
doctors can act collectively with moral certainty are those where they can join their
interests with those of patients and curb the
power of corporations that have a financial stake in the health care field. “If
enough physicians refused a company’s
contract clauses because they undermined
the doctor-patient relationship and professional values, the companies might
eliminate such clauses,” Goold states.
Goold can be reached at [email protected]
t h
e
H u r o n
From Back Flip
to Back Pain:
A Warning for Young Gymnasts and Other Athletes
E
Joyce Wahr with her research assistant,
Dalai Zhou.
Cardiac surgery
risks higher
when potassium
levels are low
P
atients undergoing cardiac surgery are
twice as likely to experience certain complications when their pre-surgical potassium
levels are below accepted standards, according to a study published in the June 16, 1999,
issue of The Journal of the American Medical Association.
Researchers from leading medical institutions
in the United States, including Joyce Wahr,
M.D., associate professor of anesthesiology
in the U-M Medical School, examined the
potassium levels of more than 2,400 patients
undergoing cardiac surgery. They found that
arrhythmias, including atrial fibrillation, during
and after surgery doubled when a patient’s
serum potassium level fell below 3.5 millimoles per liter (mmol/L). At levels below 3.3
mmol/L, the need for cardiopulmonary resuscitation also doubled.
“We hope these results will change the
impression that mild decreases in potassium
are within normal limits,” says Wahr.
Potassium is essential to maintaining a normal heart rhythm, and is responsible for the
conduction of nerve impulses and muscle contraction. The ratio of potassium outside the
cell to that inside the cell maintains polarity,
allowing an electrical charge to conduct along
a row of cells, causing the heart to beat.
Hypokalemia results when the level of potassium in a person’s blood becomes too low.
Hypokalemia is usually caused by gastrointestinal or renal problems or prolonged treatment
with certain prescribed medications. Both low
and high potassium levels can cause problems for the heart because the electrical
charge is affected.
xcessive athletic training by young
athletes may lead to an increase in
curvature of the spine. A study released
by University of Michigan researchers
found an increased potential for curved
spines and back pain in young athletes
who devote long hours to their sport.
Gymnasts, in particular, are at risk for
back problems.
“We found that training and conditioning
is good and, in fact, needed for normal
spine development,” says Edward M.
Wojtys, M.D., medical director of the
MedSport program at the University of
Michigan Health System. “But we also
found that at the other end of the spectrum, if you do too much, you can push
the spine into a curvature that we think
is cosmetically less acceptable and can
make you more susceptible for back pain
later on in life.”
The U-M study determined that up to
300 hours of sports activity per year is
usually a safe level of activity. “Where
we’re more concerned about kids is when
they start getting over 400 hours per year.
Wahr and her team found that patients with
potassium levels between 3.5 and 5.0 mmol/L
showed no association between potassium
and the incidence of any perioperative
arrhythmias. However, when levels fell below
3.5 mmol/L, the association became progressively stronger and even occurred at levels
often considered safe by anesthesiologists,
surgeons and other clinicians. When levels
dropped below 3.3 mmol/L or rose above 5.2
mmol/L there was an association with the
need for cardiopulmonary resuscitation due
to cardiac arrest.
Wahr says they don’t know if low potassium
levels are a cause of adverse outcomes or a
marker, pointing to some other cause. She and
colleagues feel, however, that the results of
the study provide strong evidence for using a
potassium level of 3.5 mmol/L as a standard
criterion for preoperative hypokalemia.
The study was funded by the Ischemia
Research and Education Foundation of San
Francisco. Wahr can be contacted at
[email protected]
Gymnastics is the sport
with the highest risk for
spine curvature,
researchers found,
followed very closely by
football, hockey and
wrestling.
Or when you start looking at six, eight,
10 or more hours per week of hard training and conditioning, that’s where we think
the problems lie,” says Wojtys, who is also
a professor of surgery and team physician for the U-M Athletic Department.
Gymnastics is the sport with the highest
risk for spine curvature, researchers
found, followed very closely by football,
hockey and wrestling.
Wojtys is quick to note the importance
of physical activity for young people.
What’s important is that parents,
coaches, physicians and the athletes
themselves monitor their activity.
“There’s no doubt physical activity and
athletic participation is good for normal
spine development,” he says.
Wojtys can be reached at edwojtys@
umich.edu
Medicine at Michigan 13
A Discipline
for the
by Jeffrey Mortimer
William Barsan, professor and chair of the new
Department of Emergency Medicine, worked for
seven years with his staff to achieve departmental
status in the Medical School, but his dedication
to emergency medicine goes much farther back
in time. (Barsan is pictured here with
physician Carol Schultz and (center) clinical
nurse Dianne Savage.)
14 Fall 1999
Emergency Medicine Comes of
90s:
Age and Gains New Visibility in the Medical School
I
n 1967, when he was a high school senior in Akron, Ohio, the personal became professional for
William Barsan, M.D. although he didn’t know it at the time. It’s a recurring theme among emergency
physicians — the personal becoming professional — and the chair of the newest department in the
University of Michigan Medical School is in this respect cut from the same cloth as many of his colleagues. For him, it happened when his best friend, like him still a teenager, died in the hours following a
car crash.
“It happened on the median strip of a highway,” Barsan says. “He was thrown out of this van he was
driving, was probably not breathing very well at all, had a brain injury. There were no paramedics back
then, so somebody threw him in the back of what was probably a hearse and took him to the nearest
hospital, a small hospital which didn’t have the capabilities of flying him out. Very likely, had he crashed
today out on US 23, he would probably not be dead for a lot of different reasons.”
The burgeoning field of emergency medicine can take at least some of the credit for those reasons. In fact,
Barsan’s friend’s case, which it still pains him to remember, is a dramatic reminder of what has been
learned since then. Thanks in large part to the work of emergency medicine researchers and clinicians,
not only are vehicles themselves safer and the use of seat belts more widespread, but the health care
system’s ability to respond to the consequences when a crash does occur has been vastly enhanced, from
the reaching and transporting of victims to their stabilization and treatment. ➤
Medicine at Michigan 15
I
f you apply those concepts—more effective prevention, faster
response and stabilization, and greater understanding of the body’s
behavior in such situations—to everything from sore throats to
gunshot wounds, season with the urgency of the decision-making,
complicate with a patient population that is increasing in both size and
acuity, and deduct what one emergency physician called “the need to do
a wallet biopsy,” you begin to get a picture of the specialty.
The arc of emergency medicine’s ascent mirrors, in many ways, Barsan’s
own career. He graduated from Ohio State University Medical School in
1975, only five years after the start of the first emergency medicine
residency in the country and the year before the University of Michigan
Medical Center (now called the Health System) first gave anyone official
responsibility for operating its emergency room.
Brian Zink
“Prior to that time, it had sort of been run by committee,” says Richard
Burney, M.D., who took on the responsibility for overseeing the emergency room as part of his duties as a member of the faculty in the
Department of Surgery, which became its departmental home. “It was a
stepchild of the hospital,” he adds. “It had no clinical base and nobody
paid much attention to it. Because it wasn’t part of a department it was
mostly invisible.”
It was certainly invisible to Barsan. “At the time I graduated, I didn’t even
know you could do anything in emergency medicine,” he says. “I was in a
surgery residency for a couple of years at the University of Virginia, and
then decided I didn’t like surgery. I had discovered that I liked more the
acute medical aspects.”
”This program is looked at nationally as a model of how a program can become succ
in a relatively short period of time.” So he went to the University of Cincinnati, home of the first emergency
medicine residency. The year he completed his training, 1979, was also
the year emergency medicine was approved as a specialty by the American Board of Medical Specialties. By then, there were more than 40
graduates of the Cincinnati program.
Cincinnati, as it turned out, was the canary in the coal mine of a
national trend. “In the early 1970s, patient volumes in the emergency
department rose to over 100,000 a year from 20-30,000 ten years earlier,”
says Barsan. “Nationwide, you had a real switch in demographics in
medical care from people being cared for by their primary physicians to
a much more mobile population, and more episodic care. A lot of
hospitals were finding themselves totally inundated with emergency
patients. At Cincinnati they realized that there weren’t any individuals
who could really care for all these patients who were often being
piecemealed out very inefficiently, so they thought they should train
people to do this.”
Richard Burney
16 Fall 1999
Because of the way emergency departments were organized (or not),
those patients were often treated in a rather ad hoc fashion. “You would
have medicine doctors seeing medicine patients, pediatricians seeing
pediatric patients, surgeons seeing surgery patients,” says Barsan. “That
was okay as long as the patients coming in knew what they needed, but a
lot of time they didn’t know. This led to an inefficient use of resources
because there wasn’t really anybody who could take care of assigning
patients appropriately. There was also a lot of interest among graduating
medical students in pursuing that. That’s what
got people interested in it. It was a societal need
and a medical need.”
There was also a need to recognize the unusual
demands of many emergency cases that helped
make emergency medicine a distinct branch of
health care: the need for fast-moving triage and
stabilization and airway management, a need to
understand toxicology, head and brain injury,
hemorrhage. In many locations, including
Michigan, once emergency medicine was
recognized as a discrete entity, it was put under
the aegis of the surgery department. Historically,
after all, surgeons had seemed to be the busiest
group in the emergency room.
25 Years
of Progress
in Emergency Medicine
But it could also be, as it was at Cincinnati before
gaining departmental status in 1984, a kind of
freestanding division that reported to the dean,
“analogous to a blood bank,” says Barsan. “People
didn’t have a clue as to what to do with emergency medicine, so it was dealt with on a local
basis.”
James Mackenzie in 1981 on the roof of the old North Outpatient Building, soon to be
razed, trying to determine where a new helicopter pad might go. “One of the first goals
Richard Burney and I had was to develop both a scientific basis and a teaching
component in emergency medicine,” he recalled recently. “The helicopter, while we
hadn’t initially thought of it in that way, became a research instrument, if you will, every
bit as much as a lab test. It was a way of bringing in people who were seriously ill and
having them fresh enough to do something to them and see if the ‘something’ made a
difference.”
While U-M was not among the first to get a clue,
it has arguably been among the shrewdest. “It
took a long time for the University to come
around to the fact that emergency medicine
1974-A U-M task force recommends establishing a Section of Emergency Services in the
essful academically in emergency medicine
would be a valuable addition to the academic
medical center,” says Brian Zink, M.D., “but once it
made its commitment, it did it the right way.”
Zink is an associate professor in the department
and the Medical School’s assistant dean for
medical student career development. He is also the
incoming president of the Society for Academic
Emergency Medicine, where presentations by
Michigan researchers have dominated the proceedings in recent years.
Michigan succeeded, he says, because “it provided
resources, guidance for young faculty, start-up
money for research, research laboratories, adequate
administrative support, adequate office space—all
the ingredients that were needed to make a
successful program, and they did a good job of
recruiting probably the best person at the time in
the country who could come in and make it work
for them. This program is looked at nationally as a
model of how a program can become successful
academically in emergency medicine in a relatively
short period of time.” ➤
Department of Surgery to manage the Emergency Department, which consists of five rooms on
the fourth floor of the U Hospital Outpatient Building and is staffed by moonlighting faculty
from Internal Medicine.
1976- Richard E. Burney, M.D., arrives at U-M as a member of the surgery faculty; half
his appointment is as director of emergency services.
1979-Emergency medicine is recognized as the 23rd specialty by the American Medical
Association and the American Board of Medical Specialties. James R. Mackenzie, M.D.,
becomes director of emergency services, with Burney staying on as assistant chief.
1980-There are departments of emergency medicine at five U.S. medical schools.
1981-Faculty staffing on a 24-hour basis in the ER begins; a Section of Emergency
Services is formally established in the Department of Surgery.
1983-Survival Flight begins service.
1985- Mackenzie steps down as section head and is succeeded by Burney, who held the
position earlier.
1986-The new University Hospital opens with an Emergency Department divided into
three areas; the main emergency department is managed by the Department of Surgery,
Section of Emergency Services; the medical walk-in area is managed by the Department of
Internal Medicine, and the pediatric walk-in area is managed by the Department of Pediatrics
and Communicable Diseases.
1987-Survival Flight adds a second helicopter.
1992-William Barsan, M.D., becomes section head of Emergency Medicine.
A joint emergency medicine residency program between U-M and the St. Joseph Mercy Health
System is established.
1995-The nursing staff for all three areas of the Emergency Department is centralized,
and the section head of Emergency Medicine becomes responsible for managing all areas of
the Emergency Department. The Section of Emergency Medicine begins staffing the
emergency departments at Hurley Medical Center in Flint and Foote Memorial Hospital in
Jackson.
1999-Emergency medicine at Michigan attains departmental status; more than 50
medical schools in America teach emergency medicine as a specialty.
Medicine at Michigan 17
T
he push began in 1992, when Barsan was hired. “My job was to get a
training program started,” he says, “and I think they realized they needed
someone in emergency medicine to be in charge of that. It was a specialty the
U-M didn’t offer, and every year many of their really good medical students were
choosing to go into emergency medicine somewhere else.”
Besides, as was happening at other institutions, “people began to realize that the
way things were being run in the emergency department wasn’t the best way to run
them,” he says. “It was not a real efficient triage system. People got taken care of, but
sometimes not as expeditiously as possible.”
As was happening at other institutions, “people began to realize that the way
things were being run in the emergency department wasn’t the best way to run them.”
The first priority was a training program. “The expectation was that if we were
good at recruiting residents nationally, and if we were able to run in the black as a
business, and able to get our research productivity up to a level that was considered
acceptable, they would consider making us a department,” Barsan says. “The Health
System obviously feels we did that.”
It was the defining moment at Michigan in a field that has gone from stepchild to
poster child in less than a generation, a progression in no way hindered by the
glamour associated with emergency medicine thanks to a number of television
shows. Going all the way back to M*A*S*H, they have helped make the often
dramatic work of emergency medicine seem seductively appealing, intense,
consuming, and full of professional victory. Many emergency physicians say they
like the variety and excitement portrayed in these shows as much as the viewers do;
they readily admit it’s part of the specialty’s attraction. ➤
Emergency
Medicine
Research:
The Goal is Always
Fewer Emergencies
want to find out how we can treat people
“Ibetter
who are injured,” says Ronald Maio,
Ronald Maio
18 Fall 1999
D.O., an associate professor of emergency
medicine as well as an assistant research
scientist at the University’s Transportation
Research Institute and director of the U-M
Injury Research Center in the Department of
Emergency Medicine. “But I’m even more
interested in what we can do to prevent
people from being injured in the first place.”
Broadly speaking, Maio is with that simple
statement outlining the two arenas of
emergency medicine research. The first is
medicine’s version of fire-fighting, the other
is more aligned with Smokey the Bear, and
both seek to improve the health of society,
either by treating patients better or by more
effectively keeping them from becoming
patients in the first place.
The University of Michigan Medical Schools’
new Department of Emergency Medicine is
singularly rich in top-notch researchers
interested in reducing the number of people
who get into the desperate situations that
land them in emergency rooms. William
Barsan, M.D., the department chair, is a past
president of the Society for Academic
Emergency Medicine, as is Steven C. Dronen,
M.D., an associate professor of emergency
medicine. Brian J. Zink, M.D., also an
associate professor of emergency medicine
and the Medical School’s assistant dean for
medical student career development, is the
incoming president of the Society: his
interest is the effects of alcohol in the early
period after a brain injury.
Maio is currently involved in two federally
funded projects studying the practicality
and efficacy of what might be called “preemergency” behavioral change. As with Zink,
alcohol is center stage in his work.
“We think that when a person comes into
the emergency department following an
injury that represents a teachable moment,”
says Maio. “If we can identify certain
behaviors that are putting them at risk for
future injury, it might be a particularly
effective time to make an intervention.”
It’s almost symptomatic of emergency
physicians that they would try to figure out
how to pile this on top of all the other tasks
demanding their attention. On the other
hand, if it works (and “working” includes
minimally disrupting those other tasks), the
number of their tasks might actually shrink.
Toward that end, Maio is a principal
investigator in two studies, one with adults,
(Frederic C. Blow, Ph.D., of the Department
of Psychiatry is principal investigator) and
one with adolescents (with Blow and
research scientist Jean Shope, Ph.D. of the
Transportation Research Institute as coprincipal investigators). Both studies
employ computer technology, the first a
hand-held device, and the second a laptop,
to provide a brief, tailored intervention to
change drinking behaviors or, in the case of
teens, to prevent alcohol use.
For Maio, the beauty of the high-tech
approach is its efficiency. “It precludes the
need for a lot of personnel-intensive
intervention,” he says. “You don’t have to
have a lot of counselors and doctors talking
to people, which in the emergency department can be difficult to accomplish.”
Also difficult, says Zink, is erasing the
notion that being drunk can actually protect
people from injury because they’re “more
relaxed.” “We’ve observed that alcohol
worsens injury and increases mortality, after
motor vehicle crashes in particular,” he says,
“so we’re trying to use a laboratory model to
figure the mechanisms that account for
alcohol’s potentiation of injury. We looked
at breathing, blood pressure, hemorrhagic
shock, circulation, and what alcohol’s effects
were, and we found that it depressed the
respiratory response and reduced blood
pressure and blood flow to the brain. Now
we’re starting to look at the biomolecular
reasons for those physiological changes.”
Which is all quite fascinating, but what does
it have to do with saving someone’s life? “We
are responsible for providing airway control
and resuscitation of trauma victims,” says
Zink, “and if these changes that we see in
laboratory animals are happening in injured
humans, then we need to be extra aware that
alcohol-intoxicated people may require a
different level of airway control or resuscitation.
“We also need to be aware that physiological
changes we might attribute to the injuries
could actually be caused by the alcohol, and
it also becomes important in anesthesia,” he
adds. “Then there is the public health
perspective. If this information is correct,
relying on a designated driver may not be
enough to save your life. If you’re sitting in
the passenger seat intoxicated and you’re
involved in a motor vehicle crash, your chances working with Dr. Waller. What they were
doing was giving me ideas for what to test in
of dying or being seriously injured may be
a laboratory setting, and my laboratory
greater if you’re drunk than if you’re not.”
results were giving them ideas that might
So it appears that alcohol is a double
explain what they were seeing, so there was a
whammy, increasing both the likelihood of a lot of potential for brainstorming and
traumatic event and the severity of its effects.
collaboration between us.”
It’s the sort of insight that transcends
As with many of their colleagues, the keen
academic boundaries. It’s also the sort of
sense of mission felt by both Maio and Zink
insight that emergency medicine’s broad
scope facilitates—as does the oft-lauded and was fueled in part by personal experience. “A
real good friend of mine in college got killed
very real interdisciplinary inclination of
by a drunk driver,” says Maio, “and I had
many of Michigan’s researchers.
several acquaintances from my college years
“I don’t think I could have done this research
that were killed in motor vehicle crashes.
at any other institution,” says Maio. “It’s
Then my best friend in medical school was
truly interdisciplinary, involving people
killed in a small plane crash, so the idea of
from the Department of Psychiatry, the
injury and how it can destroy young people’s
School of Public Health and the University’s lives has always kind of directed me.”
Transportation Research Institute, as well as
When Zink was an undergraduate at
many graduate students from the School of
Public Health and the School of Social Work Allegheny College in Meadville, Pennsylvania, he signed up for a work-study program
who are working as research assistants. That’s
what makes this such a great place to work.” at the town’s tiny hospital. “I worked as an
orderly or technician in the emergency
And that’s what leads to breakthroughs.
department and got to do a fair amount of
While squarely in the mainstream of
hands-on work with patients and observe
emergency medicine’s historic concern with the physicians,” he says. “None of them were
public health, broadly defined, the studies
emergency physicians but I liked what they
Maio’s leading also represent a rather
were seeing. A lot of people say this and it’s a
dramatic departure.
little bit trite, but you really feel you have
your finger on the pulse of society when
“In the past, emergency physicians conyou’re in the emergency department.
cerned with prevention have been involved
Everything is kind of unmasked.”
in education and trying to influence policy,
activities outside of the emergency departNo one was more surprised than Maio
ment clinical setting,” he says. “What we’re
himself when his enthusiasm for research
trying to do, at least with our studies, is
surfaced. “When I went to medical school
incorporate prevention activities into the
and even afterwards, I just wanted to
normal clinical practice of a busy emergency practice clinically,” he says. “Then I did some
department. That’s the challenge, and I can’t small-scale health services research when I
tell you that it’s going to work. It really is an was in the military and realized how, as a
experiment.”
clinician, you can have an impact on that
The technology developed at the U-M
obviously helps. “That’s why we’re ahead of
the pack,” says Maio. “It’s also fortunate that
we staff the emergency departments at
Hurley Medical Center in Flint and Foote
Community Hospital in Jackson. From a
research standpoint, that gives us a look at
three different populations and makes it
easier to generalize.”
The relative absence of walls between
disciplines at U-M was a factor in luring
Zink to Michigan. “One of the reasons I
came was the opportunity to work with
these people who were doing some very
interesting alcohol research,” he says,
meaning Patricia Waller, who recently
retired as director of the Transportation
Institute, as well as Maio.
“Dr. Waller did a landmark study in North
Carolina, before she came to Michigan in the
late 1980s that was the first to show, using
sound methods, that alcohol seemed to
worsen injury and increase the risk of death
following motor vehicle crashes,” says Zink.
“Then Dr. Maio got here in 1989 and started
one person you’re dealing with, but if you do
good research, you can have an impact on
the lives of thousands of people you’ve never
met. When I first got into emergency medicine,
the sicker the patient and the bigger the
challenge, the more I liked it. The more procedures I could do, the better. Now I’m more
excited about trying to prevent injuries.”
“All the issues that we deal with in emergency medicine on a daily basis are societal
issues,” says Zink, “whether it’s access to
care, potential rationing of care, or the
problems of drug abuse and domestic
violence. We truly are a safety net for people
who have no place else to go, who are
desperate. We take pride in always being
there and always being ready and always
trying to help, no matter who you are or
what time it is or how ‘undesirable’ you
might appear. We will treat you all the same.
In many ways, the emergency department is
the great equalizer in terms of patient care.”
Medicine at Michigan 19
Walter D. Dishell (M.D. 1964) shows actor Alan
Alda how to properly hold a Deever retractor for
an episode of the hugely popular M*A*S*H
television series in the early 1970s, filmed on
Stage #9 of the 20th Century Fox Studios in
Hollywood, California.
The Emergency Medicine Delivered by Hawkeye
and Hot Lips Was Always the Best—and Walter Dishell
Was There on the TV Battlefield to Make Sure of It
F
ew physicians understand the dramatic
and episodic appeal of emergency
medicine better than Walter Dishell (M.D.
1964). For over 11 years and more than 250
shows, Dishell served as the medical adviser
to the popular television series M*A*S*H,
which, as aficionados of medicine and the
military know, stands for Mobile Army
Surgical Hospital.
and his fellow actors and actresses practiced
was not too advanced. “I remember they
wanted to do a story on cortisone, but I had
to tell them that it hadn’t been invented yet,”
Dishell says. He consulted medical textbooks
from the 1950s and professional publications like the Journal of War Surgery to
ensure the show’s historical accuracy.
Whether he was showing Alan Alda (Captain
Benjamin Franklin “Hawkeye” Pierce) how
to hold a scalpel or telling Loretta Swit
(Major Margaret “Hot Lips” Houlihan) how
to pronounce “carotid” (caROTid, not
CARotid), or making sure that an IV was in
the proper position, Walt Dishell was on the
set to make sure the medicine the TV viewer
would eventually see was authentic, to make
sure, as he puts it, “that the right doctors
were doing the right things.”
Before the 1990s, television audiences
wouldn’t tolerate the high-tech, bloody
verisimilitude of today’s emergency room
shows, Dishell says. “In the early M*A*S*H
shows they wouldn’t let us show any blood
on the surgical gloves or on the gowns,” he
says. “Influences like MTV, the Internet, plus
changes in medicine itself have made a
difference in what people are willing to
tolerate. The public is not as squeamish as it
used to be. Now you can watch an actual face
lift or heart transplant being televised.”
A facial plastic surgeon in Beverly Hills,
California, for the past 30 years, Dishell first
began using his medical background in the
entertainment industry when he was asked
to be a medical adviser to a CBS production
in the 1960s entitled Medical Center soon
after completing his residency in plastic
surgery at UCLA. Like the earliest TV
medical shows, including Ben Casey and
then Marcus Welby, M.D., it focused on
physician-patient relationships rather than
on the medicine itself. “The disease itself
didn’t matter,” Dishell recalls. “They would
give me a dramatic story and then I would
build the medicine around it.”
For Dishell himself, who loved the charactercentered drama of Medical Center and
M*A*S*H, today’s emergency room shows
hold little appeal. “I’m not a big TV fan at
this point,” he says. “The emergency shows
are too technology-oriented. And the
patients never seem to leave the emergency
room.” Technology was never much of an
issue for Dishell on the M*A*S*H episodes
he oversaw; on the battlefield in the early
1950s there wasn’t a great deal of it. “There
was a lot of surgery on M*A*S*H, but it was
low-tech because of the time and the place,”
he says.
All that changed with the highly successful
M*A*S*H, also a CBS production, which
first aired in the fall of 1972. “It was the first
of the emergency shows,” Dishell says.
“Everything was acute; there was always an
injury that had to be taken care of right
away.”
Because it was set during the Korean War,
which took place in the early 1950s, one of
the challenges Dishell faced was always
making sure that the medicine Alan Alda
20 Fall 1999
When it comes to the real world, though,
Dishell welcomes emergency medicine’s
coming of age. “When I was in the Air Force,
I was an ENT guy in the emergency room,”
he says. “There used to be specialists of
every kind in the ER, but they wouldn’t
always be familiar with the kinds of
situations they were asked to deal with. It
makes a lot more sense to have physicians in
there who are familiar with the acute MIs
(myocardial infarctions), the fractures, the
things you see there again and again.”
While Alan Alda will always be his favorite
surgeon and will always be remembered for
a bedside manner worthy of many an acting
award, Dishell says he’s happy to know that
if he needed the services of a real emergency
department himself, the real doctors and
nurses there would be especially trained to
meet his real-life needs.
“
I
f I go to a dinner party and start
telling war stories about my experiences in the Emergency Department,
people say I should write a book,” says
Barsan. “You see so much bizarre, weird stuff
that most people don’t see and half the time
don’t believe really happened.
“I like those high-pressure situations,” he says.
“I like having to think on your feet. It’s intellectually challenging, having to know a lot about
a lot of things. You realize that your capacity to
intervene in a meaningful way is very high.”
He cites his previous night’s shift (and the fact
that it is, indeed, shift work, is a purely practical
part of its appeal): “I went from seeing
someone with an eyelid laceration from
playing basketball to a patient with pneumonia to a patient with chest pain to a patient
with a miscarriage to a patient with multiple
trauma to a patient having a heart attack.”
Then there are the anonymous patients.
“There are a lot of John Does, people found
unconscious at the side of the road,” he says.
“It’s a behind-the-scenes detective game
sometimes, trying to find out who people
are. And I tell students they really have to
have good interpersonal skills. You have to
figure these are patients who would much
rather be doing something else. That’s a
challenge for lots of people in the field—
finding ways to create some instant rapport
when you meet people, so that they trust
you. You never know what’s going to come
through the door.”
But whoever it is and whatever is wrong, they’re
entitled to the finest care possible. “We see everybody and we take care of them, regardless of their
ability to pay, regardless of where they come from,
and I really like that,” says Barsan. “I like taking
care of all comers. I might see professors at the
University or corporate CEOs, and I also see the
homeless guys who sleep under the bridge. I had a
patient last night who was psychotic. He kept
insulting me in the same vulgar, unprintable
language, repeated over and over again. He didn’t
care if I was the chairman of the department or not.
It keeps you humble.”
Such stories illustrate, however crudely, that the
emergency department increasingly functions as a
community triage center, a gateway to the health
system, and, in this and other academic medical
centers, an interface between town and gown.
Says Burney, the head of emergency services at U-M
from 1986 to 1992: “The University of Michigan
Hospital was not perceived as the community’s
hospital, so we tried to change that. In order to do
that, you have to change attitudes, increase
resources, teach staff to reach out, and you have to
make it clear to people that they’re going to be well
taken care of. The fact that we now have a very
busy ground-level emergency room that accepts
large numbers of people locally, and that people
situation just might be affected by “living in a house
with no heat, or not having enough food to eat.”
Many of these people will never feel any gratitude
to the emergency room staff who save their lives.
“Typically, they come in unconscious, confused, in
shock. We may save their lives but they have
absolutely no memory of us,” Barsan says. “The
people they relate to are the ones they saw later in
the hospital; they don’t have any clue what
happened at the front end.”
For reasons that are subject to debate, the percentage of patients admitted to the hospital from the
emergency room has climbed dramatically. “When
I first got in, if an emergency department admitted
15% of its patients, that was pretty high. Now it’s
between 25% and 30%,” Barsan says, “We see sicker
patients than we used to, and I don’t think anybody knows why.” Balancing this development is
the fact that “a lot of patients are able go home now
that we didn’t use to send home,” says Barsan, “and
we have better outpatient follow-up.
Carl Chudnofsky, M.D., head
of emergency medicine at
Hurley Medical Center in
Flint. “It’s the closest thing
to the vision I had as a child
of what it means to be a
doctor—Marcus Welby,
M.D., the doctor who could
take care of everything.”
“My theory is that medicine has developed to such
a state that we have patients out there who never
would have been out there in the past, because they
would have been dead,” he says. “It’s a byproduct of
becoming so successful at keeping people alive and
functioning even though they have pretty bad
conditions. My dad had his first heart attack when
“I’ve become more and more concerned with trying to do something for people
other than putting a bandaid on them.”
feel comfortable coming here, is the result of
having worked in that direction from the beginning.”
“Emergency departments are often really the
interface between society and medicine,” says
Barsan. “You see a lot of people on the fringe. You
feel like you have the opportunity to do something;
it’s a way of doing a social triage as well as a
medical triage. Sometimes the most important
things I do have nothing to do with medical care—
getting someone in a rehab program, or getting
them to a social worker.”
The emergency departments at Hurley Medical
Center in Flint and at Foote Community Hospital
in Jackson, staffed under contract with U-M and
headed, respectively, by Carl R. Chudnofsky, M.D.
and John C. Maino II, M.D., also serve to expand
the service and teaching missions inherent in
emergency medicine at Michigan, as well as to
increase clinical research opportunities.
There’s a profound and historic connection
between emergency physicians and social concerns,
given that the former have to cope so often with the
consequences of the latter. It’s the kind of field where
there is support for research focused on better
ways to connect emergency departments with
social services. As Barsan says, a patient’s medical
he was 51, and now he’s 84. It used
to be if you had your first heart
attack at 50, only very good luck
would keep you going to 65.”
That kind of progress has as much to
do with prevention as it does with
remediation, and the former, broadly
defined, is a leading concern of
emergency medicine research and
thinking. “Prevention is the way to go,” says Marie
Lozon, M.D., medical director of the emergency
department’s pediatric section. “I would like to be
put out of business. If we could get people to use
their seat belts or appropriately restrain children,
my job would be considerably easier and the
amount of morbidity from head injury would be
greatly reduced. The horse is out of the barn by the
time I get to them.”
Ron Maio, M.D., is director of the U-M Injury
Research Center and currently involved in two
major injury prevention studies. “Even though I
want to find out how we can treat people better
who are injured,” he says, “I’m even more interested in what we can do to prevent people from
being injured. I’ve become more and more
concerned with trying to do something for people
other than putting a bandaid on them.” ➤
John C. Maino II, M.D., head
of emergency medicine at
Foote Community Hospital in
Jackson. “I really liked that I
had to see essentially all the
people who came into the
hospital, and not worry
about whether they could
pay me. It’s kind of a
mission, is the way I look at
it. In many communities the
entry point into the medical
system is the emergency
department, especially for
indigents and patients who
are uninsured.”
Medicine at Michigan 21
When
Little Ones
Get Hurt
With the specialized pediatric
emergency care of the 90s, they’re
getting better care than ever before
hildren are not little adults,” says Marie
“CLozon,
M.D. “My secret,” she adds,
grinning, “is that adults are just big children.”
The comment bespeaks the cheerful
earthiness of the medical director of the
Health System’s Emergency Department’s
pediatric area, but her point is nonetheless a
serious one. Just as the care of children is
recognized as a specialty in its own right, so
the emergency care of children is sufficiently
different from other aspects of both fields to
warrant its subspecialty status.
“We have a whole different set of issues to be
concerned about,” says Lozon. “Injuries can
affect children differently than they do
adults. Children are growing, their bones are
not completely fused. Their brains are not
like adult brains. If children suffer an injury,
their little bodies may react differently from
those of adults. If you don’t have a sensitivity
for the different ways children react to
illness or injury, you can miss the boat, miss
a serious injury or illness, and then it’s too
late to do well for the child.”
many little kids’ bottoms that I can tell you
what looks normal and what doesn’t.”
Perhaps equally important, she knows “what
sounds like a reasonable story and what
doesn’t.” This is invaluable from a pedagogical perspective. “The young training
physicians seeing patients in the emergency
department do not have the experience that
the attending physicians have,” says Lozon.
“One of the important ways we can help
them is to give them the “Heads up” that
says, ‘This doesn’t look kosher, let’s contact
the child protection authorities.’”
Marie Lozon
Physical separation of adult and pediatric
patients is also better for all concerned. “It’s
often not reasonable to house ill children
next to ill adults, for both their sakes,” says
Dr. Lozon. “If you’re having a heart attack,
do you want to hear a nine-month-old baby
screaming? If you bring in a child with croup
in the middle of the night, do you want to
hear a drunk cursing in the next room?
That’s why we feel having a special area to
care for children, where there are toys,
distracting pictures, and a certain kind of
nursing staff is really very important.
Children tend to do better in that environment.”
Pediatric emergency physicians also must
learn to recognize, and act on, the symptoms
of physical and sexual abuse. “It can be a
very tricky and subtle business,” says Dr.
Lozon. “The child may come into the emergency department with an injury or a complaint
that, on the face of it, seems very innocent,
but if the child is examined or the story does
not seem to match up with the pattern of
injuries or pattern of illness, this can be
recognized and appropriate steps taken.”
This sense of urgency rises a few notches
with the knowledge that trauma is the
leading cause of death among children older
than nine months. “It’s more than all other
diseases combined,” says Lozon, “so expert
care of injured children is required to reduce
morbidity and mortality. Children have
different patterns of head injury than adults
do, and head injury is what usually kills them,
so being able to recognize and manage serious
head injury in children is very important.”
She has her share of war stories, but prefers
to focus on the ones that represent successful teaching experiences. “A resident saw a
little girl who complained that it hurt when
she went to the bathroom,” she says. “He got
a urine specimen, which was the appropriate
thing, and it indicated she might have a
urinary tract infection, and he wrote a prescription. I said, ‘Did you examine the child’s
bottom?’ He said, ‘No, she looked okay.’
And there are procedural differences as well.
“One of the most important things to be
able to do for an emergency physician is to
manage the airway, and the airway of a child
is very different from the airway of an adult,”
she says. “And the way that a child’s vascular
system reacts to shock is different from the
way an adult’s does. Children can compensate
for hemorrhagic shock in such a way as to
appear generally stable or well until they’re
very seriously in danger.”
“We went back to examine her genital area
and it was clear she had been sexually
abused. When the family was questioned
more deeply about the child’s caregivers
and any potential for abuse, it was clear that
the potential was high. The make-up of the
household revealed many suspects. The child
was admitted to the hospital and later found
to indeed have been abused. Possibly in
another department, that child would have
been dismissed as simply having a UTI,
which she indeed had, but I’ve looked at so
1999
2222
FallFall
1999
Reporting abuse to the proper authorities,
though, can be the least of it. “Sometimes
you have to be willing to incur the wrath of a
parent when you say you have to take
custody of their child because you believe
they’ve abused or neglected them,” she says.
“You have to do what’s best for the child and
not have fear, and that’s a scary thing.”
At such moments both the emergency
physician’s self-confidence and can-do
attitude, and the pediatrician’s experience in
dealing with parents are both needed.
“In pediatrics, there is more than one
patient in the room,” Lozon says. “You’re
also taking care of the parents. The people
making the decisions for children are the
adults. A huge part of pediatric practice is
reassurance, of parents and children.”
In addition to knowing how to provide
reassurance, the pediatrician in the emergency room has to know how to quickly
change her style or way of interacting with
the child according to the child’s developmental age, which may not always match
chronological age. “Learning to deal with a
recalcitrant toddler to obtain a proper
physical exam is one thing,” Lozon says. “You
have to change your style in dealing with an
adolescent, who is basically still a child but
feels an element of autonomy. You have to go
from room to room and instantaneously
change the way you relate to people.”
But people skills and being light on one’s
feet are among the hallmarks of emergency
medicine. “Most people attracted to
emergency care enjoy the requirement to
make decisions based on a very limited set of
data,” she says. “You have one opportunity to
address the patient’s illness, you have a brief
window, and you need to have a very good
ability to integrate information.
“There’s an element of self-confidence that’s
required. You have to be the leader of a team
of people who could be called upon at any
moment to work on a patient with what may
be a limb- or life-threatening problem, and
you have to be able to do that instantly and
keep in mind all the other patients in the
emergency department. And these patients
are very stressed; they can be quite annoyed
with you, they may have had long waits,
they’re anxious, and when their most
unappealing characteristics come forward,
you have to be a counselor, a spiritual
advisor, a friend, a fellow parent.”
And you also—as a bonus—get to practice
procedural skills. “Many people don’t want
to do procedures all day, so they don’t
become surgeons,” says Lozon, “but they
would like the opportunity to do life-saving
procedures when necessary. I enjoy doing
complex intravenous line placements,
managing airways. And I’m interested in
pain relief in injured children. That is a
major mission of mine that has been only
recently addressed in the medical community. Children historically have been vastly
under-treated for their pain, and this is an
area where the pediatric emergency specialty
has made great strides.”
She cites, as an example, the evolution of
treating a child with a broken leg. “If you
asked an orthopedic surgeon who had been
here for many years, ‘What kind of support
did you receive to care for a child with a
broken leg in the emergency department 20
years ago vs. now?’, he would tell you he now
receives expert pain control and sedation for
children when they have their fractures
reduced,” she says. “That means the child is
better served, and the surgeon doesn’t have
to tie up an operating room or an anesthesiologist to put the child to sleep to set the
bones. The best thing is that the child
doesn’t have to endure undue pain and
suffering, and the orthopedist can do the job
humanely and more effectively because the
child is asleep, and at much less cost than
calling in an anesthesiologist and an OR
team. That is now the standard practice—to
put the child to sleep in the emergency
department and do their care there.”
Lozon and her team can enjoy such moments
of triumph only briefly, however, before
they’re on to the next emergency. “I think a
lot of us have a short attention span,” she
chuckles, “and this is where I can put mine
to good use.”
I
n June, work began on what might be called the externalization of emergency medicine’s new status, an expanded and reconfigured space at
University Hospital. “When this hospital was built, there were no emergency
physicians here,” says Barsan. “The departments of pediatrics, medicine and
surgery each ran their own sides, so when they built the emergency department,
they built it as three separate areas. Now all of it is run under emergency
medicine, but we still have three separate geographic areas, which has been very
problematic for us. It’s not a very good system, the way we have it right now.”
Soon, it will be better—more efficiently designed, better integrated and, yes,
bigger. The cowboys of health care (James MacKenzie, M.D., a Canadian
surgeon who worked closely with Burney in the formative days at U-M and
was Emergency Services chief from 1979-1986, actually was a rodeo rider
before turning to medicine) will have more room and improved tools. “The
ambulance entrance leads right into the resuscitation areas,” says Barsan, ticking off
improvements, “which can be used for any sick patient: pediatric, adult, medical
or surgical. They all go into the same area, which is more economical than
having separate resuscitation areas.”
No longer will patients taken from ambulances or helicopters be wheeled
through public areas in the department, a chronic source of distress for all
concerned. “We’re building a new landing pad, with a tunnel right to a onefloor elevator for the exclusive use of the helipad,” says Barsan. “CAT scan and
regular radiology are right there; they can all get done right within the department. Emergency laboratories will be right next to the vestibule, and an on-site
lab will make a huge difference. Psychiatry—and this is the only 24-hour emergency psychiatry facility in Washtenaw and Livingston counties—has 2,200
square feet instead of 700.”
Another part of the expansion will be a “clinical decision area” for observing
patients, such as those with chest pain, who may require more time for
diagnosis. “If you had come to the emergency department with chest pain five
years ago, and we did an electrocardiogram and you weren’t actually having a
heart attack, the only way to know if you were really coming to a heart attack
would be to admit you to the hospital, observe you for two or three days, do a stress
test, and probably schedule at least one or two return visits.”
Now the whole process can be expedited. “After we evaluated you in the
emergency department to make sure you were not having a heart attack right
now, you would go into the clinical decision area,” Barsan says. “You would be
seen by a cardiologist, have a stress test, and we would get you out in 12 to 16
hours. We’re taking what used to be a two- to three-day work-up and compressing it into less than a day. You get a quicker answer, you’re not spending
days in the hospital when you don’t need to, and you’re having the same
outcome you would have had if you had been admitted to the hospital.”
Asthma attacks are another example. “Someone having a bad attack that
doesn’t clear up in several would typically get admitted and be in the hospital
several days,” he says. “With this new area, if they’re not better in six hours but
better in 16, we’re able to get them out much quicker.”
“Emergency medicine has matured into an independent discipline here
at Michigan as it has at our peer institutions around the country.” —Dean Allen Lichter
Needless to add, reducing admissions and shortening stays are popular
procedures with the moguls of managed care, but better care remains paramount with Barsan and his colleagues, who feel great pride in being the first
new department in the Medical School in 15 years. “Emergency medicine has
matured into an independent discipline here at Michigan as it has at our peer
institutions around the country,” notes Dean Allen Lichter, who was the first
chair of the Department of Radiation Oncology when it was established in
1984. “Under Bill Barsan’s direction, the department is in an excellent position
to experience the academic growth it deserves and to attract more of the best
faculty and trainees from around the country.” m
Medicine at Michigan 23
CAN THE
COMPUTER
MAKE IT
BETTER?
IF THE SUBJECT IS MEDICAL EDUCATION,
THE ANSWER SEEMS TO BE A RESOUNDING “YES!”
I
nvoking “Moore’s Law” is a popular way to illustrate the fabulous pace of the information
technology revolution. In the mid-1960s, Gordon Moore, the semiconductor engineer who
later co-founded Intel, gave a talk in which he introduced the concept that came to be
named after him: i.e., the amount of information that could be stored on a given amount of
silicon had roughly doubled every year since the technology was invented.
By Jane Myers
Thirty-five years later, the pace of change in the world of information hasn’t slowed perceptibly. And in the world of medical education, it’s just heating up. Casey White, director of the
University of Michigan Medical School’s Learning Resource Center, could write her own
version of Moore’s Law: the number of students and faculty demanding more Internet- and
Web-based learning and teaching doubles every time she turns around. Some might find this
daunting. But it is Casey White’s own version of paradise. “I want to see them lined up out
there in their white coats asking for more,” she says with the enthusiasm of a true believer. A
native New Yorker who still talks at the speed of a subway passenger determined to finish a
complicated explanation before the next stop, White is the right woman in the right place at
the right time.
A would-be novelist, she decided 18 years ago that the challenge of helping medical faculty
with the development of curriculum was every bit as creative as writing fiction. The addition
of high-tech to the mix has made it even more so. And there are nail-biting days that even
Stephen King would appreciate—like the morning somebody mistakenly turned off a server
when a group of medical students was taking an exam on-line. “I handed out M&Ms that
day,” she says.
24 Fall 1999
“
WE KNOW THAT STUDENTS MUST BECOME LIFELONG
LEARNERS, WELL ATTUNED TO INDEPENDENT LEARNING.
THE WEB, BECAUSE OF ITS ACCESSIBILITY AND INTERACTIVITY,
MAY BE ONE OF THE BEST NEW AVENUES AVAILABLE TO US.
—JOE FANTONE, ASSOCIATE DEAN FOR MEDICAL EDUCATION
”
chair of the Department of Medical
Education, to describe those precious
instances when everything clicks and the
student discovers what he or she really
wants to know and will thus probably
remember forever.
For many faculty, the realistic way to
begin is one small step at a time. When
the students in Professor of Pediatrics
Mary Ellen Bozynski’s clerkship asked for
more time to study pediatric X-rays,
White’s staff helped her put the X-rays up
on a Web site. The Learning Resource
Center now has a “Faculty Development
Station” where faculty can enhance and
upgrade their teaching materials and gain
ideas for original computer-based
materials.
Casey White with second-year medical student Aashish
Didwania.
Such momentary glitches with their accompanying
high anxiety don’t dampen the ardor of medical
students for what Casey White is trying to
accomplish. Mere infants in the late 1970s when
computers began transforming the way people
manage information, they are among that generation that views computers, cell phones, pagers,
fax machines and TVs as something akin to
extensions of the human body. For them, the only
question is, “When do we get more?”
White’s biggest challenge these days is helping
faculty find the time to create the Web-based
materials they envision for their own teaching
futures. “‘Busy’ is a big factor,” she says. “Our
faculty are so, so, so, so busy. They want to be
creative; they want to find new and exciting ways
of delivering their courses and clerkships. But the
time pressures that interfere with the creative
impulse are enormous for them.”
Associate Dean for Medical Education Joseph C.
Fantone III, M.D., believes that students would
benefit from less time in lecture halls, and he is
encouraging faculty to think about ways to make
medical learning more interactive. “We know that
students must become lifelong learners,” he says,
“well attuned to independent learning. The web,
because of its accessibility and interactivity, may
be one of the best new avenues available to us.”
The quest is always for those magical “teachable
moments,” a phrase used by Roland “Red” Hiss,
(M.D. 1957, Residency 1964, Hematology Fellowship, 1966), professor of internal medicine and
Last year when Casey White set up two new
express e-mail stations where students could
quickly sign on to check their e-mail, the stations
were an instant hit. “They lined up out there in
their winter coats at 7:45 a.m, laughing as they
read their messages,” she says, “and before long
they were asking for more stations.” In addition to
their e-mail, students can check exam scores and
their ranking among their classmates, a kind of
high-tech reassurance in the competitive world of
medical learning. “They always want to know how
they’re doing,” White says, “ and computers are a
great way to give them their exam scores quickly,
along with a great deal of other information they
want and need.” White credits Dean Allen Lichter
for understanding the importance of technology in
medical education today and for providing the
resources, such as assistance from the School’s
Information Systems staff, that make her work
possible.
The Medical School, of course, is not alone in
finding that ways of learning and communicating
are evolving with the addition of computers and
the Web to the educational landscape. Casey
White has also been grateful to have the resources
of the University’s Office of Information Technology
in the Instructional Technology Division (known
around campus as ITD) available to her with their
technical knowledge and their awareness of what
is happening elsewhere on campus.“ It gives us
access to a higher level of expertise and helps us
avoid reinventing the wheel,” she says. “At some
point we need to be able to look across campus and
ask, ‘Has this been done before?’” ➤
Medicine at Michigan 25
L
ast year in a pilot program half of the students in the first-year class took
their quizzes on-line, a step proposed by the faculty to give students more
flexibility time-wise in taking their quizzes. For image-heavy disciplines
like histology, the computer-based format has particularly high potential. The
pilot was a popular success with both students and faculty, and this fall, all firstyear students will be taking their quizzes on-line. Nationally, more examinations
are going on-line as well. The United States Medical Licensure Examinations, a
three-step series of exams students must pass to obtain a license to practice
medicine, are now computer-based.
“
WE WANT TO BE SURE WHAT WE’RE OFFERING THE STUDENTS
For White, getting it right is her
MEETS A HIGH QUALITY STANDARD,” WHITE SAYS.
main goal these days. “We
want to be sure what we’re
“WE DON’T WANT TO DO ANYTHING THAT TURNS PEOPLE OFF;
offering the students meets a
WE DON’T WANT TO DELIVER ANY DUDS.
high quality standard,” she
says. “We don’t want to do anything that turns people off; we don’t want to
deliver any duds.” The quality of video on the Web, for instance, still isn’t
great. But as it improves, White envisions “the perfect cardiology exam or a
psychiatric interview where you can see tiny nuances in facial expressions.”
”
Does the advent of the computer mean less personalized teaching? “Students
and faculty interacting with each other and with patients will never go away,”
White says. “It’s really a matter of balance, finding ways to deliver all the
things it takes to educate a physician or medical scientist these days.” Given
the amount of information that is out there now, computers and the Web are in
many ways the salvation of medical education. “There was too much information to digest when I was a student,” noted Dean Allen Lichter in a speech
recently. “And now there’s many times more.”
Certain kinds of technology to support medicine are not new at all: X-rays, for
instance, were discovered by German physics professor Karl Wilhelm Röntgen
more than a century ago and were used for clinical purposes by 1896. But
Röntgen’s X-rays and today’s digital imagery are about as far apart as rockscratchings and smoke signals are from electronic communications.
In our lifetimes alone, the leap forward has been dramatic. Reed Dunnick, M.D.,
chair of the Department of Radiology and the Fred Jenner Hodges Professor of
Radiology, remembers the first CT scans in the late 1960s that over a 10-day
period generated an image block by block. That same image, much improved,
is now not only generated in seconds but can be instantly transmitted around
the U-M Health System or around the world—allowing extremely skilled
subspecialists to view the images.
The extraordinarily detailed views of the human body provided by computerized axial tomography and magnetic resonance imagery are not only a boon for
the practicing physician and the patient, but for medical students as well.
Dunnick foresees the day when cadavers will mostly be superseded for the
teaching of anatomy by the almost limitless range of views of the human body
provided by CT and MR images.
The importance of technology in the teaching of radiology is
underscored by the fact that Dunnick last year appointed an
associate chair for information technology, Professor James
H. Ellis, M.D. In a world where the practice of medicine
itself is increasingly based on digital imagery, with threedimensional fluoroscopic image-guided interventions the
wave of the very near future—including such procedures as
putting a stent in an intracranial blood vessel or removing renal
stones—technology is no longer an optional part of medical
education but an essential part. ➤
Radiology Chair Reed Dunnick
with Richard Urbancic,
first-year resident in radiology.
26 Fall 1999
A medical student performs surgery on a life-like human
patient simulator, which not only looks eerily real, but
also functions, responds and can be monitored like a
real patient. The goggles worn by the student and video
projections onto screens surrounding the operating table
are used to mimic the distractions, noise and competing
priorities of an emergency situation.
The
“Cave:”
a place where virtual life
and virtual death
offer swift and
unforgettable lessons to
the physician in training
T
here’s no Alice, but immersive virtual
reality is nevertheless enough of a
wonderland to have its creators
grinning like the Cheshire Cat. It’s a world
where things are not as they seem but
where the “reality” created by technology
is more useful than the real thing — where
a human being that bleeds fake blood and
goes into fake shock can provide invaluable insights to a medical student or a
practicing physician in a way never before
possible. For Dag von Lubitz, Ph.D., a
scientist who is director of the Emergency
Medicine Research Laboratories and
participant in an unusual enterprise known
as a virtual reality “cave,” it’s at least as
mind-bending as Alice’s experiences after
she tumbled down the rabbit hole. (The
word ”cave” is actually an acronym for
“cave automated virtual environment.” The
basic product is licensed by Pyramid
Systems and uses Silicon Graphics
computer technology.)
“The possibilities are limitless,” says von
Lubitz, of a six-month-old research effort in
the Department of Emergency Medicine.
“We ourselves, within this little group of
enthusiasts, are discovering new frontiers
almost daily.”
“Immersive virtual reality” results from the
fusion of two technologies: one that makes
a robot-like plastic and wire invention act
very much like a living, breathing human
being and another that, via a complex set
of goggles, infuses a make-believe
operating room with enough high-tech
computer data that it begins to look and
feel very much like the real thing. The
result is a whole that’s greater than the
sum of its parts, what von Lubitz calls “a
hyper-rich environment.”
The team that’s doing all this, which
includes engineers, computer specialists,
emergency physicians and von Lubitz
himself, is as impressive as the results it’s
producing. Von Lubitz, who holds degrees
in neuropathology and marine biology,
believes it could exist only at a place like
Michigan because of the presence of
academic stars in so many disciplines and
an underlying philosophy that nourishes
collaboration. “It wouldn’t happen, to my
mind, anywhere else,” he says. “We could
serve as a model of how an interdisciplinary team should work.”
Members of the team include Timothy
Pletcher, an information technology
“genius,” as von Lubitz describes him;
Klaus Peter Beier, Ph.D., a naval architect
and world recognized authority on virtual
reality; William H. Wilkerson, M.D.,
clinical assistant professor of emergency
medicine, James A. Freer, M.D., clinical
assistant professor of emergency medicine,
and David J. Treloar, M.D., clinical
assistant professor of pediatrics and
communicable diseases and clinical
assistant professor of emergency medicine
— all senior emergency medicine
physicians. “The beauty of this team is that
it needs no leader because we communicate so well,” von Lubitz says. “But the
critical and absolutely unique achievement
of our team is the fact that we merged
these two technologies into a seamless
entity,” he adds. “We created what we now
call a hyper-rich environment, where we
can expand the tactile, visual combination
of learning that the patient simulator gives
you with any type of medical information
available to you by any electronic means.”
“There are about 60 universities worldwide
that are using human patient simulation in
anesthesiology training,” says von Lubitz.
“We are the first to make emergency
medicine and trauma medicine a primary
target, exposing students to elements that
are destructive, elements that are stressful,
elements that increase the adrenaline rush
and decrease the amount of, shall we say,
readily available knowledge. All that
comes with experience, but experience
can be rather costly in terms of poor
performance. This system allows you, for
the first time, to combine a number of
elements that you have in real life, and
drop your trainee into hot water and say,
‘Deal with it, that’s real life!’”
Having once served as a junior medical
officer on a military ship, von Lubitz is
familiar with operating under adverse
conditions. “Many years ago, I was on a
minesweeper in the North Sea and one of the
seamen tripped on the threshold of a hatch,
flew headlong along the passageway and
broke his forearm,” he says. “It was the
simplest fracture, but we were in a very nasty
gale with mountainous seas. The ship
behaved like a totally unpredictable express
elevator and it took me one and a half hours
to deal with the problem. That experience has
stayed with me forever because I was not
prepared for it. You don’t have any type of
training that prepares you for unpredictable,
sudden motions of the floor, smells that are
excruciatingly unpleasant.” If von Lubitz has
his way, virtual reality will soon allow
students to experience every kind of real-life
horror in the virtual reality “cave,” facing
useful challenges never possible to experience in this way before.
“It’s completely unconventional,” Tim
Pletcher says, “but it’s also very persuasive.
When you put a student into this environment,
where the learning takes place by feeling, by
seeing, you quickly see that we learn best by
using our senses. You can see that a student
learns more about pharmacology by seeing
the physiological response of the human
patient simulator than by reading five
chapters in a book of pharmacology.”
Because virtual reality is so real it has
dramatic implications for research as well as
for teaching. “We’ve done a couple of
experiments where we’ve simply repeated
animal experiments on the simulators to see
what happens, and our results were within 10
to 15 percent of the lab results,” von Lubitz
says. “If it turns out we can use them as
predictors of bench research, that could mean
massive savings in expenses on research
animals, and also saving a number of
research animals.”
The virtual patient in von Lubitz’s “cave” may
also offer whole new ways of testing the
competence of medical students. Instead of a
paper exam, he or she might be presented
with a “virtual” elderly, slightly obese woman
with elevated blood pressure who has just
fallen in the street. “Based on information
from the triage nurse or EMT, the doctor has
to start managing the case,” says von Lubitz.
“That simulator is very, very physiological.
You either do it right or you do it wrong and if
you do it wrong, you may well kill the patient,
which obviously terminates the examination.”
Von Lubitz, who gives great credit to William
Barsan, chair of the Department of Emergency
Medicine, for his courage in supporting such
an unlikely venture and to Jocelyn DeWitt,
Ph.D., director of the Hospital’s information
technology, delights at the thought of all the
possiblities that lie ahead in immersive
virtual reality. “The intellectual atmosphere of
this department is absolutely unprecedented,” he says. “Great discoveries lie
ahead. Alice? She would have loved it.”
Medicine at Michigan 27
T
he curve is steadily upward,”
Dunnick says, standing in a
darkened film-viewing and CT
scanning room down the hall from his
office that these days has the look of a
major television network studio: banks
of monitors with physicians peering into
them while the “production” behind
the glassed window is the patient who,
with a single breathhold, can have his
or her body scanned from neck to pelvis,
creating stored images of amazing
complexity that can be magnified,
viewed laterally or longitudinally, made
lighter and darker, stored for comparison a week later with new images, or
sent around the globe.
“
THE WEB OFFERS A RICH TAPESTRY OF TOOLS
FOR VISUAL CONTENT,” STOOLMAN SAYS.
“WE’RE JUST BEGINNING TO TAP IT.
WEB-BASED MATERIALS, WITH
THEIR WIDE ACCESSIBILITY,
HELP TO CREATE ELECTRONIC
BRIDGES AND PROVIDE A WAY
TO REVIEW MATERIALS AS
MANY TIMES AS
NEEDED, WHICH GRUPPEN
SEES AS A GREAT PLUS.
28 Fall 1999
”
Not surprisingly, it is in the image-heavy
specialties like radiology and pathology
that the most effort has been made to
date to integrate Web-based learning
into the curriculum. Associate Professor
of Pathology Lloyd Stoolman, M.D.,
was chosen as a 1999 Laureate and
finalist in the highly competitive
“Education and Academia” category of
the Computerworld Smithsonian
Awards this year for his work in
developing Web-based courseware
called “The Virtual
Microscope,” separate
versions of which are
being used by secondyear medical students
and by dental students.
Putting microscopic
images on the Web turns
out to be a real boon for
many students. Such
“slides” can be accessed
at any time. They can be
looked at over and over
again. They can include
annotations to highlight
key structural features. Clues can be
embedded in the images so that the
student, rather than being directed by
static arrow, can be allowed to explore
the slide and use his or her detective
skills to discover the nature of the
underlying disease process.
Stoolman’s Web-based “virtual microscope,” which uses the FlashPix image
format and the Live Picture Image
Server technology, is, in his view and
that of many of his students, a fine
addition to the arsenal of teaching tools.
“Great,” “nice,” “awesome,” “cool,”
“excellent,” “perfect,” “very helpful,”
are some of the adjectives students
have used in anonymous evaluations.
“The Web offers a rich tapestry of tools
for visual content,” Stoolman says.
“We’re just beginning to tap it.” Like all
the pioneers in this area, Stoolman has
had his frustrations with the limitations
of a technology still evolving. With
higher screen resolutions, faster CPU’s,
and higher Internet speeds, much greater
advances will be possible. But he
already feels the great satisfaction of a
teacher who has found yet another way
to engage his students in their quest for
competence. And he applauds the efforts
of his many colleagues who recognize
the virtues of putting visual content on
the Web and the University’s Intranet.
These innovators include: Richard
Lieberman, M.D. (Departments of
Pathology and OB/GYN), Professor of
Pathology Andrew Flint, M.D., Associate Professors of Pathology Paul Killen
and Joel Greenson and Professors of
Anatomy Donald MacCallum and Kate
Barald, who have also produced Webbased annotated atlases.
Is putting material onto a computer just
a matter of going from ink to digital,
from peering into a microscope to
staring at a computer screen? Just a
fad, perhaps? Faculty and students
overjoyed by the possibilities of
technology aren’t asking such questions any longer.
But for scholars like Larry D. Gruppen,
Ph.D., associate professor of medical
education, and Red Hiss, who have
spent their careers pondering the
complex questions of how humans—and
especially medical students—learn, the
advent of new technologies hasn’t
changed those basic questions.
One of the most attractive elements of
educational technology, in Gruppen’s
view, is that “it’s always there, it’s
always the same. With only 5-7 percent
of all patient care taking place in
hospital settings now, the education of
physicians at the residency and
fellowship levels is, by necessity, much
more dispersed than it once was.
Web-based materials, with their wide
accessibility, help to create electronic
bridges and provide a way to review
materials as many times as needed,
which Gruppen sees as a great plus.
Still, he doesn’t think we should expect
instant learning. “You rarely learn one
thing by one experience,” he says. He’s
done research on the subject of expertise and how long it
takes to develop it. “What’s striking is how long it takes,” he
notes. “Learning to play chess, to play the violin, to play the
piano, to excel in any of the arts or athletics—it typically
takes about 10,000 hours to become good at any of these
things, and there doesn’t seem to be any decent way to
speed it up. How this translates to medical education is not
clear, but there do seem to be some fundamental limits to how
people learn that the technology cannot eliminate.”
From what he has seen to date, Gruppen isn’t sure that
technology-based learning will be cheaper or easier. “People
have found that often the cost-savings are much smaller than
originally thought,” he says. “You might think that a faculty
member could teach 3,000 students instead of 300, but it
doesn’t work out that way. He has to communicate with each of
those students by e-mail—and students tend to write more than
they would say in person. Responding to e-mails takes a lot of
time. In some of the studies undertaken by the American
Educational Research Association, faculty have been very
disillusioned by the time-consuming nature of e-mail.”
Gruppen’s research has shown that long-distance lectures
hold promise. “Students generally perceive long-distance
lectures as being as good as the
traditional lecture,” he says. “The
TECHNOLOGY DOES GIVE US INFORMATION FASTER
information is often better prepared,
AND IN A MORE WIDELY DISSEMINATED WAY,”
more structured—the teacher can’t just
HISS SAYS. “BUT WE STILL HAVE TO OVERCOME BARRIERS
walk in with a box of slides and
OF ATTITUDE...HAVING THE INFORMATION COME AT YOU
ramble—but you lose spontaneity, the
ability to ask questions.” He points to
FASTER DOESN’T CHANGE THAT.
Richard Judge, clinical professor of internal medicine, as
someone who has successfully integrated interpretive
commentary with images in cardiology. “He’s one of the best,”
Gruppen says. “Computers can give you much more consistency,” Gruppen adds. “You can record a heart murmur, for
instance. But so much depends on how the developer
organizes it. In the hands of someone as skilled as Dick
Judge, it can be wonderful.”
“
”
CONTACT:
Hiss, who has been involved with medical education at the
University of Michigan for more than 30 years and has been
chair of the Department of Medical Education since 1982,
never loses sight of the fact that new technology, no matter
how many bells and whistles it may have, is only part of a
much bigger picture that includes curriculum development,
faculty training, learning theory and behavioral change.
Having helped teach the hematology sequence 35 times to
35 classes, he is no stranger to the mysteries of learning.
“Technology does give us information faster and in a more
widely disseminated way,” he says. “But we still have to
overcome barriers of attitude. Human resistance to change is
a basic barrier. Having the information come at you faster
doesn’t change that.”
Hiss wants to wrap up his career over the next three years
by producing a new model for continuing medical education,
a model based on 15-20 “key points” that a physician needs
to know and can apply over a year’s time, and that might take
20 hours a year to absorb. But the “teachable moments”
when those key points can be assimilated? Will it be at a
seminar? A meeting?
Or on the
Web? m
Lloyd Stoolman’s websites for students can be viewed at:
http://141.214.612/cyberscope631/
http://141.214.612/virtualheme98/
The Computerworld Smithsonian Innovation Website can be
viewed at: http://innovate.si.edu/index.html
The complete case studies for all Computerworld Smithsonian
nominees can be viewed at: http://198.49.220.47/texis/si/sc/
innovate/ (Go to “Education and Academia,” then “University of
Michigan,” then, at the bottom of the page, “More Detail.”)
Faculty members featured in the above article may be reached
by e-mail at the following addresses:
Mary Ellen Bozynski: [email protected]
Reed Dunnick: [email protected]
Larry Gruppen: [email protected]
Joseph Fantone: [email protected]
Andrew Flint: [email protected]
Roland Hiss: [email protected]
Richard Judge: [email protected]
Casey White: [email protected]
Medicine at Michigan 29
History of
the Deans–
PART I
OF
III, 1850-1891
W
by Teresa Black
ith his appointment as dean of the University of Michigan Medical
School on May 1, 1999, Allen Lichter, M.D. has become part of a
long legacy of distinguished leadership. The Medical School has been
indebted to the guidance and vision of its deans since its modest beginnings,
through a period of influential and innovative reforms around the turn of the
century, to the present day when the school enjoys renowned medical facilities
and research programs.
During the first 40 years of medical education at Michigan, the top administrative posts were filled on a rotating basis. A president and secretary were
elected by fellow faculty members each year. The president was not formally
called "dean" for the first few years, but from the start his position was equivalent
in rank, if not duties, to that of today's dean. His stature, though, was somewhat diluted by the many other tasks he had to perform: the president and
secretary shared administrative chores such as bookkeeping and registration,
and had all the responsibilities of regular faculty members as well.
Their workload was often overwhelming, as illustrated by an undated faculty
resolution inserted loose in the pages of the faculty minutes for 1865. It stated
that the duties of officers had become “very burdensome” because of the large
classes, keeping of accounts, registration, seating, cataloguing of students, and
preparing of announcements. At that time the Board of Regents were asked to
change the bylaw relating to the offices of dean and secretary by consolidating
them into the office of dean alone, who would then be paid a reasonable compensation for his services. This request was granted, and a later revision of the
bylaws in 1880 allowed the dean to appoint professors’ assistants as secretaries.
The first president/dean during this early period of rotating leadership was
Abram Sager. Sager had come to the University of Michigan in 1842 for an
unsalaried position teaching botany and zoology. His position became a regular appointment in 1847, but being a medical doctor, he was eager to establish
a formal medical department at the University. Related to the economic struggles
the state of Michigan faced at this time, the University itself was in a humble
state, striving to exist despite financial problems. The Regents thus had difficulty
mobilizing the 1837 University Act to found a Medical Department. Regent
and physician Zina Pitcher encouraged Sager, along with Silas Douglas and
30 Fall 1999
others, to address the Board of Regents concerning this matter. In 1847 they did just that,
pointing out that at least 70 Michigan residents
had been forced to leave the state for a medical education. Sager’s efforts helped facilitate
the Regents’ 1848 decision to establish the
Department. Sager’s subsequent appointment as professor of theory and practice of
medicine is regarded as one of the founding
acts of the Medical School.
Besides being instrumental in the formation
of the Medical Department, Sager influenced
medicine at Michigan with his enthusiasm
for natural science. He graduated from
Castleton Medical College in 1835 with
familiarity in botany, zoology and geology.
From 1837-40, he was chief in charge of the
Botanical and Zoological Department in the
Michigan State Geological Survey. As a
teacher, he is said to have come to class with
a frog in his pocket, insects fastened to his
hat, and a snake that managed to escape into
the classroom! His vast collection of 1,200
species and 12,000 specimens helped found
the University’s Herbarium, and Sager’s ardent
interest in natural science helped forge an
important bridge between basic and applied
sciences in medical education at Michigan.
Sager’s clinical expertise also contributed to
the University’s Medical Department. He practiced in Detroit and then Jackson, performing
what was probably the first Cesarean section
in Michigan in 1869. He was a modest man,
said to have a kindly manner with the sick.
After his initial appointment at the University of Michigan, Sager became professor of
obstetrics in 1850 and the chair of diseases
of women and children from 1854-1860. He
served as dean from 1850-1851, 1859-1861,
and 1868-1875, retiring in 1875 after thirtythree years of service at the University. His
resignation was in part due to the formation of the Homeopathic Department,
which he strongly opposed. Corydon Ford,
a colleague for many years, said “Doctor
Sager’s wealth of learning and wide medical
scholarship and his eminent service in his
department of instruction did much to give
character to the institution and to qualify
many to do work which has largely blessed
humanity and reflected honor upon his
alma mater” (Ford, Corydon L. “Memorial
Address on Alonzo Benjamin Palmer.” Physician and Surgeon 10 (1888): 245-253, 297302, 355-360). Abram Sager’s legacy to the
Medical School is not only in his service as
the first dean, but also the example he set as
a fine physician and major proponent of the
school’s establishment.
Following Sager, Samuel Denton served as
dean from 1851-1853, and again from 18571858. Denton earned his medical degree in
1825 at Castleton Medical College in Vermont.
He was a successful physician, and his
dedication to his patients is evident in the following advertisement posted in the Michigan
State Journal in 1835:
[Dr. Denton] has removed his office to
the Court House, in the South Room on
the East side of the Hall. Those who call
after bedtime will please knock at the
window if the door is fastened.
Denton was influential with the Board of
Regents, of which he was one of the inaugural
members in 1837. He was politically active,
serving as a senator in the Michigan legisla-
ture from 1845-48. Denton had been trained
by Zina Pitcher, and became the professor
of physics in the University of Michigan
Medical Department when it opened in
1850. His rich professional experience and
medical training were an asset in the Medical
School’s formative years. Corydon Ford
wrote that he “bore an honorable part in
shaping the policy and giving reputation to
the school which was destined to soon create,
by its success, so rapidly rising to fame, no
little sensation in the medical world” (Ford,
Corydon L. “Memorial Address on Alonzo
Benjamin Palmer.” Physician and Surgeon
10 (1888): 245-253, 297-302, 355-360).
The third dean elected was Silas H. Douglas,
serving from 1852-57, and later from 1862-68.
Douglas had moved to Michigan from his
home state of New York in 1838, and began
to study medicine in the office of Regent
Pitcher. He also worked as a physician under
another regent, the renowned Native American scholar Henry R. Schoolcraft. Douglas was
eager to learn about medicine, writing that
“Our profession is one of a progressive character, and it requires all our energies to keep
pace with its advancement” (Silas Douglas
to Helen Welles, 24 July 1843, Douglas 1,
MHC, excerpt in The Origins of Michigan’s
Leadership in the Health Sciences by William
Hubbard, Jr. and Nicholas H. Steneck, University of Michigan, Ann Arbor, 1995). In
1842 he finished his medical studies at the
University of Maryland in Baltimore. He
moved to Ann Arbor in 1843 to practice
medicine, and his enthusiasm about the field
fueled contributions to the creation of a
medical department at Michigan. ➤
Medicine at Michigan 31
I
n 1847, Douglas signed, along with Abram Sager, the “memorial” written
to the Regents requesting a Medical Department. He, Sager and Zina Pitcher
represented the first generation of scientists at the University of Michigan.
Douglas came to the University of Michigan in 1844 to be an assistant in chemistry
without salary. Eventually uncomfortable with this arrangement, he explained to
his mentor Pitcher in 1846 that he was dissatisfied spending so much time
teaching chemistry without compensation or a regular appointment. To ensure
that Douglas would stay, Pitcher saw to it that he became professor of chemistry,
mineralogy, and geology in the Department of Literature, Science & Arts. Also
in 1846, Douglas became superintendent of university buildings and grounds,
overseeing the construction of several prominent buildings on campus.
In 1848, Douglas was appointed to teach pharmacy and toxicology as one of
the first two faculty members in the new Medical Department. Though his
official title was professor of materia medica, he kept a small lab in the medical
building and gave chemical demonstrations before class. This was not uncommon,
as many professors at this time did not necessarily teach in their named disciplines. They often taught extra fields, and were very knowledgeable about the
natural sciences and basic chemistry. Douglas persuaded the regents to allocate
money for a chemical laboratory, which was built in 1855-1856. Since the lab
was founded by Douglas, it was considered part of the Medical Department.
The building’s construction was a triumph, since it was the first university building
in the country built solely for chemistry. Douglas’ greatest legacy to the University was his work in chemistry. He published “Tables for Qualitative Chemical
Analysis” (1864) with Professor Albert B. Prescott, and “Qualitative Chemical
Analysis: a Guide in the Practical Study of Chemistry” (1874).
Medical students in the laboratory, circa 1891, one of about 80
photographs in a series on the Medical School by Ann Arbor
photographer J. Jefferson Gibson.
Douglas’ service at the University ended in 1877, under unfortunate circumstances. A discrepancy in the accounts of the chemical laboratory was discovered in 1875, and Assistant Professor Preston Rose was accused of taking more
money from students than he gave to Silas Douglas, his supervisor. Rose shifted
the blame onto Douglas, and the affair became public and highly controversial.
The scandal was taken before the regents, and eventually both Rose and Douglas
were dismissed. Although the Michigan Supreme Court ruled in Douglas’ favor
when he contested the regents’ verdict, he was not reappointed at the University.
In-between Douglas’ two sessions as dean, Moses Gunn was elected dean for
the 1858-1859 academic year. Gunn was born in New York in 1822, and in 1844
he attended the Geneva Medical College in New York. There he was mentored by
Professor of Anatomy Corydon L. Ford, who eventually succeeded him as dean at
Michigan. Ford remained at Geneva to teach, but the ambitious young Gunn
left for Ann Arbor after graduating in 1846. Just prior to his departure,
Geneva College received a cadaver, an unclaimed body from the Auburn State Prison. Since it arrived too late to be used in class, the body
was given to Gunn for teaching purposes. He brought the cadaver with
him to Ann Arbor and performed a dissection in front of guests. This
was the first such demonstration in Ann Arbor, and possibly all of
Michigan. His series of lectures were so well attended and successful
that in the fall of 1846 Gunn taught anatomy at a private medical school
in Ann Arbor. Gunn and Silas Douglas started the school while waiting for
a Medical Department to be created at the University of Michigan.
After the regents made their decision to found the Medical Department, Gunn
was appointed as the third faculty member at the University of Michigan. At
Pitcher’s recommendation, he was made professor of anatomy and surgery in
1849 at age 27. Gunn’s research at Michigan included an investigation of which
particular tissues cause hip and shoulder joint dislocations. He worked on a
method of guiding these dislocated parts back into position by gently directing
the bone back through its course of escape from the socket. Gunn’s results
were published in the Peninsular Medical Journal.
Though Gunn initiated a tradition of excellent anatomy instruction at Michigan,
he was also interested in surgery. A capable, determined man, Gunn became professor of surgery in 1854, holding the title until 1867, when it was taken over by
his long time friend and colleague Corydon Ford. Gunn served as a surgeon for
32 Fall 1999
11 months in the Civil War, seeing active
duty during General McClellan’s peninsular
campaign. Gunn resigned from the University in 1867 after the sudden death of his
son by drowning, and moved to Chicago
with his family. There he became chair of
surgery at Rush Medical College until he
died in 1887. C.B.G. de Nancrede wrote of
Dr. Gunn that:
Altogether he presented an impressive figure of a man of physical and mental power,
of one who must investigate everything
presented to his senses, who quickly
observed, classified his impressions, deciding upon the respective merits and proper
relation even of passing events, a man of
an alert and enthusiastic temperament,
ready and eager to digest new ideas, yet
one whose judgment restrained his zeal
within due bounds… A man thus opulently
endowed by nature and trained by a life
of continuous effort to excel, could not
fail to command at the very outset the
attention and confidence of any audience,
and to exert an actively compelling influence over them. [Nancrede, C.B.G. de.
“Moses Gunn, A.M., M.D., LL.D.”
Michigan Alumnus 12 (1905-06): 364-374].
Gunn’s friendship with Corydon L. Ford
proved to be an asset for the University. Like
Gunn, Ford earned such respect and distinction in the Department that he was elected
dean in 1861, and returned to the post from
1879-1880 and 1887-1891. Ford earned his
M.D. from the Geneva Medical College in
1842, where he then taught anatomy from
1842-1848. He came from a family of farmers,
but paralysis of one leg as a child made it
impossible for him to pursue this vocation.
He used a cane the rest of his life, and had
he not been dealt this setback, he most likely
would have followed his family’s line of work
in farming. This would have, as Alonzo
Palmer wrote in 1886, deprived “the profession of medicine and the science of anatomy
in this country of what many have reason
to believe its most successful teacher.” Ford
began teaching at the age of 17, and in 1834
he started studying medicine in the office
of Dr. A.B. Brown of Niagara County, New
York. It has been said that Ford’s disability
and illness caused him to view the darker side
of life, but he was nonetheless compassionate,
approachable, and kind.
Ford was greatly respected and admired by
his students and colleagues. By the time he
was appointed to the chair of anatomy at
the University of Michigan in 1854, he was
known as an excellent teacher at several institutions. He was described as “an eloquent
teacher, able to infuse life within dry bones.”
Considered a great lecturer and demonstrator, he was one of the students’ favorite
teachers. He had a high skill in dissecting, an
ability to make a clear and concise presentation of the material, and an enthusiastic
demeanor. Dr. William Mayo, a Michigan
alumnus and student of Dr. Ford, said
By his forceful personality and his intense
love of his subject he made the too often
dull study of general anatomy as interesting as a novel. Contrary to custom, Ford
preferred to make his own dissections
while he talked, and he did them beautifully and rapidly. When he had finished
one he would swivel the table around
toward the class with a flourish, pointing
upward with his cane to emphasize his
words, “Now gentlemen, forget that—if
you can.” (Clapsattle, Helen: “The Doctors Mayo,” Atlantic Monthly 68:645-47,
1941)
Aside from teaching, Ford wrote several
significant works including “Questions on
Anatomy, Histology, and Physiology, for the
Use of Students” (last ed. Ann Arbor, 1878),
“Syllabus of Lectures on Odontology,
Human and Comparative (1884), and
“Questions on the Structure and Development of the Human Teeth” (1885). Dr. Ford
was given a LL.D. from Michigan in 1881.
After giving his last lecture in 1894, he
turned wearily to an assistant and said, “My
work is done.” He collapsed on his way
home, and died the next morning.
The sixth faculty member elected dean during this early period of rotating deanships
was Alonzo Palmer. Following Abram
Sager’s retirement, Alonzo Palmer was dean
from 1875-1879, and then from 1880-1887.
Palmer was recruited by Michigan in 1852
as professor of anatomy. However, since
there were limited funds for faculty, Moses
Gunn continued to teach both anatomy and
surgery. Two years later Palmer’s appointment became more active when he took
Abram Sager’s place as the professor of
materia medica and diseases of women and
children. In 1860, Palmer became professor
of pathology and practice of medicine. Like
Sager, Palmer advocated the blend of basic
science with clinical practice in medical education at Michigan. Palmer did all he could
in the best interest of his students, and was
a loved and respected teacher. He enjoyed giving lectures, and prepared as many as 196
in one year, half of which were new. This
was nearly double the workload of the average faculty member.
Prior to his teaching career, Alonzo Palmer
had become distinguished as a practicing
physician and administrator. He graduated
from the College of Physicians and Surgeons
in New York in 1839. He opened a practice in
Tecumseh, southwest of Ann Arbor, and kept
a general practice for 10 years. Palmer was
city physician in Chicago during the 1852 outbreak of cholera among northern European
immigrants. There he was head of the cholera
hospital, where 1,500 patients were treated
that year. Palmer received wide recognition
for his services in Chicago, and one of his
principal works, “A Treatise on the Epidemic
of Cholera” (Ann Arbor, 1885), drew on his
experience there.
In addition, Alonzo Palmer made numerous
other contributions to the field of medicine.
From 1852-59, he edited The Peninsular
Journal of Medicine, and from 1872-73 he
was president of the Michigan Medical
Society. He served for six months as a regimental surgeon in the 2nd Michigan Regiment
of Infantry during the Civil War, and is said
to have dressed the first wound inflicted by
the enemy at Blackburn’s Ford on July 18,
1861. During the war, he was president of
the American Medical Association. He published “Homeopathy, What Is It? A Statement
and Review of Its Doctrines & Practice”
(Detroit, 1880), in accordance with his general critique of homeopathy. In 1886 Palmer
published The Temperance Teachings of Science,
which examined the effects of alcohol and
narcotics on the body. Palmer advocated
temperance, and his book circulated widely,
in part due to its promotion by the Woman’s
Christian Temperance Union. Alonzo
Palmer’s teaching and writing had a strong
influence on the almost 10,000 students he
taught. He received a LL.D. from Michigan
in 1881, and died in 1887. Corydon Ford
wrote of his colleague that “His cheerful and
encouraging manner was often more than
medicine, it was courage, it was hope, it was
mental stimulus, it was an uplifting influence,
leaving sunshine for darkness, cheerfulness
for despair” (Ford, Corydon L. “Memorial
Address on Alonzo Benjamin Palmer.” Physician and Surgeon 10 (1888): 245-253, 297-302,
355-360).
After the end of Palmer’s service as dean in
1887, Corydon Ford was the last dean to be
elected. He served until 1891. Although the
faculty had for more than 40 years elected
deans of the Medical Department, the concomitant growth of the University led to the
decision that the selection of deans ought
to be centralized. Beginning in 1891, with the
tenure of Victor Vaughan, deans were
appointed by the president and the board
of regents of the University. The history of
this new era of leadership at the Medical
School will be highlighted in the next issue
of Medicine at Michigan. m
Medicine at Michigan 33
1900
|
1901
|
1902
1901
Dr. Reuben Peterson becomes Bates
Professor of Diseases of Women and Children,
and professor of obstetrics and gynecology.
He will also have a thriving private practice,
buying or leasing enough houses in the South
University-Forest Avenue area to have beds
for 40 patients, as well as a private nurses
training school. His standing as a
gynecological surgeon will bring him the
presidency of the American Gynecological Society and founding membership in the
American College of Surgeons.
The cornerstone of the large, new
Medical Building (now the School of Natural Resources and
Environment) is laid with great ceremony. In addition to offices and
museum space, the building will contain spacious laboratories, two
large amphitheaters and two large recitation rooms. The
amphitheaters will be free of the bright red lines used by some
professors to demarcate male and female seating in earlier lecture halls,
but other forms of gender segregation and outright denial of female
participation will endure for some time.
University Hospital gains 50 more patient beds, laboratory space
and a surgical amphitheater when it takes over the vacated Homeopathic
Hospital on Catherine Street. A new homeopathic hospital opens on
North University.
John D. Rockefeller, Jr. invests $200,000 from his oil profits to
establish the Rockefeller Institute for Medical Research. Such
private philanthropy for many years will be the primary source of funding
for medical research. The Hygienic Laboratory at the U-M, under the
direction of Victor Vaughan and Frederick George Novy (MD 1891), is
awarded two fellowships in the first group of Rockefeller awards.
Karl Wilhelm Röntgen, a physics professor at Wurzburg in Germany,
receives the Nobel Prize for Physics for his 1895 discovery of X-rays.
|
1903
1903
A children’s ward is
added to the Catherine
Street hospital complex
with a gift of $20,000 from
Love M. Palmer, Alonzo
Palmer’s widow, and
funds from the regents. A
shortage of space in other
hospital departments will
mean, however, that by
1916 the ward’s 75 beds
will be shared with
orthopaedic surgery, oral
surgery, dermatology and
gynecology.
|
1904
Graduation from an
approved high school,
or its equivalent, becomes
a requirement for
admission, and 60 hours
of college credit is
considered desirable.
An outbreak of rabies in
Ann Arbor leads the
regents to establish
a Pasteur Institute within
the Hygienic Laboratory to
examine animals suspected
of having rabies that have
been killed and to treat
victims of animal bites
with preventive injections.
1907
James Playfair McMurrich
leaves for the University of
Toronto after 13 years at
Michigan. An outstanding
teacher of gross anatomy, he
produces his 661-page
Textbook of Invertebrate
Morphology while at
Michigan. With the arrival of
Professor George Streeter, women students
are no longer relegated to separate laboratories
for anatomical dissections.
Walter R. Parker, who
maintains an active private
practice in Detroit, is
appointed clinical
professor of diseases of
the eye and professor of
ophthalmology the next
year. He will commute to
Ann Arbor two days a
week until his retirement in
1932. He and his wife will
give many pieces of Asian
and Western art to the
University’s Museum of Art.
|
1905
1905
David Murray Cowie
(MD 1896) is selected by
George Dock, professor
of internal medicine, to
teach pediatrics when it
becomes a permanent
course, partly because of
his special interests in
gastroenterology and
infectious diseases.
1906
|
1907
1906
A psychopathic hospital is
completed on Catherine
Street with a $50,000
appropriation by the
state legislature
following a campaign
by William James
Herdman (MD 1875),
professor of diseases of
the mind and nervous system
and electrotherapeutics. The goal: to
obtain a “more accurate knowledge
of the nature and cause of insanity.”
It will make possible academic
training for residents in psychiatry.
Victor Vaughan attempts once
more, unsuccessfully, to move the
clinical years to Detroit. (Vaughan
was on record as saying that the
entire University should have been
built on Belle Isle, an island east of
the city of Detroit.)
|
1908
|
1910
|
1911
|
1908
George Dock, whose clinical clerkship,
introduced at Michigan in 1899, will be of
monumental importance to the teaching of
medicine in America, leaves for Tulane partly
because Michigan will not give him a teaching
laboratory for clinical pathology that he considers
adequate.
Cardiologist Albion Walter Hewlett joins the
Medical School after the San Francisco
earthquake damages Cooper Medical College
where he was a member of the faculty. He will
stay for eight years, and then return to his native
California and Stanford. His advocacy for
laboratory tests to supplement clinical
evaluation will be an important contribution to
American medicine. He will note prophetically in a
1909 article in Physician and Surgeon that “it is
not improbable that the electrocardiogram will
ultimately permit of an early diagnosis of disease
of the heart muscle.” His son William will
establish the family name in computer technology
by co-founding the Hewlett Packard Company.
1916
At a meeting of the Medical Library
Association in Ann Arbor, Aldred Scott
Warthin proudly describes Michigan’s
substantial medical library with its
30,000 volumes and subscriptions to 370
journals, 151 in German, 130 in English, 10
in Italian and 14 in Dutch, Spanish and the
Scandinavian languages.
The nation’s first university
hospital clinic for
training dermatologists
and syphilologists is
established by Udo Wile,
a Hopkins graduate who
succeeds William F.
Breakey (MD 1859)
upon his retirement after
a 50-year career. Wile
will be a member of the
faculty for 35 years until
his own retirement, will
have a private practice in Ann Arbor,
and will serve in a medical capacity
in both World War I and World War II.
Abraham Flexner’s influential
study of American medical
education, sponsored by the
Carnegie Foundation, gives high
praise to the U-M Medical
School, noting that its faculty
are “productive scientists as
well as competent teachers.”
In the wake of his urging that
medical schools be associated
with universities, five out of
seven black medical colleges and
all but one of the medical schools
for women will close, resulting in
a nationwide decline in the
percentages of women and blacks
in medicine.
Carl Dudley Camp is appointed clinical
professor of diseases of the mind and nervous
system and serves until 1950. Psychiatry and
neurology remain closely linked, with Albert
Moore Barrett as professor and chair of the
joint department. Independent departments will
be created in 1920.
|
1912
Two years of college credit
become strictly required for
admission, along with credentials
in foreign language and science.
Enrollment temporarily dips, but
rebounds in subsequent years.
1912
|
Marie Curie receives her second Nobel Prize for her
work with radium, the discovery of which she and her
late husband, Pierre, first announced to the world on
December 26, 1898.
Allen Richardson (MD 1910),
is appointed the School’s first
demonstrator in anesthesia.
He leaves the next year and
Laura M. Davis (Dunstone),
a nurse-anesthetist, takes his
place and remains solely
responsible for teaching
anesthesia to medical students
and nurses until 1938.
Max Peet (MD 1910), a general surgeon,
returns to Michigan, where he will eventually
specialize in neurosurgery. His operation for
hypertension, improving on work done at the
Mayo Clinic and involving the sympathetic
nervous system, will be performed more than
1,800 times at Michigan through the 1940s.
1920
Charles Wallis Edmunds (MD 1901), professor of materia
medica and therapeutics since 1907 and known for his ability
to bring harmony and compromise in a difficult situation,
proves a great asset to the U.S. Public Health Service in
advancing the standardization of drug potencies, and himself
sets the standards of assay for digitalis and ergot.
1917
Professor C. B. G. de Nancréde
retires after 25 years on the faculty.
An early and strong advocate of
aseptic surgery, he described to
students in detail the technique of
scrubbing one’s hands and preparing
a patient for aseptic operation. He
was also a pioneer in another way:
he brought his wife and daughters to
Michigan football games at a time
when women did not usually attend
athletic events.
1918
An influenza pandemic
sweeps the globe, its
breadth enhanced by the
massive movements of
people associated with
World War I. More than
25 million people die,
many of them in their
20s, within six months.
The pandemic is followed
by an epidemic of
encephalitis lethargica
and another wave of
killer flu in 1920.
More than $1 million is
appropriated for construction of
a new hospital; actual construction
is delayed because of World War I.
1913
1913
G. Carl Huber (MD 1887),
professor of histology and
embryology and director of the
histological laboratory, is invited
to give a lecture on the
morphology of the sympathetic
nervous system to the XVII
International Congress of
Medicine in London, signaling
recognition of Huber’s mastery
of the subject.
1911
Aldred Scott Warthin (MD 1891), professor of
pathology and director of the Pathological Laboratory,
persuades the regents to rule that all surgical
specimens removed in University Hospital be turned
over to the Department of Pathology, thus greatly
increasing the numbers of autopsies and diagnostic
cases undertaken.
Louis Harry Newburgh joins the Internal
Medicine faculty, where he will perform
many clinical observations with calorimetrics
until his retirement 35 years later, adding to
the literature on diabetes and obesity, and in
1938 will describe what we now call “Type
2” diabetes. He will be among the first to
bring science in its most quantitative,
rigorous form to medical research, thus
helping Michigan to gain distinction as a
research institution.
The Department of
Roentgenology is created
with J. G. Van Zwaluwenburg
(MD 1908) as clinical professor
of roentgenology. Almost every
month he will show lantern
slides of recent work to the
University’s Clinical Society. In
one month in 1916, for instance,
he will show bone disease and
fractures, an unerupted tooth, a
brain tumor, and a bullet in the
tip of the frontal lobe.
The Afflicted Children’s Act,
providing mandatory treatment
at state expense for afflicted or
deformed children, results in the
growth of pediatrics, oral surgery
and orthopaedic surgery.
|
1914
|
1914
The people of Ann Arbor vote a
bond issue of $25,000 to build
a 24-bed isolation hospital
perched on a ridge overlooking
the Huron River for patients with
contagious diseases including
chicken pox, mumps, scarlet
fever, whooping cough,
diphtheria, Vincent’s angina,
tuberculosis and pneumonia.
1915
|
1916
|
1917
|
1915
Elizabeth Caroline
Crosby earns her Ph.D. at
the University of Chicago
with a thesis on the
neuroanatomy of the
forebrain of the alligator.
She arrives at the office of
G. Carl Huber in 1920 and
becomes a beloved teacher
at Michigan, advancing to
full professor, with more
than 40 students earning
their Ph.D.s in neuroanatomy under her tutelage.
Cooperation between basic scientists and clinicians, once
rare, becomes more frequent in the Medical School as the
practical value of her work is realized.
1918
|
1919
Construction begins on the new
hospital. The original appropriation is
only enough, however, to pay for the
shell of the building, and it stands gaunt
and boarded from 1921 to 1923, when
Governor Groesbeck obtains an
additional $2.3 million in appropriations
to complete what is called “Groesbeck’s
Folly” by his political opponents, who
cannot believe that the hospital’s 700
beds will be filled.
The regents adopt new organizational nomenclature.
Units issuing undergraduate degrees are to be known as
“colleges;” those issuing professional degrees will be
known as “schools.” The Department of Medicine and
Surgery thus becomes the Medical School.
Hugh Cabot, a
graduate of the
Harvard Medical
School and a
specialist in
genitourinary
surgery, joins the
faculty as professor
and director of
surgery. Two years later he will be
appointed dean and will serve a colorful
and controversial term of office until
1930. A critic of the School’s curriculum
and its solid blocks of preclinical
subjects for the first two years followed
by clinical subjects in the next two, he
wants earlier contact with patients and
more effort to give students an
“understanding of human beings.”
In the fall, junior medical
students Huber John and
Samuel Donaldson start an
honorary society for medical
students to be called Galens,
after the Greek physician and
prolific writer on medicine,
Galen, (129- c. 216 A.D.).
Entrance to Medical
Building which
opened in 1903.
1920
Forty students take Warren
Plimpton Lombard’s lab
course in physiology. The
high-caliber instruction with
human subjects includes measurement of the form and force of the pulse
with a sphygmograph, the recording
of respiratory movements on a
smoked rotating drum, and
experiments in muscle
fatique.
1910
Walter R. Parker, chair
of the Department of
Ophthalmology from
1904 to 1932, establishes a
formal training program
in ophthalmology.
Ophthalmological and
otolaryngological
specialties expand rapidly
after a well-equipped new
building, known as the Eye and
Ear Ward, opens on
Catherine Street.
1914
1900
1900
Aspirin, a stable form of
acetylsalicylic acid, is
commercially marketed for
the first time. Destined to
become the most popular
drug of all time, it is the
result of years of work by
chemists following the
1826 discovery that the
active ingredient in willow
bark is salicin.
1904
Roy Bishop Canfield (MD
1899) is appointed clinical
professor of diseases of
the ear, nose and throat,
and one year later is
advanced to professor of
otolaryngology. By 1906 he
organizes a 3-year plan of
graduate training and
pursues a vigorous
operating schedule. He
successfully lobbies the
faculty and regents for a
new building for
otolaryngology and
ophthalmology, which
will be completed in 1910.
1906
1902
Frederick Novy (ScD 1890,
MD 1891), an organic chemist
who became interested in
bacteria through his work
with Victor Vaughan (PhD
1876, MD 1878) and earned
his doctorate of science in
1890, writing his dissertation
on the toxic products of the
bacillus of hog cholera,
becomes head of the Bacteriology
Department. He will remain until 1935,
serving as dean the last two years
before his retirement. Early in his career
he attains an international reputation as
an authority in the field of bacteriology,
and as a great teacher and scientific
investigator.
1919
Frank Norman Wilson, who left in 1916 to go with George
Dock to Washington University in St. Louis and then to serve
in the Medical Reserve Corps in Colchester, England, during
World War I, returns to the Department of Internal Medicine.
His research over the next 32 years at Michigan will make
him the world’s leading electrocardiographer.
|
1920
|
1921
Frederick Coller,
a war veteran, is
recruited to Michigan
as assistant professor
of surgery by Hugh
Cabot, who also
served in World War I. In his first years Coller will perfect
thyroid surgery and reduce deaths from appendicitis by
deferring surgery for those with peritonitis. He will become
chairman of surgery on Cabot’s departure and remain
chairman until he reluctantly retires in 1957.
1924
David Murray Cowie (MD 1896), the
Medical School’s first professor of pediatrics
and an energetic advocate of iodized salt to
prevent goiter, asks the Michigan State
Medical Society to endorse iodized salt,
which it does, and the incidence of goiter
soon shrinks dramatically. Cowie and his
wife, also a graduate of the Medical School,
run their own hospital at 320 S. Division and
develop the formula-based Michigan
Method of Infant Feeding.
The Department of the Diseases of the Mind and
Nervous System is divided into the Department of
Psychiatry and the Department of Neurology as both
disciplines experience rapid growth.
|
1922
1921
John Alexander, a graduate of the
University of Pennsylvania, comes to
Michigan after service with the U.S.
Army Medical Corps in the First World
War. He introduces thoracic surgery at
Michigan, and types a 356-page
manuscript for The Surgery of
Pulmonary Tuberculosis while flat
on his back “to rest the lungs” at a
sanatorium in Saranac Lake, New York,
fighting the disease himself. Beginning
in 1928, he establishes a program of
resident training in thoracic surgery
with which he is associated until his
death in 1954. His 1937 book, The
Collapse Therapy of Pulmonary
Tuberculosis, becomes a classic.
|
1923
1923
Udo Wile, professor of
dermatology and syphilology,
complains that his university
salary of $4,000 requires him to
spend evenings and weekends
seeing private patients, and he
proposes to President Burton
that the clinical faculty be
allotted beds for private
patients in the University
Hospital, which is limited
mostly to indigent patients.
|
1924
|
1925
1925
In early August nearly 600 patients move into the
new 724-bed University Hospital with its nine levels
and two miles of corridors. When the beds in the older
existing hospital buildings are included, total capacity is
over 1,100.
The old Eye, Ear, Nose and Throat ward in the Catherine
Street Hospital is converted into an 82-bed obstetrical
hospital to replace wooden buildings and other
makeshift arrangements for patients, all charity patients,
who are customarily kept several weeks before and
after delivery. Reuben Peterson will argue that
students need to see more obstetrical patients, but
President Little, when told that Michigan is not
meeting its accreditation requirements in obstetrics, will
counter in a letter to Cabot that cases involving the births
of illegitimate children are not good teaching material.
A 285-room nurses’ dormitory, built with a gift of
$619,000 from James Couzens, a Republican member of
the U.S. Senate from Michigan from 1922-36, is completed.
1922
The American Medical Association arranges for all
homeopathic schools in the U.S. to close or merge with medical
schools, and this includes the University’s Homeopathic
Medical College, which graduated 672 homeopathic physicians in
its 47 years of existence. The Homeopathic Hospital also closes,
and the building will eventually become, and still is
in 1999, the home of U.S. military officer education
programs (ROTC) at U-M.
Roentgenologist James G. Van Zwaluwenburg
dies of pneumonia after nine years on the faculty.
He is succeeded by Preston Hickey, a graduate of
the Detroit College of Medicine, who had specialized
in pathology and then otolaryngology before becoming
interested in roentgenology. He founded the
American Quarterly of Roentgenology and had
been elected president of the American Roentgen
Ray Society in 1906.
The East Medical Building (now the C.C. Little
Building) is built at a cost of $1.14 million and
accommodates the departments of anatomy,
bacteriology and physiology.
Reed Nesbit, a graduate of Stanford Medical
School, joins Michigan as an assistant resident of
surgery. He eventually becomes Hugh Cabot’s disciple in
genitourinary surgery and greatly refines
techniques for relieving urinary obstruction
caused by enlargement of the prostate gland.
Sinclair Lewis’ medical novel,
Arrowsmith, is published. His friend
Paul de Kruif, a onetime bacteriologist in
the Medical School who will publish his
own successful book, Microbe Hunters,
the next year, advises Lewis on much of
the medical content. Arrowsmith is awarded the
Pulitzer Prize, which Lewis declines, not believing in
such awards.
September 1999
University of
Michigan
Medical School
Sesquicentennial
Calendar of
Events
M E D I C I N E AT M I C H I G A N :
A Postcard
History
“I’ve marked around this window to
show where I am inside,” wrote patient
Maude Reynolds to Mrs. James Ross of
the town of Leslie in Ingham County in
1905. “Hello. How are you? I am fine and
dandy. Write to me.” Postcards were a
popular way of sending a quick message
in the early part of the century, and “realphoto” cards like the one Maude Reynolds
sent from her hospital room on Catherine
Street were especially popular from about
1905 to 1920.
Postcards shown on this page, from top, are: University Hospital (in use 1925-1986, demolished in 1988); the
original Medical Department building (occupied 1850-1906, used for storage up to 1911, torn down in 1914);
and the new Medical Building, (occupied by medicine from 1903 to 1958, now used by School of Natural
Resources and Environment); the Catherine Street complex of hospital buildings (occupied 1892 to 1950s, when
the last of the buildings was torn down) and the Couzens Dormitory for nursing students, built with a gift from
U.S. Senator James Couzens in 1925 and still in use today as a general co-educational dormitory.
During the 1999-2000 academic year
the University of Michigan Medical
School will celebrate its 150 years of
scholarship and service, beginning with
a formal convocation on October 1,
1999. Over the course of the following
year, a series of special events in Ann
Arbor and around the country will
celebrate the School’s sesquicentennial,
concluding with a “grand finale”
weekend, October 10-14, 2000, in
connection with the Medical Center
Alumni Society Reunion Weekend in
Ann Arbor. Various national meetings
will feature U-M Medical School
sesquicentennial receptions. Also: A
history of the Medical School will be
featured in the February 2000, issue of
the Journal of the American Medical
Association.
October 1999
Internal Medicine Grand Rounds with speaker Donald A. Henderson, M.D., Ph.D. (9/
10) and the Raymond Waggoner Lecture with Paul Appelbaum, M.D., (9/15) in Ann
Arbor; Medical Alumni Regional Celebration (9/16) in Grand Rapids; the meeting of the
Michigan chapter of the American College of Physicians (9/23-26) in Traverse City; the
reunion of U-M otolaryngology alumni at the American Academy of Otolaryngology
annual meeting (9/27) in New Orleans, Louisiana.
The Sesquicentennial Convocation on October 1 from 1-5 p.m. at Hill Auditorium on
the University of Michigan campus. An academic procession will be followed by noted
speakers, including former U-M President Harold T. Shapiro, Medical School alumni
Antonia Novello and Keith Black, and William Hubbard, dean of the Medical School
from 1959-70.
Also: Medical Center Alumni Society Reunion for classes ending in “4” or “9” (10/1-2) in
Ann Arbor; meeting of the Walter P. Work Society (10/1) at the Towsley Center in Ann
Arbor; the Robert B. Sweet, M.D., Memorial Conference with speaker Luis Michelsen,
M.D. (10/2) at Weber’s Inn in Ann Arbor; Nu Sigma Nu Alumni Open House (10/2) at
the Nu Sigma Nu fraternity house in Ann Arbor; a lecture by Richard D. Judge, M.D. to
the Michigan chapter of the American College of Cardiology at Grand Traverse Resort in
Traverse City (10/8); a reunion of U-M anesthesiology alumni at the meeting of the
American Society of Anesthesiologists (10/9) in Dallas, Texas; a reception for U-M
surgery alumni at the meeting of the American College of Surgeons (10/12) in San
Francisco, California; a reception for U-M emergency medicine alumni at the meeting
of the American College of Emergency Physicians (10/12) in Las Vegas, Nevada; a lecture
by Jonathan Epstein to the A. James French Society (10/22) in Ann Arbor; a reunion of
U-M human genetics alumni at the meeting of the American Society of Human
Genetics (10/22) in San Francisco; a U-M medical alumni regional celebration (10/24) in
Washington, D.C.; a reunion of U-M ophthalmology alumni at the meeting of the
American Academy of Ophthalmology (10/25) in Orlando, Florida.
November 1999
January 2000
March 2000
Reunion of U-M radiation oncology alumni at the meeting of the American Society of
Therapeutic Radiology and Oncology (11/1) in San Antonio, Texas; reception for U-M
cardiology alumni at the meeting of the American Heart Association (11/8) in Atlanta,
Georgia; reunion of U-M physical medicine and rehabilitation alumni at the meeting of
the American Academy of Physical Medicine and Rehabilitation (11/12) in Washington,
D.C.; reception for members of the William D. Robinson Rheumatology Society at the
meeting of the American College of Rheumatology (11/14) in Boston, Massachusetts;
Department of Neurology Sesquicentennial Lecture with Anne Young, M.D., Ph.D., at
University Hospital (11/17) in Ann Arbor; Brockman Lecture by Patricia Spear, Ph.D.,
in Department of Microbiology and Immunology (11/18) in Ann Arbor; meeting of the
Fred Jenner Hodges Society at the Radiological Society of North America (11/29) in
Chicago, Illinois.
Reception and dinner for members of the John Alexander Society at the meeting of the
Society of Thoracic Surgeons (1/30) in Fort Lauderdale, Florida.
The Sesquicentennial Symposium “The Other Half of Medical Education: A Critical
Look at Graduate Education,” from March 29 through April 1 at the Towsley Center.
Also: Reception of U-M orthopaedic surgery alumni at the meeting of the American
Association of Orthopaedic Surgeons (3/17) in Orlando, Florida; reception for the A.
James French Society at the meeting of the USCAP (3/25) in New Orleans, Louisiana;
Radiology Grand Rounds with Melvyn Schrieber, M.D. (3/30) in Ann Arbor.
April 2000
Reception for U-M neurosurgery alumni at the American Association of Neurological
Surgeons (4/10) in San Francisco, California; national meeting of the American College
of Physicians (4/13-16) in Philadelphia, Pennsylvania; meeting of U-M physiology
alumni at the Experimental Biology meeting (4/16) in San Diego, California.
May 2000
Internal Medicine Grand Rounds with lecture by the ninth William N. Kelley Visiting
Professor (5/1) in Ann Arbor; reunion of U-M family medicine alumni at meeting of the
Society of Teachers in Family Medicine (5/1) in Orlando, Florida; reception of U-M
urology alumni at meeting of the American Urological Association (5/2) in Atlanta,
Georgia; reception and dinner for the DeJong Alumni Society at the meeting of the
American Academy of Neurology (5/2) in San Diego, California; Abram Sager Lecture
by George W. Morley, Norman F. Miller Professor Emeritus of Gynecology (5/3) in Ann
Arbor; reception for U-M geriatrics alumni at meeting of the American Geriatrics
Society (5/18) in Nashville, Tennessee; reception for U-M gastroenterology alumni at the
meeting of the American Gastroenterological Association (5/21-24) in San Diego,
California; meeting of the Norman F. Miller Gynecologic Society at the meeting of the
American College of Obstetricians and Gynecologists (5/22) in San Francisco, California;
U-M medical alumni regional celebration (5/22) in San Francisco, California.
June 2000
Reunion of U-M nuclear medicine alumni at meeting of the Society of Nuclear
Medicine (6/5) in St. Louis, Missouri; reunion of U-M alumni of biological chemistry at
meeting of the American Society for Biochemistry and Molecular Biology (6/6) in
Boston, Massachusetts; reception and dinner for U-M vascular surgery alumni at
meeting of the Society of Vascular Surgeons (6/11) in Toronto, Canada.
July 2000
Sheldon Society reunion (7/14-15) at Towsley Center.
September 2000
David Murray Cowie, M.D. Symposium on the history of child health and pediatrics in
America (9/22-24) in Ann Arbor.
October 2000
“Grand Finale” celebration from October 12-14 with lectures, programs, luncheon and
reunion dinners, exhibit at the U-M Museum of Art and Hall of Honor induction
ceremony, and ending with a black-tie “Sesquicentennial Gala” at the Crisler Arena on
Friday evening, October 13, and the Michigan-Indiana football game on Saturday,
October 14 at Michigan Stadium.
A surgical demonstration
before students at the
Catherine Street Hospital.
Mary Giles, who collaborated with Dean
Hugh Cabot to co-author a textbook on
surgical nursing. She taught at Vanderbilt
University.
Years
1900-1925
The
Professor Warren P. Lombard, physiologist
on the Medical School faculty from
1892-1923.
Bookplate of Frank Wilson,
M.D., reflecting his more
important achievements
using illustrations from his
scientific publications. His
research at Michigan,
beginning in 1920, made him
the world’s leading electrocardiographer of his time.
Left side, starting at the top:
ST elevation (current of
injury) from margin of
injured turtle ventricle; ST
depression caused by
subendocardial injury (turtle
heart); three left and right
bundle branch block patterns;
recordings from an
intramyocardial stab electrode
in dog; and diagrammatic
representation of the electrical
field produced by an injured
section of myocardium;
computing the mean electrical
axis of QRS. Bottom row,
from left: Laws that govern the
distribution of electric
currents in volume conductors; vector cardiography; the
course of ventricular excitation from within outward; and
the circuit diagram from the
Wilson central terminal that
made unipolar electrocardiography possible and is still
used in most electrocardiographic machines today.
Courtesy of Richard Judge,
M.D. (Residency, 1957).
Used with permission. From Not Just Any Medical School: The Science, Practice,
and Teaching of Medicine at the University of Michigan, 1850-1941, by Horace
Davenport. ©1999 The University of Michigan Press.
In the background: Architect’s rendering of the main entrance to University Hospital, which opened in 1925.
For Jeffrey
Chamberlain,
Fighting
Muscular
Dystrophy
on the Genetic
Level is His
Life’s Work F
For the millions of children
and adults who suffer from
the disease, it may mean
life itself
by Jeffrey Mortimer
or most researchers in the world of human biology, their work will
always be largely invisible to all except a handful of people. Partly
this is due to the complexity of biological research today; partly it is
due to the sub-microscopic nature of the work.
But for Jeffrey S. Chamberlain, Ph.D., professor of human genetics, who for
the past decade has headed a research team in the University of Michigan
Medical School that has made several major breakthroughs in the battle to
cure muscular dystrophy, invisibility has not been a problem. In his efforts
to promote understanding and support for his work, he has written for
Parade magazine and appeared on four different occasions on the Muscular
Dystrophy Association’s Labor Day Telethon. The Telethon, thanks to the
involvement of comedian and actor Jerry Lewis, has done much over the
years to familiarize the American public with the terrible effects of muscular
dystrophy on both children and adults and to raise invaluable research funds
for investigators like Chamberlain. The 21-and-a-half hour event was first
televised in 1966 and now reaches more than 75 million viewers.
That science and visibility could go together was something Chamberlain
understood from an early age. Growing up in Tucson, Arizona, where his
father was an astronomer at the Kitt Peak National Observatory, he knew as
family friends many of the popular astronauts and famous astronomers of
the day. When Chamberlain’s father was hired by NASA in the late 1960s
and the family moved to Houston, Texas, it was astronaut Buzz Aldrin’s
house that they bought.
34 Fall 1999
For Chamberlain, though, it was the mystery of cells rather than
the mystery of the stars and planets, that drew his attention as an
undergraduate at Rice University in Houston. The unbelievable
journey from single egg to fully developed human being
captured his attention in the same way that the journey of stars
had captured his father’s. He thought about becoming a
physician. But the desire to learn more about those mysterious
cells won out and ultimately he earned a Ph.D. in biochemistry
from the University of Washington.
It was while doing a post-doctoral fellowship at Baylor College of Medicine that
Chamberlain found a way to combine the
scientist’s love of discovery and the physician’s
love of healing: he discovered that little was
known about the development of muscle
cells and that whatever he learned could
eventually make a difference in the lives of
those with muscular dystrophy.
Insofar as there are stars in the research
firmament whose luster transcends the
world of laboratories and symposia,
Chamberlain is one. And he is outspoken,
albeit quietly. His intense determination to
conquer muscular dystrophy is coupled
with an equally intense frustration at
those whose research fervor doesn’t match
his own. “If it were left to the pharmaceutical companies, there would be no hope for
a cure for many of the major diseases in
the world today,” he says firmly. “They look
for a big-time payoff within a few years.”
The payoff he seeks may remain years
away, but it’s still closer than anyone could
have imagined even two years ago. In
Chamberlain’s view, the progress he and
his team have made can be largely attributed
to the long-term perspective of the
Muscular Dystrophy Association. Indeed,
his admiration for the Association’s modus
operandi was one of the factors that lured
the renowned molecular biologist into
what has become his life’s work. Once he
became interested in muscle development
in graduate school, he was surprised to
discover that the Association was supporting such ground-level work.
(Above) Chamberlain with
graduate student Simone Abmayr
in the lab.
(From Left:) Graduate students
Dennis Hartigan-O’Connor, Susan
Dombrowski, Scott Harper, and
Laura Warner conferring with
Chamberlain.
“This was considered basic research in its
purest form,” he says, “so I was amazed to
find out that it was heavily funded by the
Muscular Dystrophy Association. The
reason was that we knew almost nothing
about the causes of the muscular dystrophies (there are more than 15 forms of the
disease), so the organization felt it was
important to learn as much as possible
about normal muscle biology in the hope
that it would lead to greater understanding of the muscular dystrophies. Knowing
that they were supporting research that
didn’t have an obvious link to diseases
piqued my interest. They’re one of the few
organizations in the world that has been
willing to invest 20 or 30 years ahead of
time to try to achieve a goal.”
About a million people worldwide suffer
from some form of muscular dystrophy;
20,000 of them are in North America, and
two-thirds are children. The most
Jeffrey Chamberlain is the recently appointed interim director
of the U-M Health System’s Center for Gene Therapy.
The Center was created in 1997 to link basic science, clinical
investigation and technology transfer at a time of extraordinary
activity and progress in gene therapy and molecular medicine.
The Center’s original director, Gary Nabel, was recently appointed
director of the new Vaccine Research Center at the
National Institutes of Health in Bethesda, Maryland.
common form of the disease is caused by
mutations in a large, complex gene that
normally produces dystrophin–a protein
critical for maintenance of muscle tissue.
Without dystrophin, children with
muscular dystrophy gradually lose muscle
tissue and eventually die by their mid-20s
of heart or respiratory failure.
The next big step will be human clinical
trials, expected to begin within the next
year, of a viral vector, developed in
Chamberlain’s lab, that proved capable of
long-term delivery of the dystrophin gene
to the muscles of adult mice with
Duchenne-like muscular dystrophy.
Duchenne is the most common type of
muscular dystrophy, and the hope is that
whatever will remedy the Duchenne form
will also be effective against most other
forms of the disease.
“We have a vector with the potential to
deliver a miniature factory capable of
producing normal dystrophin, but which
should not lead to self-destruction of the
treated muscle,” says Chamberlain. “By
taking a cold virus known as adenovirus
and removing all the viral genes, which
was critical because they can trigger a
person’s natural immunity, we’ve been
able to pack a normal dystrophin gene
into the virus.” ➤
Medicine at Michigan 35
Sellners Endow Professorship in
Department of Human Genetics
A reception in the late spring at the Ford Amphitheatre in University Hospital honored Morton and Henrietta Sellner of Coral Springs, Florida, for their gift of $1 million
in the form of an irrevocable charitable remainder trust to benefit the Department of
Human Genetics and to honor the work of George J. Brewer, M.D., professor of human
genetics and a specialist in the research and treatment of Wilson’s Disease.
Morton Sellner worked for many years as an insurance broker in New York City and
served as an adviser to the New York State Insurance Commission. The Sellners’
gift, with $750,000 in matching funds from the Medical School, will
eventually establish the Morton S. and Henrietta K. Sellner Professorship in Human Genetics, and a $250,000 endowed research fund
to accompany it.
ut, he says, “the greatest challenge is that we must find
Morton and Henrietta Sellner
B
ways to get these viruses to muscles throughout the
human body. And we must show that these new viral
vectors can be used safely, without toxicity or side effects. We
also need to know as early as possible if there are serious
drawbacks to the system we’re developing. If it’s not safe, it’s
not worth spending years to perfect. If it is safe, only then can
one start to ask questions about efficacy.”
There are, in fact, a whole host of questions to be asked. The
relative youth of gene therapy means that its investigative
protocols are often quite different from those for traditional
drug therapy. “For example, we don’t have a single drug that
can be given in pill form to a patient and it will spread
throughout the body,” says Chamberlain. “We have a very
complicated delivery system that’s in the infancy of its
development. Even after we find out if it’s safe and showing
promise for further development, we’ll want to perfect the
ability of the system to produce maximal levels of the therapeutic protein, and we’ll need to modify the way the system is
put together in order to maximize its ability to persist for very
long periods of time in the human body.”
The initial trials will “be addressing some of the early questions,”
he says. “We’ll be testing our system by single-site injections
in order to ask whether we are getting a safe uptake of the
virus at the site of the injection and long-term retention in
the muscle. But taking this to the next
level and being able to deliver these
type of viruses to all the muscles of the
patient is an enormous challenge. It is
going to extend many years beyond the
initial trials.”
H. Ascher Sellner, M.D., a gynecologist in private practice
in Brookfield, Connecticut, who was in Ann Arbor with his
parents for the annual meeting of the Wilson’s Disease
Association, of which he is president, with Dean Allen
Lichter. Wilson’s Disease is a rare, inherited disorder of
copper metabolism in which copper accumulates slowly in
the liver and is then released and taken up in other parts of
the body.
“Today we know muscular dystrophy can
be cured,” he says with the determination of a
man who knows his goal and intends to reach it.
“It’s only a question of when.”
But, just like Jerry Lewis, who has been
associated with the Tucson, Arizonabased Muscular Dystrophy Association,
now in its 50th year, since its earliest
days, Chamberlain has made a long-term commitment. So have
his sponsors, the National Institutes of Health (slightly more
than half his support comes from the NIH), the Muscular
Dystrophy Association and private donors. “Today we know
muscular dystrophy can be cured,” he says with the determination of a man who knows his goal and intends to reach it. “It’s
only a question of when.”
You may reach Jeffrey Chamberlain at [email protected]
36 Fall 1999
m
Profiles of Medical School
professors who have retired
from active faculty status
Professors Emeriti
A. Kent Christensen, Ph.D., professor of
anatomy and cell biology and research
scientist in the Reproductive Sciences
Program, retired from active faculty status
on May 31, 1999.
Professor Christensen received his A.B.
degree from Brigham Young University in
1953 and his Ph.D. degree from Harvard
University in 1958. For the next two years, he
pursued postdoctoral training with Don Fawcett, M.D. at
both Cornell and Harvard Medical Schools. He was appointed
assistant professor of anatomy at Stanford University in 1961
and was promoted to associate professor there in 1968. In
1971, Professor Christensen moved to Temple University
School of Medicine, where he was appointed professor and
chair of the anatomy department. He came to the University
of Michigan as professor and chair of the Department of
Anatomy in 1978. He served as chair until 1982.
Christensen has
had a distinguished career
as a cell biologist.
Professor Christensen has had a distinguished career as a cell
biologist. His laboratory research contributions have concentrated on the cell biology of the testis, polysome ultrastructure,
and designing techniques for the preparation of ultrathin
frozen sections at the electron microscopic level. A major
local contribution was his establishment of the Cell Biology
Laboratories, a microscopy core facility at the University of
Michigan. As chair, he was instrumental in introducing a
significant emphasis on cell biology, in addition to changing the
department name from anatomy to anatomy and cell biology.
As a teacher, Professor Christensen has been an enthusiastic
participant in a variety of histology and cell biology courses,
and he taught a popular course on morphology for molecular
biologists. He also trained six Ph.D. students and eight
postdoctoral fellows. Professor Christensen has served as
president of a number of professional organizations, including the Association of Anatomy Chairmen, the American
Association of Anatomists, and the Michigan Electron
Microscopy Society.
Prasanta K. Datta, Ph.D., professor of
biological chemistry, retired from active
faculty status on December 31, 1998.
Born in Calcutta, India, Professor Datta
received his B.Sc. (1949) and M.S. (1951)
degrees from Calcutta University and his
Ph.D. degree (1956) from the University of
Washington in Seattle. After completing his
postdoctoral studies, he went to Washington
University in St. Louis, Missouri, as an assistant research
professor and research associate from 1961-65. He joined the
University of Michigan faculty in 1966 as an assistant professor
in the Department of Biological Chemistry; he was promoted
to associate professor in 1968 and professor in 1976.
Datta has been an
invaluable faculty member in the
Department of Biological
Chemistry.
Professor Datta has been an invaluable faculty member in the
Department of Biological Chemistry. He has been an outstanding and dedicated teacher and has been extremely active
with committee participation at all levels of the University as
well as internationally. Professor Datta was one of the
founding members of the Graduate Program in Cellular and
Molecular Biology.
Professor Datta has had more than 30 consecutive years of
research support from the National Institutes of Health for
his research in the areas of gene structure and regulation of
expression, control of enzyme function by cellular metabolites, and molecular evolution. He has been an invited speaker
at numerous national and international symposia and
seminars, and was research advisor for more than 25 doctoral
and postdoctoral trainees and a dozen undergraduate
students. Professor Datta was awarded two separate National
Institutes of Health special research fellowships for sabbatical
leaves at the Salk Institute and Stanford University. He was
also a United Nations visiting professor at the Indian Agricultural Research Institute in New Delhi, India. ➤
Medicine at Michigan 37
Pentti T. Jokelainen, M.D.,
associate professor of anatomy and
cell biology, retired from active
faculty status on December 31, 1998.
Jokelainen received his formal
education in Finland. He was awarded
his M.D. degree in 1960 and his
Ph.D. degree in 1963, both from the
University of Helsinki. A postdoctoral year at New
York Medical College in 1963-64 was supported by a
Fulbright Fellowship. Following this, he accepted an
appointment at the New York Medical College in 1964
as an instructor of anatomy and was promoted to the
rank of assistant professor of anatomy in 1967. In
1972, Jokelainen was named acting director of the
electron microscopy laboratory at the University of
Turku in Finland; he was named a docent there in
1973. He joined the University of Michigan faculty in
1974 as an associate professor of anatomy.
Jokelainen’s early research
constituted a ground-breaking
study of the ultra structure of the
developing kidney.
Jokelainen’s early research constituted a groundbreaking study of the ultra structure of the developing kidney. This research still stands as one of the
definitive works in this field. Somewhat later, he
carried out technically demanding electron microscopic work on cell organelles during cell division.
At the University of Michigan, Jokelainen divided his
career between teaching gross anatomy to medical
students and conducting research on hypertension.
His hypertension research involved a meticulous study
of the genetics of a special strain of hypertensive rats.
Alan C. Menge, Ph.D., associate
professor of obstetrics and gynecology and associate research
scientist in the Reproductive Sciences
Program, retired from active faculty
status on December 31, 1998.
Professor Menge received his B.S.
degree in 1956 from the University of
Illinois and his M.S. and Ph.D. degrees
in 1961 from the University of Wisconsin. He joined
the faculty of Rutgers University in 1961 and came to
the University of Michigan in 1967 as an associate
professor, having been recruited by the Department of
Obstetrics and Gynecology to establish a basic research
program in reproductive immunology in conjunction
with the clinical program directed by S. J. Behrman, M.D.
Menge built the preeminent unit
studying the immunology of
reproduction...developing clinical
assays that are in use today.
Professor Menge built the preeminent unit studying the
immunology of reproduction, markedly expanding the
38 Fall 1999
knowledge base of the immunobiology of sperm and
developing clinical assays that are in use today. He
trained a generation of fellows and clinicians and was
an active member of the educational program of the
department.
From 1979-80, Professor Menge was a Fogarty Senior
International Fellow at Uppsala University, Sweden.
He was vice chair in 1980 and chair in 1982 of the
biannual Gordon Research Conference on the
Mammalian Genital Tract. From 1990-91, he was a
visiting scientist at the University of Alabama at
Birmingham. In 1994, he established the Laboratory
of Assisted Reproductive Technologies at the University of Michigan in support of the clinical program.
There he refined a number of techniques, leading to
his certification in 1995 as a high complexity clinical
laboratory director. Professor Menge has achieved an
international reputation for his work in reproductive
immunology.
Ronald H. Olsen, Ph.D., professor of microbiology
and immunology, retired from active faculty status on
December 31, 1996.
Professor Olsen received his B.A. degree in 1957, his
M.S. degree in 1959, and his Ph.D. degree in 1962, all
from the University of Minnesota. He joined the
University of Michigan faculty in 1965 as an assistant
professor of microbiology. He was promoted to
associate professor in 1969 and professor in 1975.
Professor Olsen also served as associate director of the
Dental Research Institute from 1979-89, assistant vice
president for research from 1987-88, associate vice
president for research from 1988-91, and director of
the Institute of Science and Technology from 1987-89.
Olsen’s work in biodegradation
research led to the formation of
the Michigan Universities
Consortium for the Management
of Hazardous Wastes.
Professor Olsen’s research has included studies of low
temperature effects on cellular growth; evolution and
epidemiology of antibiotic resistance; isolation and
characterization of bacteria which degrade environmental compounds and their synthetic analogues;
and biochemical genetics of metal working fluid
microorganisms. He was a mentor for doctoral
students and teacher of undergraduate, graduate,
medical, dental, and pharmacy students.
In 1987, Professor Olsen’s work in biodegradation
research led to the formation of the Michigan
Universities Consortium for the Management of
Hazardous Wastes, one of most successful outcomes of
which was the Cooperative Bioremediation Research
for Michigan project (“CoBioReM”), for which
Professor Olsen served as principal investigator.
CoBioReM was a collaboration among university
researchers, petroleum and gas industry site-owners,
and state regulators that developed and deployed
acceptable methods for remediating soil and groundwater contamination caused by hydrocarbon leaks
and spills. For his leadership role in this project, in
1993 Professor Olsen received a Certificate of Merit
from the governor and a salutary resolution from the
Michigan Legislature.
Professor Olsen has served on a number of advisory
and editorial boards and has been an invited speaker
at numerous conferences and symposia. He was
elected a fellow of the American Academy of Microbiology in 1982 and received the Distinguished Environmental Scientist Award from the U.S. Environmental Protection Agency in 1985. The holder of 20
domestic and foreign patents, in 1985 he received the
Inventor of the Year Award from the Niagara Frontier
Association.
John T. Santinga, M.D., associate professor of
internal medicine, retired from active faculty status on
February 28, 1999.
Santinga has played a key role
as a highly respected clinician and
teacher linking programs in
cardiology and geriatric medicine.
A native of Kalamazoo, Santinga did undergraduate
work at Hope College from 1950-53 and received his
M.D. degree from the University of Michigan Medical
School in 1957. He completed an internship and
residency at Butterworth Hospital in Grand Rapids
and residency and fellowship training at the University of Michigan. He served in the U.S. Air Force from
1959-62. In 1965-66, he was a staff physician at the
Burns Clinic in Petoskey, Michigan. He then moved to
Seoul, Korea, where he served as assistant professor at
Yonsei Medical Center from 1966-70. He joined the
faculty of the University of Michigan in 1970 as an
instructor in the Division of Cardiology in the
Department of Internal Medicine. He was promoted
to assistant professor in 1971 and associate professor
in 1974.
In 1984, Santinga was awarded a Hartford Foundation
Mid-Career Fellowship in Geriatric Medicine, which
allowed him to spend the year 1985-86 in the Division
on Aging at Harvard Medical School. He subsequently
joined the Division of Geriatric Medicine as well as
the Division of Cardiology upon returning to the
University of Michigan in 1986. Santinga has also had
an appointment as a faculty associate at the Institute
of Gerontology and was medical director at Glacier
Hills Nursing Center in Ann Arbor from 1986-96.
Santinga has played a key role as a highly respected
clinician and teacher linking programs in cardiology
and geriatric medicine and has achieved national
recognition for his scholarly efforts in this growing area
of medicine. He has lectured widely and published a
number of important book chapters on the subject of
heart disease in older adults. He has been a key
participant and collaborator in a project focusing on
self-management and behavior of women with heart
disease. Santinga has been listed in Best Doctors in
America. Other recognition includes the Outstanding
Clinical Medicine Instructor Award from the sophomore medical school class in 1972, the Galens Smoker
Award in 1974, and the Kaiser Permanente Award for
Excellence in the Clinical Sciences for the Medical
School in 1998.
Edward M. Schwartz, Ph.D.,
associate professor of psychology
in the department of pediatrics and
communicable diseases, retired
from active faculty status on
December 31, 1998.
A native of New York, Professor
Schwartz received his B.S. degree in
1959 from City College of New
York, and his A.M. and Ph.D. degrees, in 1961 and
1966, respectively, from the University of Michigan. He
joined the faculty as an instructor in 1966 and was
promoted to assistant professor in 1970 and associate
professor in 1976.
Professor Schwartz’s early research focused on
problems of children adopted in infancy. His work led
to one of the earliest research studies and publications
in this area, and provided some of the impetus for
opening up adoption records to adoptees and for
studying the long-term impact of the adoption
process on adoptees.
Schwartz has followed patients with
neurometabolic disorders and has
contributed to identifying cognitive/
learning and behavioral patterns
and risks...of children with
phenylketonuria, galactosemia and
maple syrup urine disease.
For the past 30 years, Professor Schwartz has followed
patients with neurometabolic disorders and in the
process, has contributed to identifying cognitive/
learning and behavioral patterns and risks in these
populations of children with phenylketonuria,
galactosemia and maple syrup urine disease. He has
had extensive clinical and research involvement in the
cognitive and behavioral risks and issues in children
diagnosed with cancer. Other studies, all involving
children, have included the impact of PBB exposure
on developmental/cognitive abilities, the impact of
congenital hypothyroidism on learning and behavior,
and long-term cognitive and psychosocial outcomes in
children with heart transplants and cochlear transplantations.
A skilled and sought after teacher, Professor Schwartz
has served on over 20 dissertation committees and
has supervised and trained many psychology graduate
students. He has shared his extensive clinical knowledge about meeting the needs of chronically ill
children and families within the medical setting with
medical students and house officers in pediatrics. He
also served as director of Pediatric Psychology for 10
years and has served on a number of departmental
and Medical School committees, including having
chaired the review committee for the University of
Michigan Children’s Center. m
Medicine at Michigan 39
(Left) Graduate Rupa
Mehta sings the lyrics for
“It’s In Your Quiz!”
(Below) Third-year student
Steve Lindholm and
fourth-year student Fabian
Salinas
I
rreverent, uncouth, and a must-see for medical students
every year, the student-run Galens Smoker is a raucous
display of medical student talent, dedication and energy
that is now more than 80 years old.
The first documented “All-Medic Smoker” was held at the
Michigan Union in 1918 and featured a program of skits
followed by refreshments and talks by professors. The
“Smoker” name recalls those early performances when the
Galens men enjoyed the pleasures of tobacco along with their
ribald humor.
“The Thymico-Lymphatic Constitution,” a humorous printed
satire of Medical School life bordering on the obscene, was
distributed for the first time at the 1931 Smoker. By 1948 the
outrageous content of the publication as it had developed
over many classes of students caused the Galens group to be
sentenced to social probation for a year by the administration,
but their good standing was reinstated after a year. Officially,
Galens members attempted to “clean up” the Smoker’s humor
for the next several years, but this effort seems to have been
pursued with little enthusiasm.
The Galens Smoker:
Still Bawdy, Still Ambitious After All These Years
A History by Megan Schimpf
Second-year student Steve McKinley helps
fourth-year student Amanda Bauer as they
learn about family practice “surgery.”
The first modern Smoker debuted in 1962 when then-junior
Robert Bartlett (M.D. 1963, Residency 1969), now a professor
of surgery and a Galens honorary, proposed a Smoker with a
theme designed around the popular musical, “The Music
Man,” instead of a series of random skits. Since that time, the
Smoker has parodied musicals and movies while lampooning
medical student life and those who shape it.
The admission of women to the Smoker audience was a hotly
debated issue, with the Galens men fearful that their humor
would have to be restricted in mixed company. However, in
1963 wives of Galens members were admitted to a rehearsal
and the following year, three members of the Alpha Epsilon
Iota sorority hid in the rafters during a performance of
“JAMA Game,” and afterwards sent a check for their admission to the outraged Galens president, Philip D. Allmendinger,
who attached it to his president’s report with the notation
that “it is our fond hope that never again shall the shadow of
a female fall upon the stage of the Galens Smoker.”
Allmendinger’s fond hopes were dashed in less than a decade,
however, with Galens membership being opened to women in
1971 and women joining the cast of the Smoker for the aptly
named 1972 performance, “Michigan Impossible.” Renewed
calls for purifying the Smoker’s content throughout the 1960s
met with scant success, and the admission of women in the
1970s did little, as had once been feared, to tame the
content. ➤
40 Fall 1999
Fourth-year
student Craig
Barkan and
third-year
student Jeff
Gaines play
physiology
professor
Louis
D’Alecy and
pharmacology professor
Benedict
Lucchesi as
students.
Third-year student Neda Yousif, playing radiology professor Ella Kazerooni in her
days as a beauty queen, throws the switch on the time machine, sending the
students “Back to the Suture.”
Back to the Suture, the 81st Galens Smoker, lived up to the tradition of
its 80 outrageously tasteless predecessors, which have included such
inspired productions as Piddler on the Roof, My Fair Malady, the Wizard
of Gauze and How to Succeed in Medicine Without Really Trying.
This year’s performance met all previous standards with its Viagrafueled time machine, its remorseless parodies and uncanny representations of faculty behavior, its high-energy dances and original song
lyrics (“Our fourth year, has been a piece a’ cake, eeeee-zzzzzz
rotations but our future was at stake, We applied and now we’re
done, Residency, yah, here we come.”).
A production that includes writing of the script in the fall, casting in
January, choreography of dances in February and rehearsals and set
construction through the spring, the Galens Smoker’s carefully constructed elements all come together on the stage of the Lydia
Mendelssohn theater in late April. “Opening night is very exciting and
always a surprise,” says Jeremy Kaplan, a third-year student and
veteran of two Smokers. “The audience reactions are what really make
the show. You have no idea where the high points are going to be, but
when they happen, you can feel the electricity and you know you made
the connection.”
Third-year student Steve Lindholm, fourth-year student
Fabian Salinas, graduate Mike Widlansky and third-year
student Josh Buckler doing “VAMC” to the tune of “YMCA.”
June graduate
Martha Miller
performs “I’ve
Got My Slides.”
Medicine at Michigan 41
Third-year student
Steve Lindholm plays
a student bound for
surgery, graduate
Ross Johnston plays a
student destined for
internal medicine, and
modern-day secondyear students Penny
Vongsvivut, Kiran
Khanuja, David
Whalen and Rahul
Anand try to reconcile
the differences
between them before
going back to the
future.
Graduate Carl Schmidt, a former Galens
president, plays biological chemistry
professor Paul Weinhold as a student
explaining a breakthrough in cell biology.
S
ince 1974, all medical students, not just
Galens members, have been invited to
participate as members of the cast, crew and
band, though many today are still Galens members. “These are our future colleagues, and the
Smoker provides an excellent way to form bonds
that are not totally based on medicine,” says
Victoria Jewell, a three-year Galens member. “Each
of us has something special about us that usually
isn’t seen by classmates. The Smoker allows us to
explore these other sides of our character.”
Author's note
Megan Schimpf is a third-year student in the
Medical School from East Lansing. She
earned her undergraduate degree, a bachelor
of science in biology, from the University of
Michigan in 1997. She was on the staff of
The Michigan Daily for six years, including
one year as a news editor, and two and a half
years as an editorial columnist. She earned a
Gold Circle Award from the Columbia Scholastic Press Association last
year for her column on her experiences as a student in the anatomy lab.
She is vice president of the Galens Medical Society and has provided
support for the Galens' Smoker for the past two years, helping with the
writing of the script and design of the program and the scrapbook.
42 Fall 1999
David Rosen (M.D. 1984), clinical associate
professor of pediatrics and communicable diseases,
insists he actually made his decision to attend the
University of Michigan Medical School because of
the existence of the Smoker, a performance of
which he had attended as an undergraduate with
his friend, and later Smoker co-director, Matthew
Bueche (M.D. 1984, Residency 1989). “It was
always my plan to try to go to Stanford to medical
school,” Rosen says, “but when it came time to
choose, I came to Michigan so that I could do
Smokers. Really!”
“The Smoker is one of the truly creative outlets we
have in medical school. It’s a chance to relax and
poke fun at the stresses of daily life,” says current
Smoker “czar” Erik Bauer. “The faculty here know
they haven’t really made it until they’ve been
humiliated in the Smoker.” m
2 6 T H
A N N U A L
Mott Golf Classic
Victories on the Golf Course Celebrate Victories
for Children’s Health and Raise $250,000 for
Mott Children’s Hospital
he 26th Annual Mott Golf Classic, played every year on
T
(Left to
ri
profess ght) James Pe
o
g
Barnett r of family med gs, M.D. clinic
,
a
ic
and oto Charles Koopm ine, Zachary l associate
laryngo
Barnett
an, M.D
,D
logy.
., profes
sor of p ale
ediatric
s
the University’s Radrick Farms golf course and the private Barton
Hills Country Club course near Ann Arbor, annually attracts
more than 250 golfers who vie for hole-in-one prizes and a chance
to raise money for Mott Children’s Hospital.
Each year the event also celebrates the health of a former Mott
patient, who is honored at the Golf Classic’s Monday evening
banquet. This year’s event, held on June 7, celebrated the good
health of 11-year-old Zachary Barnett of Dallas, Texas, who was
brought to the University of Michigan Health System’s Mott
Children’s Hospital by his parents shortly after his birth in Texas so
that he could be treated for his congenital heart problem by Edward
Zachary Barnett
L. Bove, M.D., professor of surgery and head of the Section of
Cardiac Surgery. Zachary was accompanied by his parents, Kim and Dale Barnett, a broadcaster with the
cable sports network, ESPN, in Dallas, on his celebratory visit to Ann Arbor.
m
Medicine at Michigan 43
A
t the Thursday evening honors convocation
held the night before graduation in the main
auditorium of the Horace H. Rackham
Graduate School, family, friends, colleagues and
fellow students gathered to honor those 42
students, mostly graduating seniors, and five
members of the faculty who were honored for
their exceptional achievements this past year in
the Medical School. Named in honor of esteemed
members of the faculty over the history of the
School and sometimes in honor of the donors of
the prizes, the awards highlight scholarly excellence and faculty dedication across many areas.
The honors convocation address was delivered by
Roland G. Hiss (BS ’55, MD ’57, Residency ’66), a
member of the faculty in internal medicine and
medical education for the past 33 years who joked
that it was the first time he’d ever
given a speech with “no slides, no
handouts and no syllabus.” His
subject was the long expanse of
education that marks a career in
medicine, one that begins with
learning that is “dependent on the
word,” shifts in its second phase to
learning dependent on experience,
and then returns, in its third phase, to
learning based on the word again as
the practicing physician relies on
continuing medical education for new
(Above) Convocation
speaker Roland Hiss,
knowledge. A great believer in
professor of internal
experience-based learning, Hiss said
medicine: in search of that graduate medical education was
the physician’s
definitely the “peak” of a physician’s
“teachable moment”
training, and he recounted his own
experience of returning alone to “Old Main, which
had stood empty and silent for a year,” and going
up to the medicine floor, 6E, to the second bed on
the left, to the very memorable place where he
had learned “what congestive heart failure really
was. I had lots of lectures before that time, 44
lectures for 32 straight weeks,” he said, “but that
patient experience was what brought it all together.”
Hiss will spend the remainder of his career at
Michigan creating a continuing education model
that he hopes will meet the needs of physicians at
those “teachable moments” when they most
need information and can use it most effectively,
and that will deal with the “huge and impenetrable”
barriers, including geography, attitudes, economics
and the delivery of medical care itself that interfere
with a physician’s ability to keep learning. m
(Right) The lamp of
learning: Dean Allen
Lichter presents
Professor Roland Hiss
with the convocation
speaker’s traditional gift.
(Above) Brian Zink, M.D., associate
professor of emergency medicine,
reads, on behalf of the faculty, the
citation honoring Arul Chinnaiyan
with a Dean’s Award for Research
Excellence for his work on
programmed cell death.
Honors
(Above) Jason Van Ittersum is congratulated by
Dean Lichter for his William B. Taylor Dermatology
Award, named in honor of a member of the
faculty from 1950-92. Van Ittersum also received
a Hewlett-Packard Award as one of the top five
graduates who excelled academically
throughout the four years of his medical
education.
(Right) Mark Jacoby and Vidya Krishnan hold the Rappaport-Sprague stethoscopes they received
44 Fall 1999
from Hewlett-Packard for being among the top five graduates who excelled academically
throughout the four years of their medical education.
(Left) Inteflex graduate
Patrick Javid accepts the
congratulations of
Alphonse Burdi, director
of the Inteflex Program,
for his outstanding
performance in the junior
clerkship, senior
electives and surgery
research, for which he
received the C. Gardner
Child III Award, named for
a former chair of the
Department of Surgery.
Javid also received the
Association for Academic
Surgery Student Research
Award.
(Above) Jennifer Zelenock receives the J. Robert Willson Award, named
in honor of the late chair of the Department of Obstetrics and Gynecology,
and given to a student for outstanding performance in obstetrics and
gynecology, from Timothy Johnson, Bates Professor of the Diseases of
Women and Children and chair of the Department of Obstetrics and
Gynecology.
Convocation 1999
Honoring those who, in a class and a school
of great distinction, nevertheless managed
to distinguish themselves by their excellence
(Below) Tracey Oppenheim
is congratulated by Michael Jibson.
clinical assistant professor of
psychiatry, on receiving the Raymond
W. Waggoner Award, given by the
faculty of the Department of
Psychiatry to a graduating senior for
distinguished performance
in psychiatry. The award honors
the chair of the Department of
Psychiatry from 1937-70.
(Left) Dean Lichter presents Rosemarie
Fernandez with her Excellence in Emergency
Medicine Award for her outstanding
performance in emergency medicine.
Fernandez also received a Dean’s Award for
Research Excellence for her research
contributions during her medical school
career, especially her work on the body’s
inflammatory process.
Medicine at Michigan 45
Graduation Day 1999
46 Fall 1999
Deborah Berman (Obstetrics/Gynecology, U-M Hospitals) with her
family: mother and fellow U-M alumna Barbara, (AB ’63, MA ’64, Ph.D.
’72), father and fellow Medical School alumnus Jack L. Berman (AB
’64, M.D. ’68), and brother Joshua.
Speaking on behalf of
her class: Gerami D.
Seitzman (Ophthalmology, Johns Hopkins
Wilmer Sinai - MD)
with “This Won’t Hurt,
But You May Feel
Some Pressure.”
Professor of Anethesiology Satwant K. Samra with her
graduating daughter Neena Szuch (Orthopaedic Surgery,
Medical College of Ohio).
y
m
d
a
e
l
l
i
w
I
t
a
h
T
t
a
th
y
b
r
a
e
w
s
ly
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o
”I do s
.
d.
e
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The appreciative audience that graduation speaker Gerami
Seitzman still knows how to play to: from left, Cyril M. Grum,
professor of internal medicine and associate chair for
undergraduate medical education, Susanna Bahng (PediatricsSpectrum Health, Downtown Grand Rapids), Seth Bagan (Family
Medicine, Tacoma Family Medical Center - WA), Jesse
Arellano (Family Medicine, Northridge Hospital Medical Center
- CA), Charlene An (Emergency Medicine, Hospital of the
University of Pennsylvania), Kristen Allen (Obstetrics/
Gynecology, Thomas Jefferson University - PA), Christopher
Aho (Neurosurgery, Oregon Health Sciences University),
Jyotsna Agrawal (Psychiatry, UMDNJ).
O
n a June afternoon in Ann Arbor, a sunny day as beautiful as might have been dreamed of by the most
optimistic of events planners, the 1999 senior class
of the University of Michigan Medical School assembled in Hill
Auditorium for their last and most triumphant gathering—their
graduation. The assembled students, 169 strong, walked across
the stage of Hill Auditorium, resplendent in their robes and
hoods, trimmed in the traditional dark green velvet (the color
of healing herbs) which has been the faculty color for medicine
since the late 19th century, to receive their Doctoris in arte
medica diplomas and pledged, by their recitation of the ancient
Hippocratic Oath, to practice “uprightness and honor” in their
profession.
The ceremony was convened by Nancy E. Cantor, Ph.D., provost
and executive vice president for academic affairs, and Gilbert S.
Omenn, M.D., Ph.D., executive vice president for medical affairs,
introduced honored guests. Dean Allen Lichter (M.D. 1972) presided over the ceremony, and described to the students, based
on his own experience as an alumnus, what their Michigan
medical degrees would mean to them: “After this day, nothing
will be the same. On this day you are joining more than 16,000
graduates of the University of Michigan Medical School. When
Professor of Surgery Gerald B. Zelenock (M.D. ’73)
congratulates fellow alumna and daughter Jennifer
(Obstetrics/Gynecology, U-M Hospitals).
you meet them there will be an immediate bond of understanding
between you.”
The students’ fellow graduate Gerami Seitzman, who began her
academic life thinking she wanted to be on the stage and who
did improvisational theater in Chicago, represented the class
with a theatrical reflection on their years together in her speech,
“This Won’t Hurt, But You May Feel Some Pressure,” recalling
via her carefully constructed “plot,” memorable moments that
she and her fellow students, sustained by pizzas, then saltines
.
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and graham crackers, experienced on their arduous but poorly
fed journey to medical knowledge. ➤
Medicine at Michigan 47
Benjamin S. Carson, Sr.,
director of pediatric
neurosurgery at the Johns
Hopkins University
School of Medicine,
delivers his commencement address, “Physician,
Heal Thyself.”
Charlene An (Emergency Medicine, Hospital of the
University of Pennsylvania) sings a spirited rendition
of Yellow and Blue with Jesse Arellano (Family
Medicine, Northridge Hospital Medical Center - CA).
I
n his commencement address, “Physician, Heal
Thyself,” Johns Hopkins pediatric neurosurgeon
Benjamin S. Carson Sr. (M.D. 1977) described
his path from a poor childhood in Detroit to the great
satisfactions of his highly successful medical career,
and the hospital public address system (“Dr. Jones,
Dr. Jones to the OR”) that had inspired him to become
a doctor. (“Now they have beepers, so I never do get
to hear my name broadcast in that way, but the dream
was wonderful,” he said.) He did an impressive
riff on the extraordinary complexity of the human
brain, but reminded the graduates that science isn’t
everything — that “those little caring moments”
between a physician and a patient can make all the
difference. He ended his lecture on a spiritual note,
suggesting that the graduates not leave God out of
their thoughts (“If it’s in our constitution, and our
pledge of allegiance and our courts and on our
money, and we can’t talk about it, what is that?”)
m
Patrick Javid (General
Surgery, Brigham &
Women’s Hospital MA) and Sumac Diaz
(Obstetrics/Gynecology, Riverside
Regional Medical
Center - VA).
48 Fall 1999
(From left) Ali Bydon (Neurosurgery, Henry Ford
Health Science Center), Cheryl Claxton (Ob/Gyn
SUNY HSC-Brooklyn), Alan Brown (Radiation
Oncology, Massachusetts General).
Jonathan Osburn (Family
Medicine, U-M Hospitals) with daughter, Grace.
Dean Allen Lichter presents
diploma to Theodore Welling
(General Surgery,
U-M Hospitals).
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Graduates’ residency specialties will be as follows: internal medicine, 33;
family medicine, 24; pediatrics, 15; obstetrics and gynecology, 10;
general surgery, 8; medicine/pediatrics, 8; ophthalmology, 7; radiologydiagnostic, 7; anesthesiology, 6; emergency medicine, 6; psychiatry, 6;
orthopaedic surgery, 5; otolaryngology, 4; dermatology, 3; neurology, 3;
neurosurgery, 3; preliminary surgery, 3; medicine preliminary, 2;
pathology, 2; plastic surgery, 2; radiation oncology, 2.
Medicine at Michigan 49
Class Notes
1950s
Robert E. Anderson (M.D.
1953, Residency, 1956), a
pioneer in the field of sports
medicine, has retired from
the position he held for 32
years as team physician
for the University of
Michigan Athletic Department. Anderson’s career
at Michigan included
25 bowl games and
spanned the tenure of
four Michigan football
coaches: Chalmers W.
“Bump” Elliott, Glenn
E. “Bo” Schembechler, Gary Moeller
and Lloyd Carr. Anderson became
interested in sports medicine
while doing his graduate training
at Hurley Hospital in Flint, where
he helped organize a sports medicine program for high school
athletics in Genesee County. His
retirement was covered in a feature
story on the front page of the
sports section of the Ann Arbor
News on June 10. Anderson will
continue to practice medicine,
providing primary care in internal
medicine at the U-M Health
System’s East Ann Arbor Health
Center at 4260 Plymouth Road.
Robert D. Burton (M.D. 1953,
M.S. 1959, Residency 1959) was
the subject of a long and flattering feature in The Grand Rapids
Press on July 15, 1999. The article
celebrated his many years of work
for a mandatory seat belt law in
Michigan, which will become effective April 1 next year in Michigan.
Burton, now 71, retired from practice as an otolaryngologist in
Grand Rapids in 1993. He is a past
member of the board of the U-M
Medical Center Alumni Society.
N. Thomas O’Keefe (M.D.
1961) earlier this year joined the
University of Michigan Kellogg
Eye Center as a comprehensive
ophthalmologist.
1960s
William J. Hall (M.D. 1965), an
internist in Rochester, New York,
has been reelected to a second
term on the Board of Regents of
the American College of Physicians-American Society of Internal Medicine. Hall is chief of the
general medicine/geriatrics unit of
the Department of Medicine, University of Rochester School of
Medicine and Dentistry. He is
involved in geriatric outreach programs and in the development of
preventive strategies for the frail
elderly.
Daniel T. Anbe
(M.D. 1960, Residency 1961), a
hospital-based
physician in private practice with
Cardiology Specialists of Michigan at the McLaren Regional
Medical Center in Flint, has been
elected to a 3-year term as governor of the Michigan chapter of the
American College of Cardiology.
He will also serve on the Education Committee of the American
College of Cardiology. Anbe completed his residency in internal
medicine at Henry Ford Hospital
in Detroit in 1964 after two years’
service with the U.S. Army Medical
Corps. He completed his cardiology
training at Henry Ford Hospital in
1968, and served as a staff cardiologist there for 12 years and as
clinical assistant professor of
medicine in the U-M Medical
School. He currently is associate
professor of medicine on the Flint
campus of the Michigan State
University College of Human Medicine. Anbe is a fellow of the American College of Physicians, a fellow
of the Council on Clinical Cardiology and a fellow of the Society
of Cardiac Angiography and
Intervention.
Hossein Gharib (M.D. 1966)
has been chosen treasurer of the
American Association of Clinical
Endocrinologists. He is professor
of medicine at the Mayo Medical
School in Rochester, Minnesota,
and a consultant in the Department of Internal Medicine, Division
of Endocrinology/Metabolism at
the Mayo Clinic in Rochester.
1980s
Kenneth Faber (M.D. 1985) has
agreed to join the scientific advisory
board of Vitro Diagnostics in
Littleton, Colorado. Faber is chief
of the Department of Reproductive Endocrinology at Colorado
Permanente Medical Group in
Denver and assistant professor in
the Department of Obstetrics and
Gynecology, Section of Reproduc-
Your bequest to Michigan will help keep the
Medical School great for another 150 years
A bequest is a wonderful way to ensure that the Medical School's future will be as bright as its past. For some, a bequest
offers the opportunity to make a more substantial gift than would be possible during a lifetime. For others, it's an
opportunity to round out many years of giving with a lasting legacy to the Medical School to meet faculty, student
and program needs, and to enjoy the financial advantages associated with a bequest to a charitable institution. If
you'd like to support the work of the School by establishing a bequest, please call the Medical Center Alumni and
Development Office at (734) 998-7705. We'll be happy to send you all the information you need to establish a
bequest to advance medicine at Michigan.
50 Fall 1999
http://
www.med.umich.edu/
medschool/mcado
Y
ou can keep up with the many developments in the University of Michigan Health System through the new Internet
doorway of the Medical Center Alumni and Development
Office (MCADO). Read news about medical alumni/ae and friends, about regional
Medical School Sesquicentennial events, about upcoming reunions, volunteer opportunities, clinical and departmental research, and put your own professional information on
the web at no cost. Pay us a visit at: http://www.med.umich.edu/medschool/mcado
tive Endocrinology, at the University of Colorado Health Sciences
Center. Faber will provide scientific
consultation relevant to the business objectives of Vitro Diagnostics,
especially as they relate to the
treatment of human infertility.
1990s
Ruben Montelongo Lopez
(M.D. 1991) finished his fellowship in cardiothoracic and vascular
surgery at the Texas Heart Institute in Houston in June. In July he
moved to Harlingen, northwest of
Brownsville in the Rio Grande
valley, with his wife, Rosie, and
children David, 8, and Sara, 5,
where he joined Cardiovascular
Associates. Lopez completed both
his general surgery residency and
a fellowship in trauma at the University of Texas Health Science
Center in Houston.
Sunghoon Kim (M.D. 1994) has
been selected by his colleagues in
the Department of Surgery at the
University of California, Davis, as
surgical resident of the year. He
will spend the next two years in
research in Galveston, Texas.
Five alumni of the University of
Michigan Medical School are contributors to the 1999 centennial
edition of The Merck Manual of
Diagnosis and Therapy. They are:
Thomas G. Boyce (M.D. 1990)
on gastroenteritis; Eugene P.
Frenkel (M.D. 1953) on anemias,
iron overload and principles of
cancer therapy; Jonathan Jay
(M.D. 1991), with chapter reviews,
Nathaniel F. Pierce (M.D. 1958)
on cholera and Robert W. Rebar
(M.D. 1972) on hypothalmicpituitary relationships and pituitary disorders.
Deaths
Michael C. Kozonis (M.D.
1945) on February 16, 1999, at St.
Joseph Mercy Hospital in Pontiac,
after recently retiring from his
position as director of preventative medicine at St. Joseph Mercy
Hospital in Pontiac. He was
founder of the first coronary care
unit in Michigan and had been
chief of cardiology at St. Joseph
Mercy Hospital in Pontiac and director of the EKG Department. He
also was assistant clinical professor at the Wayne State University
School of Medicine in Detroit. He
served as a cardiac consultant to
the General Motors Corporation.
He was a diplomate of the American Board of Internal Medicine, a
life fellow of the American College
of Cardiology, a life fellow of the
American College of Physicians, a
diplomate of the American Board
of Cardiovascular Disease, a fellow
of the Council of Clinical Cardiology of the American Heart Association, and a member of the board
of trustees of the Michigan Heart
Association. He was a member of
the Phi Chi honorary medical
fraternity at the University of Michigan. He was 78.
John C. Shelton
(M.D. 1955), who
died on March 8,
1998, in Ann Arbor,
at the age of 69,
was honored by the
city of Ypsilanti in
June when they
named the block of Ferris Street
where he practiced for 35 years at
103 Ferris Street the “Dr. John C.
Shelton Boulevard.” His son, Craig
Shelton, a podiatrist, has his practice in the same building today. At
a ceremony on June 26, local community members remembered
Shelton’s dedication as a physician
and his concern for the commu-
nity. “When John spoke, I always
listened, because he was a man of
great wisdom and great humility,”
said Richard DeVries, president of
Citizens Bank, where Shelton
served on the board of directors.
Andrew H. Foster (M.D. 1982)
at a hospital in Baltimore on July
16, 1999, of lymphoma.
Foster interned and served a surgical residency at the University of
Michigan before serving from
1984-86 as a cardiothoracic clinical associate and staff fellow with
the National Institutes of Health.
From 1989-92 he served a residency in cardiothoracic surgery at
the Medical College of Virginia.
From 1991-97 he was an assistant
surgery professor at the University
of Maryland Medical School in
Baltimore. He then served as an
associate professor and director of
the School’s transmyocardial and
laser program. Last year he became
chief of service and associate surgery professor in the George
Washington University Medical
Center’s cardiothoracic surgery
division. Before attending medical
school, Foster was a flamenco guitarist with the Jose Greco Spanish
Dance Company for two years in
the mid-1970s. He was 42.
Stay in Touch
Share your news with those with
whom you trained at the University of Michigan. Please send news
(and photos or other art) to Jane
Myers, 301 E. Liberty, Ann Arbor,
MI 48104-2251; fax: 1-734-9987268; e-mail: [email protected]
Please include your name, Michigan affiliation, current practice,
titles, awards, postal address, telephone and e-mail address along
with your professional and personal news. m
MCAS
Nominations
Sought
The Medical Center Alumni Society is
requesting nominations for the
following:
• MCAS BOARD
Appointment to the Society’s board,
for a term of office lasting three years.
The board meets twice a year, usually
in Ann Arbor. The board serves the
Health System in a variety of ways,
through its outreach programs to
students and by assisting faculty and
Health System leadership in promoting
and strengthening the worldwide
network of graduates of the University of Michigan Medical School.
• THE 1999 MCAS AWARDS:
– The Distinguished Service Award
for outstanding service to the
University of Michigan.
– The Distinguished Achievement
Award for professional accomplishments.
– The Early Distinguished Career
Achievement Award for professional accomplishments in the first
20 years following graduation.
• THE MCAS HALL OF HONOR
The new Hall of Honor will provide
permanent recognition for those
individuals associated with the
Medical School who distinguished
themselves in significant ways over
the course of their professional
careers.
In each case, please submit relevant
information, including biographical
data and qualifications for service or for
awards, to Michael DeBrincat in the
Medical Center Alumni and Development Office, 301 E. Liberty, Suite 300,
Ann Arbor, MI 48104-2251. Questions
may be directed to DeBrincat at (734)
998-8107.
Medicine at Michigan 51
Professor Emeritus of Pediatrics and
Communicable Diseases David G. Dickenson
(M.D. 1945, Residency 1950) of Lewiston talks
with Irene S. Danek (M.D. 1968) and her
husband, Charles J. Danek (M.D. 1968,
Residency, 1976), of Traverse City.
CELEBRATING THE
SESQUICENTENNIAL AT SPRING
ALUMNI/AE EVENTS IN CHICAGO AND
ON MACKINAC ISLAND
Dean Allen Lichter talks with Jean
Kapenga (Residency, 1991) and her
husband Kevin Canagh of Okemos and
with William Olsen (1957 M.D.,
Residency 1962) of Frankfort.
R
egional Sesquicentennial events in Chicago the
weekend of April 17 and on Mackinac Island
the weekend of June 18 brought together alumni/ae
who renewed friendships with one another,
celebrated the 150-year history of the Medical
School and learned about some of the exciting
initiatives in medical education, research and
clinical care now taking place in the University of
Michigan Health System from faculty and the
Health System leadership.
Upcoming activities of the Medical Center Alumni
Society include the fall board meeting on September 30, 1999, class reunions for those whose
graduation years end in “4” or “9” on October 1-2,
1999, and events to be held March 16 through
March18, 2000: Match Day, the spring board
meeting and the senior luncheon for the class of
2000. For more information about other U-M
Medical School alumni/ae activities or sesquicentennial events, please call (800) 468-3482. Those
alumni/ae interested in volunteering to support
alumni/ae-related activities are invited to call
Michael DeBrincat at (734) 998-7619 or email him
at [email protected].
Oscar A. Linares of Lincoln Park and
Annemarie L. Daly (M.D. 1989) of
Plymouth.
Joan Stover Van Camp (M.D. 1989, Residency 1995) of Eden
Prairie, Minnesota, with her husband Joseph Van Camp
(Residency 1995).
Calvin R. Brown, Jr. (Residency,
1985) of Hinsdale, Illinois, with
Ruth Bittner and Paul Helman
(M.D. 1966) of Evanston, Illinois.
52 Fall 1999
Michigan’s Continuing Medical
Education Calendar Fall 1999
OCTOBER
1-2
Asthma and the Athlete
Ypsilanti Marriott, Ypsilanti
4-5
Update on Pulmonary and Critical Care Medicine
8-9
Alternative Therapies for Health and Healing
14-15
Eleventh Annual Modern Perinatal Problems
15-17
After Hours Radiology: What You Need to Know to Survive
Soaring Eagle Resort, Mount Pleasant
16
17-20
Toxicology: Epigenetic Toxicant-Induced Signal Transduction and Altered
Cell-Cell Communication
Towsley Center, Ann Arbor
18-22
Practical Training in Vascular Interventions
21-22
Neonatology 1999; Clinical Issues and Advances
22
Executive Vice President for Medical Affairs
and CEO of the U-M Health System Gilbert S.
Omenn, left, talks with Donald C. Overy (M.D.
1946, Residency 1955) of Bloomfield Hills and
his wife, Elsie.
Cancer Symposium/Field of Dreams: Bone Marrow Transplant
Towsley Center and Cancer Center, Ann Arbor
25-26
Otolaryngology for the Non-Otolaryngologist—A Practical Update
Towsley Center, Ann Arbor
25-26
Child Abuse and Neglect—Prevention, Assessment, and Treatment
Ypsilanti Marriott, Ypsilanti
27
29-30
30
Gerald O. Strauch (M.D. 1957) of
Winnetka, Illinois, with his wife
Margaret.
Community Acquired Pneumonia
Novi Hilton, Novi
Care of the Terminally Ill Patient
Advanced Trauma Life Support Student Course
New Therapies in the Treatment and Management of Advanced Heart Failure
Amway Grand, Grand Rapids
NOVEMBER
3-5
11-12
Ultrasound in Obstetrics and Gynecology with Transvaginal Sonography Option
Advances in Psychiatry XI
13
Update in Office Cardiology
Dearborn Inn, Dearborn
17
Management Issues in Atrial Fibrillation
Dearborn Inn, Dearborn
19
Parkinson’s Disease Update
Towsley Center, Ann Arbor
DECEMBER
2-3
11
Eighth Annual Primary Health Care for Women
Update in AIDS Management for the Primary Care Provider
Laurel Manor, Livonia
Course dates may change. For verification or more information about course locations
and content, call or write: Office of Continuing Medical Education, Department of
Medical Education, University of Michigan Medical School, Box 1157, Ann Arbor, MI
48106-1157
Jeffrey Kushner (M.D.
1982) of Verona,
Wisconsin, and
Matthew Trunsky
(M.D. 1992) of Chicago.
Phone: (734) 763-1400 or (800) 800-0666
Fax: (734) 936-1641
Website: http://www.med.umich.edu/meded/
E-mail: Registrar Edna Walker: [email protected]
Registrar Joyce Robertson: [email protected]
Medicine at Michigan 53
In the Limelight
James R. Baker, M.D., professor of internal medicine,
chief of the allergy division and
director of the Center for Biologic Nanotechnology, received a
special recognition award from
the Board of Directors of the
American Academy of Allergy, Asthma and
Immunology. Baker’s award recognizes his
work as editor of JAMA Primer, a publication
on allergic and immunologic diseases, which
is “the most widely read publication on allergy,
and is utilized extensively by medical students,
residents and primary care physicians.”
Robert H. Bartlett, M.D.,
professor of surgery and chief
of the Division of Critical
Care, was awarded a Medal of
Special Recognition from the
National Academy of Surgery
of France for his work in surgical critical care. Dr. Bartlett has also been
chosen to receive the McGraw Medal of the
Detroit Surgical Association, an annual award
given since 1948 for major contributions to
American surgery. In conjunction with the
award, Bartlett gave a lecture entitled “Romance,
Science and the White Plague.”
Bartlett also was honored as the Robert E. Gross
Memorial Lecturer in June, 1999. This honor
is bestowed annually by the Boston Children’s
Hospital and Harvard Medical School and his
lecture was entitled “Surgery on Shattuck
Street.”
Christin Carter-Su, Ph.D.,
professor of physiology and
associate director of the
Michigan Diabetes Research
and Training Center, received
the 15th Annual Sarah
Goddard Power Award from
the University of Michigan. Carter-Su received the
Award in recognition of her leadership, scholarship and sustained service on behalf of
women. The Sarah Goddard Power Award was
established to honor the late regent who was a
strong advocate for women.
54 Fall 1999
Arul Chinnaiyan, (Ph.D.
1997, M.D. 1999), a recent
graduate of the Medical Scientist Training Program, received
a regional (North America)
award from the Amersham
Pharmacia Biotech and Science
Young Scientist Program for 1998. Chinnaiyan
was honored for his essay, “Destined to Die:
Molecular Dissection of the Cell Death
Machine,” and the award was announced in the
December 4, 1998 issue of Science. He also
received a 1998 Distinguished Dissertation
Award from the Horace H. Rackham School
of Graduate Studies.
Theodore M. Cole, M.D.,
professor emeritus and retired
chair of the Department of
Physical Medicine and Rehabilitation, has been selected by
the American Spinal Injury
Association (ASIA) as the 1999
recipient of their prestigious ASIA Lifetime
Achievement Award. This award is bestowed
on an individual whose professional career has
centered around the care of individuals with
spinal cord injury and disease.
A cofounder of ASIA, an early member of its
Board of Directors and past chair of the ASIA
Foundation, Cole has had a distinguished career
as both clinician and academician. He recently
completed his second term as president of the
American Congress of Rehabilitation Medicine.
Eva Feldman, M.D., Ph.D.,
(Ph.D. Neuroscience 1979,
M.D. 1983), associate professor
of neurology, has been accepted
as a member of the 1999-2000
class of fellows in the Hedwig
van Ameringen Executive
Leadership in Academic Medicine Program for
Women (ELAM). ELAM fellows work with
eminent faculty and national leaders to find
innovative ways to implement positive changes
needed to reconfigure academic health centers
for the 21st century.
New York Public
Library Taps Markel
as Director’s Fellow
Howard Markel, M.D., Ph.D., (M.D.
1986) associate professor of pediatrics
and communicable diseases and director of the Historical Center for Health
Sciences, has been named a director’s
fellow of the Center for Scholars and
Writers of the New York Public Library.
Markel is one of only fifteen fellows
named to this highly competitive inaugural class of the new Center for Scholars
and Writers. As a director’s fellow, he
will take up a year-long residency at the
Center in the New York Public Library beginning in
September. Markel will devote his fellowship to a
study of the interactions of American immigration,
nativism, and public health over the past 120 years.
Duvernoy Named Scholar of
Society for Women’s Health
Research
Claire S. Duvernoy, M.D., (M.D. 1990, Residency 1993, Fellowship 1996
& 1998), assistant professor of internal medicine, has been chosen by the
Society for the Advancement of Women’s Health Research and Pfizer
Women’s Health to receive a 1999 Pfizer/SAWHR Scholars Grant for Faculty Development in Women’s Health. The Scholars program is designed to
provide research training opportunities for physicians who wish to pursue
original research in women’s health at U.S. medical schools.
Duvernoy is one of only three scholars to receive this grant, which provides
$65,000 of support per year for three years. Her research focus will be on
“Combined Continuous Hormone Replacement Therapy and Myocardial
Blood Flow.” She was sponsored by Mark R. Starling, M.D., professor of internal medicine.
The Society for Women’s Health Research was founded in 1990 when it
brought to national attention the problem of the exclusion of women from
medical research studies and the resulting need for research on conditions
experienced by women. The Society is the only national advocacy group
whose sole mission it is to improve the health of women through research.
Lazar J. Greenfield, M.D.,
Frederick A. Coller Distinguished Professor and chair of
surgery, has been selected to
receive a 1999 Distinguished
Alumnus Award from Rice
University. Greenfield received
his award at a ceremony on May 15, 1999 in
Houston.
Julian T. Hoff, M.D., Richard
C. Schneider Professor of Surgery and chief of neurosurgery, has been named to the
National Neurological Disorders and Stroke Advisory
Council, the major advisory
panel of the National Institute of Neurological
Disorders and Stroke. The Council reviews
applications from scientists seeking financial
support for biomedical research and research
training on disorders of the brain and nervous
system. Members of the Council also advise the
Institute on research program planning and
priorities. The Council is composed of physicians, scientists and representatives of the public.
Terence Joiner, M.D.,
(Residency 1985), clinical
assistant professor of pediatrics, was named a 1999 “Health
Champion” by the Board of
Commissioners and Washtenaw
County Public Health Department. Joiner was recognized for his support of
the County’s Health Improvement Plan and his
work on asthma. “He is especially appreciated for
his enthusiasm, his caring about suffering in the
community, and his insight into many of the
puzzling aspects of the health assessment data—
the ‘why’ of certain health statistics,” the Health
Department said. Joiner was one of only four
individuals and organizations recognized.
Ella A. Kazerooni, M.D.,
(Bachelor’s 1986, M.D. 1988,
Residency 1992) associate
professor of radiology, has
been elected to the office of
Secretary-Treasurer of the
Association of University
Radiologists (AUR). Kazerooni will serve as
president of AUR in 2002.
The goals of the AUR are to encourage excellence in laboratory and clinical investigation,
teaching and clinical practice, to stimulate an
interest in academic radiology as a medical
career, to advance radiology as a medical science,
and to represent academic radiology nationally
and internationally. ➤
Medicine at Michigan 55
Zazove Receives
Neubacher Award
Donald G. Kewman,
Ph.D., clinical professor of
physical medicine and rehabilitation, was recently elected
a fellow of the American Psychological Association and the
Michigan Psychological Association. These honors are bestowed on less than
10 percent of members of these associations
and are given for significant contributions to
the field of psychology.
Kewman was also elected president of the
Rehabilitation Psychology Division of the
American Psychological Association and will
assume that office in September 1999. The
Rehabilitation Psychology Division of the
American Psychological Association is the largest organization of psychologists working in
the medical rehabilitation field with approximately 1500 members.
Charles J. Krause, M.D.,
professor and former chair of
the Department of Otolaryngology, has been selected as a
recipient of the 1999 Harold R.
Johnson Diversity Service
Award. The award was established in 1996 in honor of the former dean of
the School of Social Work, Harold R. Johnson,
to recognize University of Michigan faculty
who have exhibited outstanding leadership in
the area of cultural diversity. Krause was chosen
for his extensive and extraordinary contributions to the multicultural mission of the University, particularly his work in promoting diversity
while chair of the Department of Otolaryngology and senior associate dean of the Medical
School.
James V. Neel, M.D., Ph.D.,
Lee R. Dice Distinguished University Professor Emeritus of
Human Genetics and Professor Emeritus of Internal Medicine, received the Annual
Award of the Environmental
Mutagen Society for 1999 for outstanding
research contributions in the area of environmental mutagenesis.
Richard R. Neubig, M.D.,
Ph.D., (Residency 1984), professor of pharmacology and
associate professor of internal
medicine, has been named the
chair of the Pharmacology
Study Section for the National
Institutes of Health for 1999 - 2000. The skill
and leadership offered by the chairperson of
an NIH study section are important for the
effectiveness and efficiency of the review process.
56 Fall 1999
Philip Zazove, M.D.,
clinical associate professor and assistant
chief of family medicine, was awarded the
1998 James Neubacher
Award from the University of Michigan. He
was honored for his
commitment to deaf
students, for his contribution of time and
talent, and for his role
as mentor and role
model for deaf students at the U-M and other institutions of higher
education.
“Through his efforts,” noted the citation, Zazove “has enabled individuals with disabilities to live more productively and independently, and in
so doing, he has enriched our community and represented the University of Michigan in an exemplary manner.” The Neubacher Award is
given annually by the U-M Council for Disability Concerns in honor of
James Neubacher, a columnist at the Detroit Free Press and advocate for
the rights of people with disabilities, who died in 1990 of multiple sclerosis.
Zazove also is the author of When the Phone Rings, My Bed Shakes:
Memoirs of a Deaf Doctor. Currently the medical director of the west
region for ambulatory care at the Health System, he is one of a small
group of deaf physicians practicing in the United States.
Lichter President-Elect of
American Ophthalmological
Society
Paul R. Lichter, M.D., (M.D. 1964, Residency 1968,
M.S. 1968), chair and F. Bruce Fralick Professor of Ophthalmology and Visual Sciences and Director of the
Kellogg Eye Center, has recently been elected presidentelect of the American Ophthalmological Society (AOS).
Lichter, a glaucoma specialist, will begin his term as
president in May 2000.
Lichter follows two former U-M Department of Ophthalmology chairs to
serve as president of the AOS. Walter R. Parker, M.D., served in 1929, and
John Henderson, M.D., Ph.D., filled the role in 1970.
Lichter has also been elected to the International Council of Ophthalmology by the International Federation of Ophthalmologic Societies. He is
one of three U.S. members of this council. The Council works to improve
standards in the practice of ophthalmology worldwide to combat and prevent blinding eye diseases.
Malhotra Recognized
for Research
Jyoti Dhar Malhotra, Ph.D., postdoctoral fellow
in pharmacology in the laboratory of Lori Isom,
Ph.D., assistant professor of pharmacology, and
Michael Hortsch, associate professor of anatomy and
cell biology, received the Roche Bioscience Prize for
an outstanding poster presentation at the Advances
in Ion Channel Research meeting this spring. Their poster was entitled:
“Characterization of the cell adhesion functions mediated by voltage-gated
sodium channel beta subunits and their interaction with the membrane
cytoskeleton.” As the presenting author, Malhotra received the crystal
trophy at the Ion Channel Research meeting in San Francisco.
Malhotra also recently received a National Multiple Sclerosis Society
Fellowship grant to support her work on molecular interactions of sodium
channel beta subunits with cytoskeleton. The Fellowship is a three year
award given to only 200 investigators in the United States and abroad
who share the Society’s goal of ending the devastating effects of multiple
sclerosis.
Burrows Receives Distinguished
Dissertation Award
Heather Burrows, a student in the Medical Scientist Training Program, received the University’s
1999 Distinguished Dissertation Award for her dissertation, “Anterior Pituitary Products Involved in
Pituitary Organogenesis and the Mammalian Stress
Response.” Burrows’ dissertation was one of only
four chosen for recognition. She and the other recipients were honored at a ceremony on April 29, 1999.
“Burrows’ mentors and evaluators have evaluated
her not only as ‘careful’ and ‘brilliant,’ not only as ‘innovative and
driven,’ but something more compelling than these,” wrote Mark E.
Siddall for the University’s Society of Fellows, “something that rarely is
the hallmark of a biomedical researcher. Above all, Heather Burrows is
widely regarded as ‘dramatic,’ and appropriately so.”
The Distinguished Dissertation Award is given in recognition of the
most exceptional scholarly work produced by doctoral students nominated in 1998 after completion of their theses. The program is sponsored
by the Horace H. Rackham School of Graduate Studies, and the U-M
Society of Fellows.
Alexander Ninfa, Ph.D., associate professor
in biological chemistry, was chosen to receive
a 1998-99 Henry Russel Award from the Uni-
versity of Michigan. This award, which recognizes both exceptional scholarship and teaching excellence, is one of the highest honors the
University bestows upon its faculty. The award
was presented in March by President Lee C.
Bollinger and Provost Nancy Cantor at the
annual Henry Russel Lecture in March, which
was delivered this year by Jack Dixon, Ph.D., chair
and Minor J. Coon Professor of Biological
Chemistry.
Friedrich K. Port, M.D.,
M.S., professor of internal
medicine and epidemiology,
served as the Scientific Committee President of the International Society of Nephrology
Official Satellite Symposium
on “End-Stage Renal Disease Throughout the
World: Morbidity, Mortality and Quality of
Life”. This two day congress was held in Punta
del Este, Uruguay on May 8-9 and dealt primarily with outcomes research in renal failure
patients. Port will be the editor for a special
supplement of Kidney International that will
report on the main papers of this symposium.
Michelle B. Riba, M.D.,
clinical associate professor
and associate chair of education and academic affairs in
the Department of Psychiatry,
has been elected president of
the American Association of
Directors of Psychiatric Residency Training.
Riba also serves as Secretary of the American Psychiatric Association. ➤
Medicine at Michigan 57
Mark Supiano, M.D., associate professor of
internal medicine in the Geriatrics Center,
received the Outstanding Scientific Achievement Award in Clinical Investigation from the
American Geriatrics Society for 1999 at their
annual meeting in May. The American Geriatrics Society is a professional organization of
health care providers dedicated to improving
the health and well-being of older adults.
Alice Telesnitsky, Ph.D., assistant professor
of microbiology and immunology, recently
completed a three-year stint as a Searle Scholar.
The Searle Scholars Program was established
in 1980 with a bequest from John G. Searle and
his wife. Searle was the grandson of the founder
of the pharmaceutical company, G.D. Searle &
Company.
Richard L. Wahl, M.D., professor of internal
medicine and radiology, recently completed his
term as chair of the American Board of Nuclear
Medicine (ABNM). The ABNM, established in
1971, tests and certifies physicians who have
completed specialty training in nuclear medicine, and is one of the 24 primary medical specialty boards which are members of the American Board of Medical Specialties.
Wahl’s research interests lie in specific targeting of radioactive molecules to cancer for purposes of diagnosis and therapy. Wahl also
recently delivered the “Marie Curie Lecture” at
the European Association of Nuclear Medicine/
World Federation of Nuclear Medicine and
Biology conjoint meeting in Berlin, on the topic
of new radiopharmaceutical therapies of cancer. Wahl has authored or co-authored over 200
scientific papers and has previously received the
Berson & Yalow and Tetalman awards from the
Society of Nuclear Medicine. m
University
of Michigan Health
System and Its Physicians Rank
High in Local and National Surveys
Retired Detroit-area builder Thomas Duke, now a resident of Charlevoix,
describes himself as the University of Michigan Health System’s “best booster.
You have a fabulous institution,” he says. “Every visit that a member of my
family or I have paid there has been handled so well.”
Duke was so happy with the treatment a daughter received there eight years
ago that he sent a big bouquet to the person who had taken his call. Duke says
that first visit was the result of looking for a recommendation in Best Doctors in
America and that his experiences and those of both his daughters with several different physicians at Michigan since then have convinced him that many of the
best doctors in America are practicing within the U-M Health System. “We’ve
just received a lot of good diagnoses and excellent advice,” he says. “Every experience has been fantastic.”
Just as Tom Duke keeps going back to the U-M Health System because of the
care he and his family members have experienced there, those living in the
Detroit metropolitan area who participated in a recent survey said
good medical care and reputation mattered the most in picking
a hospital.
In a survey of 550 residents in Wayne, Oakland, Macomb and
Washtenaw counties published June 3 in the Detroit Free Press,
the U-M Health System was ranked at the top or near the top in
every category of the survey, which included respondents’ choice
of the health system they’d most like to use overall, for cancer
care, for a life-threatening emergency, a child non-emergency,
for giving birth and for cardiac care.
Michigan’s Comprehensive Cancer Center ranked first among
respondents for cancer care and the U-M Health System ranked
second overall for medical care.
Three of Michigan’s leading cancer specialists: Allen Lichter,
M.D., Mark B. Orringer, M.D. and Lori J. Pierce, M.D.,
were featured in the March, 1999, issue of Good Housekeeping.
They were included in a listing of the 318 “top cancer specialists
for women” in the U.S., based on the nominations of 280
department chairs and section chiefs in surgical, medical and
radiation oncology at major medical centers, who were not allowed
to recommend any specialists from their own institutions. Allen
S. Lichter appeared on both the lung and breast cancer radiation oncologists list, Mark B. Orringer on the list of lung cancer
surgeons, and Lori J. Pierce on the list of breast cancer radiation
oncologists.
58 Fall 1999
Robertson Named
Leukemia Society
Scholar
Erle Robertson, Ph.D.,
assistant professor of microbiology and immunology,
has been honored with the
Leukemia Society of America
Scholar Award. “The Scholars of the Society are highly
qualified individuals who
have demonstrated their
abilities to conduct original
research bearing on leukemia,
lymphoma, Hodgkin’s disease, and myeloma,” according to the Leukemia Society. The award includes
financial support of $350,000 over five years.
Robertson joined the Medical School faculty in 1997
and continues to conduct research on Epstein-Barr
virus and Karposi’s Sarcoma-Associated Herpesvirus.
Voorhees Most
Cited Author in
Dermatology
John J. Voorhees, M.D.,
Duncan and Ella Poth Distinguished Professor and chair of
the Department of Dermatology, is the number one cited
author in dermatology based on
his articles published in the 24
principal clinical and investigative journals in
dermatology, according to an article in the March
issue of the Archives of Dermatology.
“Citations are of course an imperfect means of measuring an author’s impact on the field,” the article
states. “Still, they provide some quantification of
scholarly contribution, the judgment of which is so
often a highly subjective exercise. Furthermore, it
seems likely that how often one’s work is cited is a
better measure of the impact of the individual’s works
than how many papers a person has authored.”
The study identified the 25 most often cited authors
based on publications from 1981 through 1996. Articles
published by Voorhees, irrespective of authorship
placement, were cited 4706 times, outdistancing the
second most-cited author by more than 1200 citations.
In Print
Recently published books
authored or edited by members
of the University Of Michigan
Medical School include the
following:
By Frederick A. Askari, M.D.,
Ph.D., assistant professor of
internal medicine: Hepatitis C,
the Silent Epidemic; The
Authoritative Guide, with
illustrations by Daniel S. Cutler.
Published in 1999 by Plenum
Publishing, New York, New York.
By Paul Carson, Ph.D., professor of radiology: Radiation Science: Uses in Medical
Imaging and Therapy, a series of 18 educational modules and videos for secondary
schools and colleges. Kendall/Hunt Publishing,
Dubuque, Iowa.
By Bruce Carlson, M.D., Ph.D.,
professor and chair of anatomy and
cell biology: the second edition of his
book, Human Embryology & Developmental Biology. Published by Mosby
Inc. in 1999.
Edited by Steven M. Donn,
M.D., professor of pediatrics and
communicable diseases:
Neonatal and Pediatric Pulmonary Graphics: Principles and
Clinical Applications, and Neonatal and
Pediatric Pulmonary Graphics: A Bedside Guide.
Futura Publishing Co.,
Armonk, New York, in
1998.
By Wendy R. Uhlmann,
M.S., genetic counselor in
the Department of Internal
Medicine Section of
Molecular Medicine and
Genetics and clinical
instructor in human
genetics, Diane Baker,
M.S., director of the
Genetic Counseling
Training Program and lecturer in
Human Genetics and Epidemiology, and Jane L. Schuette,
M.S., genetic counselor in
pediatrics and clinical instructor
in human genetics: A Guide to
Genetic Counseling. John Wiley
& Sons, Inc. m
Medicine at Michigan 59
From Getting a Ph.D.
to Getting a Job:
Annual Career Fair Helps Doctoral
Students Move From School to World
of Work
T
he Third Annual Graduate Student Career Fair
for the Biomedical and Health Sciences:
Serving Science in Many Ways attracted more than
200 Ph.D. students. The annual event is sponsored
by the Graduate Student Council of the Medical
School to meet the career-planning needs of
graduate students pursuing Ph.D.s in the biomedical sciences. There are 11 Ph.D. disciplines offered
at the Medical School through the Horace
Rackham School of Graduate Studies, including
biological chemistry, biophysics, cell developmental and neural biology, cellular and molecular
biology, human genetics, immunology, microbiology and immunology, neurosciences, pathology,
pharmacology, and physiology. Students from all
the disciplines, and from other health science
schools at the University of Michigan participated
in the day-long fair held in the Towsley Center at
University Hospital.
Steve Goldstein, interim
associate dean for research and
graduate studies, applauds the
efforts of the members of the
Graduate Student Council in
putting on the Career Fair.
The morning began with break-out sessions on:
“From Getting a Ph.D. to Getting a Job,” and “The
Search Process.” Other workshops included
“Science Policy, Science Education, and Regulatory
Affairs,” “Finding a Post-Doctoral Position,”
“Proctor & Gamble: A Global Research and
Development Corporation,” “Serving Science
Outside Academia,” and “Serving Science Within
Academia.”
“The central theme of this event – Serving Science
in Many Ways – brings together an outstanding
group of professionals from both traditional and
non-traditional career paths,” stated Rupak
Rajachar, chair of the Graduate Student Council.
The Council invited many alumni/ae to the event,
which also served as a “reunion” of sorts, particularly for the alumni members of the Association of
Multicultural Scientists, a graduate student
organization for underrepresented racial and
ethnic groups at the University of Michigan whose
goal is to assist its members in successfully
completing their doctoral degrees. m
60 Fall 1999
(From left:) Graduate students April Smith, (medicinal chemistry), Ligi Paul Pottenplackel,
(biophysics), and Marilez Ortiz- Maldonado, (biological chemistry) enjoy a light-hearted
moment as the busy day begins.
Rupak Rajachar, chair of the
Graduate Student Council,
welcomes attendees to the Third
Annual Graduate Career Fair. Rupak
is a fourth year graduate student in
biomedical engineering working in
the area of orthopaedic
biomaterials.
Irwin Goldstein, former associate
dean for research and graduate
studies, talks with alumna Avril
Genene Holt (Ph.D. 1997), and his
stepdaughter, Mira Hinman, Ph.D., a
medicinal chemist at Abbott Labs in
Chicago. Goldstein retired this year
after serving as associate dean since
1986, but continues his research in
the Department of Biological
Chemistry.
Graduate students
Carol Fawler,
medicinal chemistry,
Karen Gregson,
medicinal chemistry,
and Wendy Davis,
biological chemistry,
ponder their choices
at the Career Fair.
Medicine at Michigan 61
Surgery goes Sesqui
T
Department of Surgery Chair Lazar Greenfield and colleagues in a
rendition of “Sensitive, New Age Guys” with a member of the
singing group, The Chenille Sisters, at the gala close of Surgery’s
Sesqui Celebration at the Crisler Arena in early June.
he 150th anniversary of the founding of the
Department of Surgery in the University of
Michigan Medical School was celebrated the
weekend of June 10 when more than 250 surgery
residency graduates and their families and friends
returned to campus to visit and to meet with
members of the faculty. The weekend featured the
unveiling of a new listing of the Medical School’s
endowed professorships, the names of those who
endowed them and the members of the faculty
currently holding them on a series of bronze
panels hanging in the main lobby of University
Hospital. An identical set of panels has also been
installed in the Medical School. They are a gift
from the Department of Surgery to the Medical
School in honor of their 150th anniversary.
Another highlight of the weekend included the
installation of the George E. Wantz Collection in a
main hallway of the Alfred E. Taubman Center.
The installation is entitled Armamentarium
Chirurgicum (“arsenal of surgery”) and features a
few of the many surgical instruments and antiquarian books collected by Dr. Wantz (M.D. 1946)
over the past 40 years and given to the Medical
School’s Historical Center for the Health Sciences
in 1997. m
Dean Allen Lichter
admires the new wall
of endowed chairs in
the Medical School.
Many of the faculty whose teaching and research have been
enhanced by the support afforded by an endowed chair
assemble for a group photo before the new wall in the lobby
of University Hospital listing all endowed chairs in the
Medical School, those who made the gifts to endow them, and
those faculty holding them.
George Wantz cuts the ribbon to officially
open the exhibit of surgical instruments and
texts that form part of the collection given by
him to the Medical School and entitled
“Armamentarium Chirurgicum, The George E.
Wantz, M.D. Collection.” Howard Markel,
director of the Historical Center for the Health
Sciences and associate professor of pediatrics
and communicable diseases, looks on.
62 Fall 1999
Endowed Professorships
in Hematology/Oncology and Orthopaedic Surgery
and Bioengineering Are Inaugurated at Ceremonies
in May and June
T
wo new endowed professorships were inaugurated in the Medical School in
the spring thanks to gifts totaling more than $3 million from Frances and
Victor Ginsberg (M.D. 1937) of Fort Lauderdale, Florida, and Alma and
Rena Ruppenthal of Grosse Pointe.
The Frances and Victor Ginsberg Professorship in Hematology/Oncology was
inaugurated May 21, 1999, with the installation of Robert F. Todd III, Ph.D., M.D.
The Henry Ruppenthal Family Professorship in Orthopaedic Surgery and Bioengineering was inaugurated June 14, 1999, with the installation of Steven A. Goldstein, Ph.D.
(Above) Dean Allen
Lichter presents Steven
Goldstein with an
inscribed medal upon
his installation as a
named professor.
(Right) Steven Goldstein
and his wife, Nancy,
with their sons Aaron,
left, and Jonathan,
right.
Dean Allen Lichter congratulates Robert F.
Todd III, division chief of hematology/
oncology since 1993, and first holder of the
Victor and Frances Ginsberg Professorship.
The Henry Ruppenthal
Family Professorship
The Victor and Frances
Ginsberg Professorship
The Henry Ruppenthal Family Professorship was made possible by a gift
from sisters Alma and Rena Ruppenthal
to honor the family name and their late
brother Norman’s delight in all things
having to do with
engineering, including
the many technological
advances he observed
while a hospital patient
in his last illness.
Their father, Henry
Ruppenthal, was a
builder in the Detroit
area. Alma Ruppenthal’s
fondness for the
University of Michigan was developed
during the many years she attended
evening classes at the Rackham Building
near the Detroit Institute of Arts. The
first holder of the chair, Steven A.
Goldstein, is widely recognized for his
work in the area of musculoskeletal and
orthopaedic science. He has joint
appointments in the Medical School
and the College of Engineering. He
founded the Orthopaedic Research
Laboratory at the University of Michigan, and his research has influenced the
understanding of bone disorders and
their treatment and has led to the
development of innovative implants
and therapies.
The Victor and Frances Ginsberg
Professorship was made possible by a
gift from Victor and Frances Ginsberg.
After graduating
from the University
of Michigan Medical
School in 1937,
Victor Ginsberg
interned at Kings
County Hospital in
Brooklyn, where he
returned after serving in World War II
in Africa and Italy, having received a
Bronze Star for his work in blood
transfusions. Director of the blood bank
at Kings County Hospital, he worked to
advance his understandings of blood
banking and eventually helped establish
a company that made typing serums
instrumental in manufacturing albumin
and gamma globulin and developed a
test for hemoglobin abnormalities. The
company was sold to the Schering
Corporation (now Schering-Plough) in
1968. The Ginsbergs made their gift to
the Medical School in gratitude for the
education Victor Ginsberg received in
the Medical School and its contribution
to their full and rewarding lives. The
first holder of the Ginsberg chair,
Robert F. Todd III, a member of the
Medical School faculty since 1984 and
division chief of hematology/oncology
since 1993, is a noted investigator in the
area of leukocyte cell biology, and a
skilled teacher and clinician. m
Medicine at Michigan 63
Message from
the Executive
Vice President for
Medical Affairs
With this second excellent issue, Medicine at Michigan is
achieving our goal of providing a significant new link to
our alumni/ae and many other interested friends of the
U-M Medical School and U-M Health System. The
magazine is one of numerous terrific developments during
the Sesquicentennial Celebration. We hope that many of
you will come this October 1 for the formal Convocation
and again next October for the conclusion of the
celebrations. We are also supporting numerous events at
specialty society meetings around the country. The Sesquicentennial Calendar appears on the back page of the
timeline, before page 33.
Your Medical School and Health System are in a bold
investment mode. We completed fiscal year 1999 in good
shape, with increases in inpatient and outpatient volume,
many clinical initiatives, and high ratings of patient
satisfaction for the Hospital and Health Centers and very
good HEDIS® (Health Plan Employer Data and Information
Set) measures for M-CARE. Competition for our student
and residency positions is intense. Our Biological Sciences
Scholars Recruitment Program has already brought us six
spectacular beginning faculty. Allen Lichter is wellestablished as dean. And we are in the midst of a systemlevel strategic planning process to proactively shape a
positive future with synergies among our educational,
research, patient care, and technology transfer missions.
I want to focus my comments on the Life Sciences
Initiative President Lee Bollinger has launched for the
University. A First Amendment legal scholar, he is
intensely curious about the “biology revolution.” He and
we believe the life sciences will influence medicine and
public health, our economy, our society, and our views of
ourselves, much as the physics revolution has shaped the
past century. As Francis Collins, on leave from the U-M
to head the National Human Genome Research Institute
at NIH during this decade, wrote in the New England
Journal of Medicine (7/1/99), the program “to map the
human genetic terrain” may rank with the great expeditions of Lewis and Clark, Sir Edmund Hillary, and the
Apollo Program. A century ago, Sir William Osler wrote
that the ambitions of medical research were “to wrest
from nature the secrets which have perplexed philosophers in all ages, to track to their sources the causes of
disease, to correlate vast stores of knowledge [in 1902!],
that they may be quickly available for the prevention and
cure of disease.” We and others now have ideas and
instruments to pursue those goals on a grand scale.
In May 1998, President Bollinger appointed a special
Commission on the Life Sciences with 19 prominent
faculty from relevant departments across the University.
Their February 1999 report proposed a theme of
“Understanding the Complexity of Living Things,” with
64 Fall 1999
research and education bridging molecular, cellular,
organ system, whole organism, and ecosystem approaches,
as well as the ethical, policy, legal, and social ramifications.
They built on strengths here to recommend five related
areas for investment: genomics and complex genetic
disorders; chemical and structural biology; cognitive
neurosciences; bioinformatics, bioengineering, and
biotechnology; and theory and modeling of complex
systems.
President Bollinger, Provost Nancy Cantor, and I went
arm-in-arm to faculty meetings in various schools and
colleges to elicit comments, which were generally very
positive. By May we took a proposal to the Board of
Regents to establish a Life Sciences Institute, with 30 new
faculty, a director who would report to the president, and
an investment of $200 million from University and
Health System reserves, to be multiplied with grants and
gifts. The regents expressed strong support and approved
the initial steps. In July they gave approval for development of a Life Sciences Institute Building south of Palmer
Drive on central campus, within sight of the Medical
Center, with a linking building along Washtenaw and a
pedestrian bridge over Huron. New space to support the
Life Sciences Institute is also planned on the medical
campus and North Campus. We expect the resulting
research and technology to help lift the University to even
higher standing nationally, and to sustain our leadingedge role in clinical care.
A complementary development, the State of Michigan
Life Sciences Research Corridor, has attracted national
media attention. Governor Engler, joined by the presidents
of Wayne State, Michigan State, U-M, and the emerging
vanAndel Research Institute in Grand Rapids, signed into
law July 19 the first of an intended 20 annual appropriations of $50 million from the tobacco settlement funds to
support collaborative research, shared facilities and
equipment, and initiatives to stimulate new companies and
corporate growth in the life sciences arena — with the
long-term intent of diversifying the Michigan economy.
Thus, for those of you elsewhere, there will be much to
see on future visits to Ann Arbor. For those of you here,
there will be numerous opportunities. We welcome your
ideas and suggestions and applaud your own good works.
Go Blue!
Gilbert S. Omenn, M.D., Ph.D.
U-M Executive Vice President for Medical Affairs
and CEO, U-M Health System