pulse
Volume 12 Number 2
Summer 2014
Surgery’s
superstar
Anne Mosenthal is one of a handful
of women in the U.S. leading an academic
surgery department.
PLUS:
Minimally Invasive Brain Repair
Medical Mission to Ghana
NJMS Researchers Garner Millions
in Grants
Message from the Dean
O
n a sun-drenched morning back in May, 170 Rutgers New Jersey Medical School
graduates filed into the New Jersey Performing Arts Center in Newark to collect their
hard-earned medical degrees during our annual Convocation ceremony. As newly
minted doctors, these remarkable individuals and their families savored every moment of this
happy day. We, too, celebrated this milestone in our students’ lives, as well as a couple of our own.
After all, 2014 marked the 60th anniversary of our school’s founding and the first Convocation
ceremony since our historic merger with Rutgers, The State University of New Jersey.
Since New Jersey Medical School’s inception, our institution has become recognized as a
place where world-renowned scientists and clinicians convene to do their important lifesaving
work. Certainly, our status in the medical and academic communities would not be what it
is today if not for the numerous collaborative relationships that we have built throughout the
years—not only here at New Jersey Medical School, but throughout the Rutgers community
and beyond. From contributing to Rutgers Biomedical and Health Sciences’ ongoing strategic
planning process to forging alliances with national groups like the Association of American
Medical Colleges, the National Institutes of Health, and the American Medical Association, we
understand how important collaborative efforts are to our success. In recognition of these vital
partnerships, we are devoting this issue of Pulse to highlighting some of the collaborations that
help to make us great.
Throughout our 60-year history, we at New Jersey Medical School have worked persistently
to carry out meaningful work that makes a difference in the lives of others. We are proud of
what we have accomplished throughout the years and know that, together, we will continue to
leave our mark, not only on the fields of science and health care, but on society at large.
In health,
Robert L. Johnson, MD, FAAP’72
The Sharon and Joseph L. Muscarelle Endowed Dean
Rutgers New Jersey Medical School
pulse
Dean
Rutgers New Jersey Medical School
Robert L. Johnson, MD, FAAP’72
Chief Operating Officer
Walter L. Douglas, Jr.
Senior Marketing and
Communications Coordinator
Genene W. Morris
Business Coordinator
Iveth P. Mosquera
VOLUME 12 NUMBER 2
Senior Editor, Pulse
Mary Ann Littell
Contributing Writers
Maryann Brinley
Kaylyn Kendall Dines
Jennifer S. Doktorski
LaCarla Donaldson
Rob Forman
Eve Jacobs
Cynthia McChesney
Genene W. Morris
Carole Walker
Photo Editor
Doris Cortes-Delgado
Design
Sherer Graphic Design
SUMMER 2014
R U T G E R S , T H E S TAT E U N I V E R S I T Y O F N E W J E R S E Y
President
NJMS Alumni Association
Paul Bolanowski, MD ’65
ALUMNI FOCUS
Director
Dianne Mink
Administrative Assistant
Emily Birkitt
Keep in Touch
Pulse is published twice a year by New Jersey Medical
School. We welcome letters to the editor and suggestions
for future articles. Send all correspondence to:
Iveth P. Mosquera
Business Coordinator
New Jersey Medical School
Medical Science Building, Room C -595
185 South Orange Avenue
Newark, NJ 07103
or via email to [email protected]
pulse
SUMMER 2014
FYI
2 Notable, Quotable
5 News by the Numbers
A C LO SER L OOK
6
8
9
10
At
At
At
At
Brain Injury Research: To Heal Injured Brains
an Enigmatic Disease: What Is Sarcoidosis Anyway?
the Miracle of Cochlear Implants: Music to His Ears
a Unique Integrative Medicine Rotation: The Bigger Fix
N JMS / GSBS PEOPLE… DO YOU KNOW ?
12
13
14
15
16
18
20
Jonathan Keith: Falling in Love With Surgery
Arjun Raj: Just How Brilliant Is He?
Sourav Sinha: Getting a Cancer Drug to Patients
Ana Natale-Pereira: Never Lose Hope
Theresa L. Chang, Veronique Dartois, Marila Gennaro: Award-Winning Women
Keith and Scott Pasichow: A Tale of Two Brothers
Kevin Clarke: Surgical Care Mission Returns to Ghana
FE ATURES
22 A Pipeline to Recovery
Brain aneurysms and strokes are often deadly. But these NJMS neurosurgeons
are not only skilled at treating brain attacks (strokes), but are among the few
specialists trained to repair brain aneurysms with minimally invasive techniques.
26 The Newest Virus Buster
An NJMS researcher discovers a new type of interferon with the potential to
become a blockbuster drug and wins a sizable grant to help move his finding forward.
30 Woman at the Top
There are only six women who chair academic surgery departments in the entire
country and one of them, Anne Mosenthal, is right here at NJMS. Has the going
been tough at times? Oh yes, she says. Was it worth it? Absolutely.
A LUMNI F OCUS
33
34
36
37
38
39
40
Message from the Alumni Association President
Alumni Reunion Weekend
Elizabeth Alger’s Amazing Adventure
Gerard Malanga: Non-Surgical Solutions to Sports,
Spine, and Orthopaedic Injuries
Yvonne Farnacio: A Career That Fits
Class Notes, In Memoriam
Bringing Health Care to the Homeless
COVER PHOTO BY JOHN EMERSON
‘‘’’ Quotable
Notable
FYI
Global TB institute
Celebrates 20 Years of
Excellence
The Rutgers Global Tuberculosis Institute at
NJMS recently celebrated its 20th anniversary
“This was our first Match Day celebration since joining Rutgers and, as usual, it was an exciting and
joy-filled day. Getting to this point in their journey through medical school was no small feat for our
students. I am exceedingly proud of them and commend them on their achievements.”
ROBERT L. JOHNSON, MD’72, THE SHARON AND JOSEPH L. MUSCARELLE ENDOWED DEAN OF NJMS
with Dean Robert L. Johnson, MD; Marc
Klapholz, MD, chair of the Department of
Medicine; and Arturo Brito, MD, MPH, deputy
The Arnold P. Gold
Petros Levounis, MD, MA, chair of the Depart-
commissioner of NJ Public Health Services, who
Foundation donated
ment of Psychiatry, received the 2014 Schonfeld
welcomed faculty, students and guests. Douglas
$1,000 to the
Award from the New York Society for Adolescent
Eveleigh, PhD, professor of biochemistry and
Humanism in Medical
Psychiatry. As a Schonfeld awardee, he delivered
microbiology, Barry Kreiswirth, PhD, professor at
School — Bridging the
a lecture titled “Emerging Drugs of Abuse: From
the Public Health Research Institute, Lee Reich-
Years Project at its
Ecstasy to Bath Salts, Synthetic Cannabinoids,
man, MD, MPH, clinical professor and executive
annual luncheon held
and Beyond” at the New York Academy of
director, Global Tuberculosis Institute, and David
this spring. The project was established through
Alland, MD, associate dean of clinical research
a grant received from the foundation, which
and professor of medicine, made presentations
promotes humanism as an integral part of quality
on current TB research and developments in
patient care and physician wellness.
diagnosis of TB. Brian Strom, MD, MPH, Chancellor of Rutgers Biomedical & Health Sciences,
gave the closing remarks.
Left to right: Drs. Arturo Brito, Brian Strom, Lee
Reichman, Robert Johnson, and Marc Klapholz
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P U L S E
SUMMER 2014
Aaron Hajart, MS, senior director of administration in the Department of Neurological Surgery,
was elected to a two-year term on the inaugural
Board of Directors of the American College of
Neuroscience Administrators.
Medicine.
James Oleske, MD, MPH, professor of pediatrics, was honored as Pediatrician of the Year by
the New Jersey Chapter of the American Academy of Pediatrics.
David Chu, MD,
associate professor
of ophthalmology
and visual science,
David Livingston, MD, Wesley J. Howe Pro-
was honored with
fessor of Surgery and chief of the Division of
the Lions Eye Bank
Trauma and Surgical Critical Care, was appointed
of New Jersey’s
president of the Western Trauma Association for
Man of Vision
2013 – 2014. The WTA is the only multispecialty
Award for his
trauma organization in the U.S. He is also direc-
excellent surgical
tor of the New Jersey Trauma Center at Univer-
and leadership
sity Hospital in Newark and medical director of
skills in the field of
the Northstar Aeromedical Program.
ophthalmology.
Trauma Team on TV
When the ambulance comes screaming
through the city to the trauma center door,
delivering a patient with a bullet in his abdomen, TV cameras that capture the medical
staff’s every move are often less than welcome. Not so for the NJMS docs and their
patients featured on the second season of
ABC’s documentary series, NY Med, which
launched at 10 p.m. on June 26, and continues for eight consecutive Thursday evenings.
Brazeau Named ELAM Fellow
Chantal Brazeau, MD, interim chair of Rutgers
New Jersey Medical School’s Department of
Family Medicine, has been named a fellow of
The Hedwig van Ameringen Executive Leader-
Confidence, courage and composure are all
This season of NY Med features two hospitals:
qualities demonstrated by this NJ trauma team.
New York Presbyterian Hospital on the Upper
They know that they are always required to
East Side of Manhattan and University Hospital,
perform flawlessly on command— cameras or no
Newark, the primary teaching facility of Rutgers
cameras. The rapid-fire responses required to
New Jersey Medical School. The NJMS faculty
mend often life-threatening patient injuries create
members featured in the series (see above)
a natural drama unequalled by the most polished
deserve special documentary-actor-awards. At the
made-for-TV script. In episode 1, a young man
most critical times, they never lose their human-
is shot, and his family and friends wait agonized
ity — or their cool. These are no actors — that’s ob-
moments for the trauma surgeon to emerge with
vious. But they are experts you could count on if
news about his condition. (He survives.)
the going got tough. Watch them and feel proud.
ship in Academic Medicine® (ELAM) Program, a
core program of the Institute for Women’s Health
and Leadership at Drexel University College of
Medicine in Philadelphia.
Brazeau joins a select class of 54 women from
medical schools throughout the country in the
only program in North America dedicated to
preparing women for senior leadership roles in
academic health science institutions.
The one-year, part-time program combines three
weeklong in-residence sessions with a distancelearning component. During that time, fellows
are supported by their dean or other senior
official within their institution for continuity and
mentorship.
Brazeau will join a community of more than 800
alumni — all highly accomplished women serving
in a variety of leadership positions around the
world, including department chairs, research
center directors, deans and college presidents,
as well as chief executives in health care and
accrediting organizations.
Teams Square off in Charity Hockey Game
Rutgers Biomedical and Health Sciences presented the 2014 Winter Classic Charity Hockey Game
featuring New Jersey Medical School’s Medwings vs. the School of Dental Medicine’s Bitewings.
Dean Robert L. Johnson, MD, and RSDM’s Dean Cecile Feldman, DMD, started the game with a
ceremonial puck drop. The Medwings won 7 – 3. The event raised $14,500 for the Sean Hanna
Foundation, which benefits pediatric cancer patients and their families. In the past two years, this
fundraiser has raised $22,000 for charities.
RUTGERS NEW JERSEY MEDICAL SCHOOL
3
Trauma surgeon, gunshot wound
specialist, teacher, soldier, writer,
role model, mentor, father and
A man of action
grandfather: Kenneth Swan was all
Kenneth G. Swan, a professor of surgery
that and more.
at NJMS for more than 40 years, died on
March 22. He was a trauma, vascular and
thoracic surgeon and played a pivotal role in
developing the trauma center at University
the rank of lieutenant colonel and became
two textbooks and published more than 300
Hospital in Newark after returning from ac-
director of the division of surgery. In 1973,
articles on trauma, shock, physiology, and
tive service in Vietnam.
he left active duty to join the NJMS faculty.
medical history.
Swan graduated from Harvard in 1956;
Swan was a reservist for most of the ’80s
Swan served as chief of the NJMS
earned his medical degree from Cornell
and ’90s, and in 1991, was recalled to ac-
Section of General Surgery for more than
University Medical College in 1960; and
tive duty in Saudi Arabia during Operation
two decades, as well as director of surgery
completed his residency in general surgery
Desert Storm. He became a colonel and was
at University Hospital. NJMS recently
at New York Hospital and a fellowship in
awarded the Legion of Merit when he retired
honored Swan with a Lifetime Achievement
gastrointestinal physiology at UCLA.
from the Army in 1998. He was a flight
Award and the Distinguished Faculty Award.
surgeon, combat medic, master parachutist,
—L A CARLA DONALDSON
In 1968, Swan entered the Army as
captain, Medical Corps, and was sent to
U.S. Army War College graduate and was Air
Vietnam for one year, where he developed
Assault and Special Forces qualified.
expertise in treating gunshot wounds. He
Trauma surgery was Swan’s passion. He
was then assigned to the Walter Reed Army
treated thousands of victims of gun violence
Institute of Research in Washington, DC,
in New Jersey using skills he developed treat-
where he spent the next four years, rose to
ing gunshot wounds in Vietnam. He wrote
4
P U L S E
SUMMER 2014
Many people have expressed interest in making donations in Swan’s honor. Gifts to the Dr. Kenneth G.
Swan Fund at the Rutgers University Foundation will
be designated to support medical student education at
the NJMS Department of Surgery. To contribute visit
www.support.rutgers.edu.
NJMS NEWS BY THE NUMBERS
4
$1,580,485
An estimated 4 in 10 U.S. adults suffer from
chronic pain. Many can be helped by neuromodulation therapy, the use of implantable
devices that alter nervous system activity
through electrical stimulation. Specializing
in this therapy is neurosurgeon Antonios
Mammis, MD, director of the new NJMS
Center for Functional Neurosurgery and
Neuromodulation. Targets for stimulation
include the spinal cord for certain types of
intractable pain, including complex regional
pain syndrome, facial pain syndromes, and
failed back surgery. Mammis also specializes in deep brain stimulation (DBS) to treat
movement disorders, including Parkinson’s
disease. To make an appointment, contact
the center at 973-972-2323.
William Gause, PhD, professor of medicine,
director of the Center for Immunity and Inflammation, and senior associate dean for research, was
awarded a four-year grant from the NIH–National
Institute of Allergy and Infectious Diseases for “Innate Type II Immune Mechanisms of Resistance.”
170
Approximately 95 percent of the 170member Class of 2014 who participated
in Match Day received assignments to residency programs in competitive specialties
such as plastic surgery, neurosurgery, otolaryngology, and dermatology. The national
average was 94 percent. Of those students
who matched, 47 will stay in the state.
510
That’s the number of students who attended a
recruitment fair hosted by NJMS and Rutgers
School of Dental Medicine in July. The fair was
part of the 25th anniversary celebration of the
Summer Medical and Dental Education Program
(SMDEP). This program is for undergraduates
interested in health careers.
$727,237
In year two of a five-year grant from the NIH–
National Institute of Allergy and Infectious Diseases, Yuri Bushkin, PhD, adjunct professor of
medicine at the Public Health Research Institute
of NJMS, along with team members Marila
Gennaro, MD, and Sanjay Tyagi, PhD, are being
funded for a project titled “Rapid Analysis of Single T
Cell Immunity Signatures in Tuberculosis.”
S E C T I O N C O M P I L E D B Y C A R O L E WA L K E R
$1,391,252
The National Institute of Neurological
Disorders and Stroke awarded this amount to
Tibor Rohacs, MD, PhD, associate professor
of pharmacology and physiology, for “Lipid
Regulation of Transient Receptor Potential
Channels.”
RUTGERS NEW JERSEY MEDICAL SCHOOL
5
a closer look at brain injury research
Steve Levison, PhD, and Frances Calderon, PhD
of the brain.” He is looking at whether LIF
can also activate the resident stem cells in
the brain during the acute period of recovery
from a concussive injury and “whether these
stem cells can produce new neurons and glia,
which would be really exciting.”
Having benefitted from grant support,
including the most recent NJCBIR award of
$537,500, Levison has generated sufficient
new data to support a major proposal to the
National Institutes of Health. In addition,
“Because several labs in the Newark region
obtain funding from NJCBIR, we have
created a collaborative TBI research interest
group that meets monthly,” he says. “We
keep each other on the cutting edge.”
Feeding the Brain
To Heal Injured Brains
Ten years ago, state legislators put their heads together and established the
New Jersey Commission on Brain Injury Research (NJCBIR) to promote more
effective treatments and cures for traumatic brain injuries (TBI). Four NJMS
scientists received grants from the commission for their collaborative work.
BY MARYANN BRINLEY
Re-Growing Baby-Brains
As a developmental neurobiologist, Steve
Levison says he has “always been interested
in understanding the forces that regulate the
development of the brain.” A professor of
neuroscience in the Department of Neurology and Neurosciences and director of the
Laboratory for Regenerative Neurobiology, Levison has spent 15 years researching
6
P U L S E
SUMMER 2014
how neonatal stroke affects brain development and how to restore the brain’s proper
growth. Recently, his team discovered a
cytokine known as LIF that is important in
both brain development and as a protective
response after injury. The scientists hypothesize that LIF acts “like a cellular emergency
life support system, able to protect cells from
damage in both the gray and white matter
Frances Calderon was so astonished by the
research she participated in on the neuroprotective effect of dietary DHA on neurons
that she changed her own diet and resolved
to investigate the capabilities of these omega-3 fatty acids in improving human health.
“When I learned that DHA deficiency impairs memory and brain function, I wanted
to understand how that happens and study
the molecular mechanisms,” she explains.
It was a Eureka moment when she saw the
upsurge in proteins that modulate signaling
transduction in an adult brain being fed a
diet rich in omega-3. DHA and its derivative NPD1 are now at the core of Calderon’s
traumatic brain injury studies funded by
$539,733 from the NJCBIR.
Neural stem cells have been investigated
to repair damaged brains but these grafted
cells often do not survive. Calderon, who is
studying animal models in the Nutritional
Neuroscience Lab at NJMS, has changed
this by adding DHA. Her goal is to develop
a model of neural repair and regeneration.
Calderon, who earned her PhD at the
Pontifical Catholic University of Chile,
believes that this research will lead to effective treatments for TBI. Clinical approaches
often fail now because of drug toxicity or
side effects. “Omega-3 fatty acids are natural
neuroprotectants,” she explains.
Fish oil capsules are readily available but
ANDREW HANENBERG
DHA and EPA can also be found in fatty
fish like salmon. Another type of omega-3
fatty acids in our diets is alpha-linolenic acid
(ALA), which is found in some vegetable
oils, such as soybean and canola, in flaxseeds, and in walnuts. However, the body
converts only a small amount of ALA to
EPA and DHA. She adds, “The so-called
‘western diet’ is so deficient in omega-3 fatty
acids that I am wondering how many brain
diseases might be treated or prevented by
exploiting its capabilities.”
Jean Lengenfelder, PhD, and James Sumowski, PhD
Aerobic Exercise To Improve Memory
A recent case study by James Sumowski,
Victoria Leavitt, and colleagues at the Kessler
Foundation demonstrated for the first time
that aerobic exercise training can increase the
brain’s hippocampal volume and activity, and
can enhance memory in the neurologically
impaired. That research was conducted with
a group of multiple sclerosis (MS) patients.
TBI can also result in memory problems,
so Sumowski, an assistant professor in the
NJMS Department of Physical Medicine
and Rehabilitation (PM&R), has turned his
attention here. “There has never been an
aerobic exercise trial in TBI patients
that looked at hippocampal volume and
memory,” he says.
In the current randomized pilot trial of 36
subjects, funded by a $170,296 grant from
NJCBIR, one group of TBI patients is assigned to 30 minutes of aerobic exercise (stationary cycling) three times a week for three
months and a control group is given stretching exercises on a similar schedule. Based on
studies in the scientific literature and results
of their own MS trial, Sumowski and Leavitt
expect aerobic exercise (but not stretching) to
increase hippocampal volume and improve
memory in the TBI patients. The hippocampus plays a critical role in how we form new
memories and retain old ones. The brain
has two hippocampi, one in each cerebral
hemisphere. The good news is: “You can grow
your hippocampus,” Sumowski says.
He is also looking at “functional connectivity” or how remote regions of the brain
talk to each other. “In our MS study, greater
connectivity was observed between hippocampal regions after just 12 weeks of aerobic
training. Along with the improvement in
memory, we think that aerobic exercise can
mean improved health, productivity, independence and quality of life for those with
TBI,” Sumowski states.
Understanding the Emotional Disconnect
One of the grant-winning studies evaluates the effects of
aerobic exercise training to enhance memory in patients
with traumatic brain injury.
JOAN BANKS
As assistant director of neuropsychology
at the Neuropsychology and Neuroscience
Laboratory at Kessler Foundation Research
Center, Jean Lengenfelder has found that
after a traumatic brain injury, individuals often have problems with social and emotional
functioning that result in “difficulties in
social relationships, poor social participation,
impaired empathy, and a high degree of caregiver stress. People with TBI are not able to
recognize facial affect,” she says. Her study,
funded by a $397,941 grant from NJCBIR,
documents the prevalence of emotional
processing deficits in TBI and identifies the
neural networks engaged in such tasks.
“We knew these impairments existed but
we did not know why they occurred in TBI
or how they could be treated. This study set
out to answer those questions,” she explains.
Lengenfelder, who is also an assistant
professor of PM&R at NJMS, hypothesizes
that diffuse axonal injury in TBI is responsible for damaging the connections in the
brain essential for emotional processing.
Using three different types of neuro-imaging,
she has examined the extent to which this
emotional processing damage is being caused
by structural and functional problems. “The
identification of impairments in the neural
network of emotional processing in TBI is
essential to be able to design and monitor
effective treatment strategies,” she states. ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
7
a closer look at an enigmatic disease
What is Sarcoidosis Anyway?
A team of experts launches an interdisciplinary center to diagnose and treat a
puzzling disease that is often misdiagnosed.
W
hen Larry Frohman performs a
neuro-ophthalmic exam, it may turn
up evidence of sarcoidosis. This disease,
estimated to affect more than one million
people worldwide, most often shows up in
the lungs first. However, “about 20 percent
of patients will have ocular involvement and
5 to 10 percent will have neurologic involvement during the course of the disease,” the
eye expert states.
Frohman says he sees a “disproportionate number of sick, sometimes undiagnosed
sarcoid patients who come through the ophthalmology department as the initial point
of contact.” Some have aggressive forms of
the disease requiring therapy beyond the
standard treatment regimens. “This disease
mimics other diseases so it’s not easy to diagnose,” he states.
A professor at the Institute of Ophthalmology and Visual Science at Rutgers New
BY MARYANN BRINLEY
Jersey Medical School (NJMS), Frohman
says his patients complain of symptoms such
as eye pain, double vision, and loss of vision,
which, if left untreated or inadequately
treated, can eventually cause blindness. The
ophthalmologist has teamed up with pulmonologist Andrew Berman, MD, to found a
new center— called the NJMS Sarcoidosis
Center— dedicated to the diagnosis and
treatment of the disease.
“Up to 90 percent of sarcoidosis patients
have lung involvement,” says Berman, an
associate professor of clinical medicine at
NJMS and co-director of the center. “Patients are often referred by other physicians
for swollen lymph nodes in the chest, a dry
cough, shortness of breath, or unexplained
weight loss or fever.” According to the American Lung Association, 20 to 30 percent of
people with pulmonary sarcoidosis end up
with permanent lung damage. The disease’s
Larry Frohman, MD, and Andrew Berman, MD
varied manifestations include involvement of
the skin, lymph nodes, liver, heart, muscles
and bones, and the nervous system, including the brain and visual system.
The term sarcoidosis comes from the
Greek word “sarkodes,” meaning fleshy, and
“osis,” a Greek suffix meaning condition.
This refers to the skin lesions that can form
on various parts of the body and are often
the disease’s most noticeable manifestation.
The incidence of sarcoidosis is higher in
African Americans and northern Europeans,
particularly Scandinavians. Those between
ages 20 and 40 are most at risk, and women
are affected slightly more often than men.
The typical pathology, granulomas (small,
nodular aggregations of inflammatory cells),
can form in multiple organs, producing the
symptoms of the disease. Berman says, “We
don’t know what causes this condition. However, we do know how to diagnose it and how
to treat it with medications, generally corticosteroids, that reduce the inflammation.”
Three years ago when Berman, who
has had an interest in sarcoidosis for some
time, arrived at NJMS to direct the medical
school’s Division of Pulmonary and Critical
Care Medicine/Allergy and Immunologic
Diseases, Frohman found a partner as interested in this disease as he is. Giving comprehensive and coordinated care to hundreds
of sarcoidosis patients being seen by NJMS
faculty physicians had been problematic in
the past.
Working together, Berman and Frohman
assembled a team of experts from more than
10 different specialties who have experience
and knowledge about the disease to co-manage what can be difficult, complicated cases.
These specialties include adult and pediatric
pulmonary medicine; neuro-ophthalmology,
uveitis and other ophthalmic subspecialties;
cardiothoracic surgery; cardiology; allergyimmunology; neurology; ear, nose and
throat; and oral medicine.
“This way, a patient is able to see a number of doctors who are both used to working
together and experienced with the disease,”
Continued on page 11
8
P U L S E
SUMMER 2014
JOHN EMERSON
a closer look at the miracle of cochlear implants
Robert Jyung, MD (inset), opens up
a new world of hearing for cochlear
implant patient Jesse Solano.
Music to His Ears
BY MERRY SUE BAUM
L
ike most 12-year-olds, Jesse Solano
is part of today’s “wired” world. He
has a computer, a smart phone and a tablet
loaded with apps. But unlike your average
teen, he also has two cochlear implants that
he says, “have rocked my world.”
The Elizabeth, NJ, resident was born with
significant hearing loss, and at age 2 needed
hearing aids in both ears. He managed to get
by for the next eight years, but among the
routine things he couldn’t do were playing
sports, going to the movies, and talking
on the phone. By the time he was 10, Jesse
could barely hear at all. That’s when he
got his first cochlear implant. “Suddenly, I
could hear the birds sing,” he says. “I didn’t
know that birds made noise.” Jesse made
JOHN EMERSON
a video about his experience that is posted
on YouTube at http://www.youtube.com/
watch?v=uclqk3sZac0.
Normal ears process sound through a
perfectly timed chain of events. Part of that
process relies on movement in the fluid of
the cochlea, which sets tiny hair cells in motion. Someone with sensorial hearing loss,
like Jesse, has damage to the cochlea. Hearing aids only amplify sound, but cochlear
implants directly stimulate the inner ear with
electricity, since the inner ear can no longer
process even amplified sound. The implants
work by capturing sound vibrations with
a microphone outside the ear, and sending
them to a receiver implanted under the skin
behind the ear. The receiver takes the coded
electrical signals and delivers them to the
array of electrodes that have been surgically inserted in the cochlea. These signals
are transmitted to the brain by the auditory
nerve, which interprets them as sound.
Robert Jyung, assistant professor of
otolaryngology, head and neck surgery at
Rutgers New Jersey Medical School (NJMS),
says the surgery usually takes two to three
hours and patients go home the same day.
That is just the first step on the road to hearing, however. Jyung, who is also director of
otology/neurotology at University Hospital,
the primary teaching hospital for NJMS, explains that a person with a cochlear implant
hears differently from someone with normal
hearing. “People with implants report that
the words sound electronic,” he says. “It
takes time for the brain to adjust.” New
implant patients are encouraged to listen
to television news broadcasts or books on
tape to learn to decipher the exact sounds of
words. The patient has to meet with an audiologist to have the device adjusted. Using a
computer, the audiologist sets the threshold
for the softest sound the patient can detect
and the loudest sound the patient can comfortably tolerate for each of the 22 electrodes
that were surgically placed in the cochlea.
“This is an ingenious device,” says Jyung.
“The pioneers in the field endured a great
deal of skepticism and opposition.” The
latest implants are waterproof, have Bluetooth capability, and remote controls, and
can be synced with smart phones and iPods.
Researchers have even developed a hybrid
implant combining elements of an acoustic
hearing aid with the cochlear implant.
Jyung feels fortunate to do the work he
does. “There is such joy in helping to put
people back in the hearing and speaking
world,” he says.
The Cochlear Implant Center of New
Jersey is located at University Hospital. The
Center does about 30 implants each year and
has a success rate of nearly 100 percent. Lisa
Bell, MA, CCC-A, is the Center’s audiology
director. ●
To contact the Cochlear Implant Center of New Jersey,
call 973-972-2548.
RUTGERS NEW JERSEY MEDICAL SCHOOL
9
a closer look at a unique integrative medicine rotation
The Bigger Fix
Meditation, stress reduction, yoga, acupuncture, massage therapy, mindbody medicine, music therapy, nutritional healing. These remedies, and others,
may soon earn a place — next to drugs and surgery — on your doctor’s
prescription pad.
BY EVE JACOBS
C
onventional medicine is changing and
two Rutgers schools are leading the
way to a broader definition of what constitutes good patient care. Rutgers New Jersey
Medical School (NJMS) and Rutgers School
of Health Related Professions (SHRP)
teamed up to create a novel eight-week
rotation for second-year residents in preventive medicine/public health that introduces
them to some of the therapies now dubbed
“alternative” and “complementary” and to
the practitioners of those therapies. The
10
P U L S E
SUMMER 2014
unique program is supported by a $150,000
grant, awarded to NJMS and SHRP in
September 2012 as part of IMPriME, the
National Coordinating Center for Preventive
Medicine/Integrative Medicine programs,
funded by the Health Resources and Services
Administration.
The program’s creators —Polly Thomas,
co-director of the residency program and
an associate professor at NJMS, and Gwen
Mahon, an associate dean and associate professor at SHRP— are helping to change the
status quo in the medical world. Recognizing
that physicians often have trouble communicating with other health care providers, and
vice versa, they set about analyzing the whys
and wherefores. A lack of familiarity with
each other’s work and existing hierarchies in
the health care world that restrict interaction climbed to the top of their list. In fact,
Thomas and Mahon found that they themselves felt some of these same constraints
when sitting down to discuss their plans.
“Respect. It’s largely about respect,” says
Mahon. “Familiarity is key to eradicating
barriers and fostering respect.”
In a first step toward change, a fivemember team developed a survey, which
was distributed in 2012 to faculty members
of NJMS, SHRP, the School of Nursing
and Rutgers School of Dental Medicine to
assess their knowledge and attitudes toward
complementary and alternative medicine
(CAM). About 300 surveys were completed.
In addition to Thomas and Mahon, team
members included: Virginia Cowen, assistant professor of primary care at SHRP;
Susan Gould Fogerite, associate professor of primary care at SHRP; and Marian
Passannante, PhD, chair of the School of
Public Health’s Department of Quantitative
Methods and an NJMS associate professor in
the Department of Preventive Medicine and
Community Health.
Survey results indicated that faculty are
interested in integrative medicine and would
like to incorporate aspects of it into their
practice. Many have had some training in the
use of nutrition, diet, exercise, and physical activity in patient care. The survey also
indicated that physicians and dentists are less
likely to refer patients for integrative medicine services than other health care providers.
Mahon, who was born in Ireland, and
raised in Ireland, Toronto and Vancouver,
and whose family moved frequently while
she was growing up, was taught by her
father to “reach for the moon” and “not to
fear change.” She brings that mindset to her
work. Trained as a cancer researcher, she nevertheless likes to work outside the lab, where
the “experiments” are broader in scope and
STEPHANIE CARTER
Clinic in New Brunswick, where physician
often more impactful. She sees health care as
assistants are the primary caregivers; the
an area where a willingness to think outside
Oral Health Nutrition Clinic in Newark;
the box can translate into big dividends for
the Center for Well Being at Morristown
large groups.
Medical Center; and Atlantic Health System
The new rotation is also a reflection of
Integrative Medicine. The residents must
Thomas’s chief interests — encouraging lifealso complete a research project.
style changes to promote health and prevent
“This is a new field,” says Mahon. “There
disease, building teams of physicians and
is no model yet
other experts to
for including intecare for patients
grative medicine
in contrast to the
in preventive
current segmentmedicine residened system, and
cy programs.”
making changes
At the end of
at the population,
the day, the team
rather than the
that launched
individual, level.
the new rotaThe preventive
tion wants to
medicine/public
build bridges
health residency
among health care
that she heads
specialists and tip
up with Wilthe system toward
liam Halperin,
preventive care.
MD, chair of the
The grant gives
Department of
The integrative medicine rotation team (left to right): Virginia
Cowen, PhD, Susan Gould Fogerite, PhD, Gwen Mahon, PhD, and the team credibility
Preventive MediPolly Thomas, MD
and allows them to
cine and Combe part of a large
munity Health, is
consortium that is wrestling with this issue
the only one in New Jersey and accepts just
on a national scale. “This is more complione or two applicants each year. Most of the
cated than it sounds,” says Mahon. “We are
applicants are interested in working for a local, state, or federal agency such as the CDC; tackling a host of questions.”
It is necessary to have strong evidence that
working directly with patients to provide
CAM therapies work and are safe in order to
preventive medicine services; and doing
include them in a treatment plan, but how is
public health research.
that evidence best obtained? Do CAM pracIn the eight-week integrative medicine
titioners need to be licensed and educational
rotation, residents observe and work closely
programs accredited? Who should lead the
with professionals in such specialties as
new health care teams? If the physician is the
physical therapy, occupational therapy, and
leader, are there ways to create an environpsychiatric rehabilitation. They also attend
ment of inclusion where others can comfortwellness centers and clinics that provide an
ably bring their thoughts to the table?
array of health care services — including
“For primary care providers, integrative
alternative and complementary care — under
and preventive care are traditional and essenone roof. “Relationships are formed betial,” says Thomas. “But they need knowltween these physicians and other health care
edge about when and where to refer patients
providers and a level of respect is built,” says
for services they cannot provide.” ●
Mahon. “It’s a start.”
Among the sites hosting physicians in
Read about Yvonne Farnacio, one of the first NJMS
the program are the student-run physical
residents to participate in the integrative medicine rotatherapy clinic at SHRP in Newark; St. John’s
tion, on page 38.
K E I T H B R AT C H E R
Sarcoidosis
Continued from page 8
Berman says. “We are also planning a support group where patients can interact with
each other and a facilitator. This disease has
so many unanswered questions.”
Among the center’s missions is outreach
to community physicians who only see
sarcoidosis patients occasionally. “It would
be hard for any one physician to comfortably manage this disease with its many varied
manifestations. We have collective expertise
to assess multi-organ involvement and can
provide treatment without delay,” Berman
continues.
In addition to treating the disease,
Frohman and Berman teach, research, and
publish on sarcoidosis nationally and internationally. But their primary goal remains
helping patients transition from having an
unexplained systemic inflammatory illness with severe manifestations to getting a
correct diagnosis and therapy that will keep
them healthy and out of the hospital. ●
1-855-4-SARCOID
The Rutgers NJMS Sarcoidosis Center can assist you or your patients with
comprehensive care. Physicians and staff
are available to answer calls or coordinate visits to allow for ophthalmology and
pulmonary evaluations as well as lung
function testing on the same day.
To reach co-directors: call Larry Frohman
at 973-972-2026 or email him at
[email protected] or call Andrew
Berman at 973-972-LUNG (5864) or
email him at [email protected].
You can also call the Sarcoidosis Hotline
at 1-855-4-SARCOID.
RUTGERS NEW JERSEY MEDICAL SCHOOL
11
njms people…do you know?
said, ‘I like to think of plastic surgery as the
specialty of skin and its contents.’”
Keith joined NJMS last fall, after completing his residency at Pitt — a period that
included a stint in Belgium as the recipient
of the Stephen S. Kroll Fellowship in microsurgery at the University Hospital of Ghent.
“That was a real honor,” Keith says. “I
worked with Dr. Phillip Blondeel, an internationally recognized pioneer of this very
specific kind of breast reconstruction surgery,
where you take fat and skin from a woman’s
abdomen, sparing the fascia, the muscle, and
the nerves that make the muscle work, and
use that to reconstruct the breast.”
The Kroll fellowship also included work
with perforator surgery, a technique, Keith
explains, that involves taking “tissue and its
blood supply without taking any of the surrounding structures. A lot of the tissues are
supplied by blood vessels that come through
the muscle, and people need those muscles.”
He adds, “The fellowship was about
learning how to make a breast artistically. It
is beyond what you learn in residency.”
Keith says he’s excited to be part of
the new Breast Reconstruction Program
at NJMS. “We’re just getting it off the
ground,” he says. “We’ve done a few cases
using the techniques I learned in Belgium.
We’re trying to set up a program so that
every patient has access to this treatment,
whether they have insurance or not.”
In fact, Keith says, one of the reasons he
came to NJMS was “to provide a service
that a lot of people in New Jersey just aren’t
getting. Either they have the wrong kind of
insurance, or they don’t have enough. These
are big surgeries. They’re not something you
can do easily in private practice.”
It was his passion for teaching, Keith says,
that led him to choose academia over private
practice. “To be part of an academic resource
like Rutgers, and to teach residents and medical students — that’s what I really want to do.
Plus, I get to work with skilled partners who
have great training. They can help me, I can
help them, and we can work together.” ●
J O N ATHAN KEI TH
Falling in
Love With
Surgery
BY TY BALDWIN
J
onathan Keith, MD, didn’t exactly plan
on becoming a plastic surgeon. In fact,
Keith, who recently joined New Jersey Medical School (NJMS) as an assistant professor
in the Division of Plastic and Reconstructive
Surgery, hated biology in high school. “I
wanted to be a chef,” he says. “I was thinking about going to culinary school instead of
college. But my dad said, ‘Well…you could
think about college.’”
Ultimately, Keith enrolled at the University of Maryland, with a major in government
and politics. “But then I had a really great
professor for Biology 101,” Keith says. “He
12
P U L S E
SUMMER 2014
drew these elaborate pictures of photosynthesis. My notebook was filled with drawings
of the inside of a cell.” By the end of the
year, he had changed his major to neurobiology and physiology.
Keith graduated in December 2001, and
having made his peace with biology, was to
begin medical school at the University of
Pittsburgh the following fall. He worked that
spring at the Walter Reade Army Institute
for Research, and then, during his last summer before medical school, did what many
aspiring doctors would like to do: headed
to Los Angeles with his girlfriend (now his
wife) to work as an extra.
“I was in an episode of NYPD Blue and
also in a movie with Teri Hatcher,” he says.
“I didn’t get that many jobs. I was mostly
just hanging out, but it was fun to do something different.”
At Pittsburgh, Keith planned a career as
a urologist. But a research project he did
with a plastic surgery resident (“just for the
experience”) caught the eye of the department chair, who urged Keith to consider
the field. “He spent half an hour telling me
what plastic surgery was about,” Keith says.
“I still remember his description of it. He
To contact Dr. Jonathan Keith, call 973-972-5377.
ANDREW HANENBERG
njms people…do you know?
AR J U N R AJ
Just How
Brilliant Is
Arjun Raj?
BY MARYANN BRINLEY
E
ach year Popular Science magazine
chooses the “Brilliant Ten” from among
young scientists and engineers all over the
world, looking for individuals who are
“dramatically reshaping their fields and the
future.” To be singled out for the recent
class of stars came as a surprise to Arjun
Raj, PhD, a former researcher at the Public
Health Research Institute (PHRI) at New
Jersey Medical School (NJMS), who is now
analyzing “what makes cells tick” at the
University of Pennsylvania.
For his mentor Sanjay Tyagi, PhD, an
NJMS professor of medicine at PHRI, the
magazine’s choice was hardly surprising.
Almost from the beginning of working
together, the professor was amazed by the
grad student. “Even though they have not
met him in person, my lab’s next generation
of graduate students, and even my own son,
know all about Arjun because I admire his
intellectual abilities and continuously present
him as an ideal. I have no doubt that he will
be a future science star,” Tyagi says.
Raj, who had been studying abstract
mathematics at New York University when
he came to PHRI, was interested in applying
his theoretical math skills to biology. Tyagi
explains how unusual this is. “The cultures
of theoreticians and experimentalists are so
different that usually theoreticians can’t be
experimentalists. But that rare mixture coexists in this individual. Even though Arjun
had never touched a pipette before, he soon
became a guru in lab techniques. In fact, a
technique he developed here, single molecule
fluorescence in situ hybridization (sm-FISH)
is now used around the world.” This innovation is the basis for a commercial product
that continues to bring royalties to Tyagi’s
lab, and Raj’s published paper on the topic
has been cited hundreds of times.
For Raj, the years spent with this advisor
were “truly a magical time. Doing my graduate work there was the singular experience
that has made me the researcher I am today.”
He describes his PHRI mentor as brilliant and creative, as well as kind, generous
and unassuming. “I remember once being
bummed and stressed about my research
before walking into his office and slumping
in a chair,” says Raj. “But after 15 minutes of
talking, I bounced out of there with energy
and optimism and the work became exciting
all over again. Only a person true of heart
can imbue someone with that spirit. That is
Sanjay to the core.”
What brought Raj to the attention of
Popular Science, however, was not just a new
lab technique, but also a new understanding
of the inner workings of cells. Though each
cell in your body has the same DNA, how a
cell’s genes are arranged and expressed (and
how frequently) is critical. To see closely
what’s happening inside, Raj bathes cells
with fluorescent DNA probes, which line
up like Christmas lights along a roof, noted
Popular Science.
“Our work shows how the organization
of genes affects their function,” Raj reports.
“It’s like asking what the effects of rearranging the recipes in a recipe book might be.
This organization of genes matters, often in
unexpected ways.” Gene activity determines
whether a cell is healthy or sick as well as its
life span. “What I find exhilarating is that we
just don’t know what we’re going to see.”
Ever the proud advisor, Tyagi explains,
“For the first time, Raj showed that mammalian cells express their genes in randomly
initiated bursts that are punctuated by brief
(and random) periods of inactivity.” Raj
gleaned this dynamic view from static microscopic snapshots of RNA molecules (which
carry the genetic information from DNA),
through a powerful mathematical analysis.
What he has created is a new field of research
allowing cell biologists to see the subtle gene
activities.
Tyagi remembers how Raj wrote a powerful program to string together the idle computers at PHRI so that during the night they
would “shift through terabytes of microscopic
images and produce quantitative information
about gene activities by morning.” In fact,
when Raj left, the lab was at a loss.
“With him, I had entered the fascinating
world of quantitative biology that I couldn’t
navigate in his absence,” says Tyagi. The professor had to learn programming on his own
to continue the work of his student.
Since graduating in 2000 from the
University of California, Berkeley, with a
bachelor’s in both physics and mathematics
and earning his PhD from NYU in 2006,
Raj has received the National Institutes of
Health Director’s New Innovator Award in
2011 and other prizes have been piling up,
including a $2,400,000 NIH grant now
funding the work in his lab on RNA and
cancer biology.
Raj, like his mentor, remains modest
to his core. Call him “brilliant,” and he
responds with humor. Yes, family and friends
were proud of the Popular Science designation but he laughs about how his mother
first saw the article in a dentist’s office and
how lab mates joked about the magazine’s
cartoon image of him. “One guy started
waving it around before I could grab it.” He
admits, “I certainly didn’t expect to be on
anyone’s radar.” In fact, he says, “My only
hope is to be the same sort of mentor to the
people in my lab that Sanjay was and continues to be for me.” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
13
gsbs people…do you know?
SO U RAV SI NHA
Getting a Cancer Drug to Patients
Rutgers biomed student strives to market a promising new treatment
BY ROB FORMAN
W
hat if an experimental treatment for
an aggressive breast cancer had the
potential to save women’s lives, but nobody
could use it because there was no money to
develop and test it? With funding sources for
research and development more scarce than
in the past, it is not an unusual situation.
It’s a problem that Sourav Sinha, a Master’s
degree candidate at Rutgers Graduate School
of Biomedical Sciences, is tackling head-on.
Sinha leads a team that won first place
in its category this past March in the Breast
Cancer Startup Challenge, a worldwide competition sponsored by the Avon Foundation,
the Center for Advancing Innovation and
the National Cancer Institute. Competitors
were asked to take a drug that shows promise
in the laboratory — a powerful toxin created
and patented by scientists at the National Institutes of Health — and develop a business
plan to guide its development for potential
use in patients. With the competition won,
Sinha and his team have now begun work on
moving that plan forward.
Bringing a drug to market is a much more
daunting process than people might realize.
“We have this unique opportunity to get a
powerful treatment to breast cancer patients
who need it,” says Sinha, who aspires to be a
physician-researcher. “This is a new, exciting
avenue through which my team and I can
make a meaningful contribution to health.”
This drug is designed to kill individual
cells altered by the HER-2-positive gene mutation that is responsible for as many as 25
percent of all breast cancers. “The toxin is in
a very early stage of development right now,”
says Sinha, “but if it works it will be huge.”
That is where the need for a business plan
comes in. The drug’s inventors have shown
14
P U L S E
SUMMER 2014
it kills cancer cells in the lab, but in order
for it to work in people, an intricate transport system is also needed to carry the toxin
through patients’ bodies and deliver it to
diseased cells, while bypassing surrounding
healthy cells.
Choosing the right mechanism requires
an extensive knowledge of biochemistry. But
it also demands business sense: to negotiate
financial agreements with biotech companies
that have the expertise to construct the delivery system. Specialized components include
synthetic antibodies that are specifically engineered to seek out HER-2-positive cancer
cells, as well as “linkers” that would fuse the
toxin to the antibodies — as a space capsule
might be attached to a booster rocket — until just the moment when, inside the cell, the
toxin detonates.
If the product ultimately works, these
companies will see a share of what could be
substantial profits. Sinha and his team are
approaching venture capitalists and large
foundations — which they hope to convince
to put up the capital needed to fund both
the manufacturing process and the allimportant clinical trials.
And attacking HER-2-positive breast
cancer may be just the start. If, as Sinha
expects, the toxin can also be combined with
different antibodies that seek out other cancers, Sinha says the drug has “nearly endless”
cancer fighting potential.
“He’s an impressive young man,” says
Joseph Bertino, chief scientific officer at the
Rutgers Cancer Institute of New Jersey and
a professor of medicine and pharmacology
at Rutgers Robert Wood Johnson Medical School. Bertino, whose own research
focuses on targeted cancer therapies, is one
of several Rutgers faculty members who have
advised Sinha. “He has collaborators lined
up,” Bertino adds, “and I think he has a real
shot at it.” Sinha and his team have formed
a company, OncoLinx LLC, to help advance
their plans. The $5,000 prize they received
for winning the Challenge will help fund the
company’s operations.
Sinha’s foray into the business side of drug
development is a sign of rapidly changing
times. In the past, nearly all who earned doctorates in the biomedical sciences stayed in
academia. But now, Bertino notes, “some of
our best scientists are working with biotech
companies and big pharma. It’s important
for them to understand what industry is all
about, so we at Rutgers are trying to make
sure it’s part of their education.” ●
This article originally appeared in Rutgers Today.
ROB FORMAN
njms people…do you know?
AN A NATALE- PEREI R A
Never Lose
Hope
BY JENNIFER SALVATO DOKTORSKI
A
heart failure patient and frequent visitor
to the emergency room (ER) at University Hospital was homeless, could not speak
English, and lacked identification documents
when he was referred to the Healthcare Outreach, Prevention, and Education (HOPE)
Center about a year ago.
Working with Jeannie Garmon, the
center’s health educator, and the medical
team, the patient learned to understand his
medication regimen, changed his eating
habits, and began a modest exercise regimen.
Garmon also worked with the patient to
complete his Social Security and immigration forms and contacted a shelter manager
to help with his housing needs. As a result,
his number of trips to the ER was significantly reduced —one of the primary goals of
The HOPE team, left to right:
David Landry, Ana Natale-Pereira,
MD’96, Jeannie Garmon, and
Isaura Otero
ANDREW HANENBERG
HOPE, a collaborative program of Rutgers
New Jersey Medical School (NJMS) and
the University Hospital Ambulatory Care
Center.
“The HOPE Center works with very sick
patients who are confused about the health
care system and lack the necessary skills to
navigate it. We show patients that a team of
people is working to help them feel better,
and that gives them hope,” says Ana NatalePereira, an associate professor of medicine at
NJMS and the center’s leader.
Natale-Pereira completed her internal
medicine residency at NJMS and stayed on
as a faculty member to focus on the underserved. “I believe in the mission of caring
for our unique and very challenged, diverse
community,” she says.
The HOPE Center is one of many such
programs in which Natale-Pereira has been
involved. Established in April 2012 with
financial support from The Healthcare
Foundation of New Jersey, it was born out
of the need to address a gap in patient health
education and excessive use of the ER for
primary care services. It does that by reaching chronically ill patients who, for various
reasons —limited access to care, transportation barriers, behavioral issues, trust issues —
have disconnected from primary care. The
center, which exists “virtually” within the
Ambulatory Care Center Medical practice,
operates under the Division of General
Internal Medicine at NJMS, delivering a
comprehensive model of primary care.
“This is not a new concept. Many programs utilize comprehensive models of care,
but our patient populations are particularly
challenged and unique in their health care
needs,” says Natale-Pereira, who is also principal investigator of the center’s grant from
The Healthcare Foundation of New Jersey.
For example, before the center’s existence,
another patient, who suffered from back
pain and cardiac issues, visited the ER almost
monthly. As a HOPE Center participant, he
reconnected with primary care and received
assistance in filling out paperwork for health
insurance and Social Security benefits. Since
then, he has returned to the ER only once.
Garmon, who oversees the day-to-day
operations and organizes student participation, says: “I am truly proud of our work.
Every patient that we connect back to care,
every patient that we empower with education to understand and manage their medical
conditions, is a potential life we save.” Isaura
Otero, who supports patient recruitment,
and David Landry, whose communication
skills and patient education experience benefit patients, are vital members of the team.
“We have 73 patients enrolled in the
program,” says Natale-Pereira. “To date, 11
have not been back for emergency services,
and 60 patients have reduced ER visits by 30
percent.” Natale-Pereira says that residents
and doctors often refer patients who have
multiple chronic conditions and are frequent
users of the ER. Medical students are eager
to deliver healthy eating education sessions
and excited about the great service-learning
opportunities.
“It takes an enormous effort to change
behavior in patients, providers, and the
system as a whole,” says Natale-Pereira. “By
embedding the center into both the clinical
and educational missions of our institution,
we can expand on this concept and target a
larger cohort of patients in need.” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
15
njms people…do you know?
A
T HER ESA L. CH AN G , M A R I LA G E NNA R O , A ND VÉ R ON IQU E DARTOIS
Award-Winning Women
National Institutes of Health grants are never easy to win. The competition for
research money is fierce. Ask anyone who has labored over a submission. But
three NJMS faculty members make it look easy to the tune of $11.5 million
from the NIH. And there is more on the way.
16
P U L S E
SUMMER 2014
BY MARYANN BRINLEY
lthough women continue to be underrepresented in science, women researchers at the Public Health Research
Institute (PHRI) have made the science
world sit up and take notice. In fact, Theresa
L. Chang, PhD, Véronique Dartois, PhD,
and Marila Gennaro, MD, have secured
$11.5 million in new National Institutes of
Health (NIH) research grants. PHRI has
always made research excellence its top priority and excellent describes the work of these
three researchers, states David Perlin, PhD,
director of PHRI at Rutgers New Jersey
Medical School (NJMS).
Born in Taiwan, Theresa Chang, NJMS
associate professor of microbiology and
molecular genetics, began to study the role
of innate immunity in HIV transmission in
2002 when she was an assistant professor at
Mount Sinai School of Medicine. She joined
PHRI in 2010. Since then, she has been
working on the role of mucosal immunity
and the microbiome in the setting of sexually transmitted infections and hormone
changes associated with an increase in HIV
transmission. She received NIH funding for
this work. She has also examined human
peritoneal macrophages as potential reservoirs for HIV.
Approximately 34 million people are living with HIV worldwide and there were an
estimated 2.5 million new HIV infections
across the globe in 2011, according to the
World Health Organization (WHO). Sexual
transmission is the predominant mode of
infection. Because early immune responses
during acute infection may determine HIV
disease progression, Chang believes that
understanding innate immune responses to
HIV infection is crucial for developing effective prevention strategies.
The new five-year grant of $2,785,332
will fund a study of the role of Depo-Provera
in the spread of HIV. Chang and Zhiheng
Pei from New York University are the principal investigators. Depo-Provera, an injectable
birth control method commonly used in
Africa as well as the U.S., has been shown to
increase the risk of acquiring HIV. If use of
the hormonal contraceptive increases HIV
K E I T H B R AT C H E R
Major Grant Will Support Research
to Develop New Antibiotics
The National Institute of Allergy and Infectious
acquisition or transmission, it would have
profound implications for family planning
policies.
Chang and her colleagues will study her
hypothesis that injectable Depo-Provera
alters immune responses and cervicovaginal and colonic microbiomes, leading to
increased HIV acquisition and transmission.
Véronique Dartois is Belgian but arrived at PHRI in 2012 by way of Singapore,
where she had spent seven years with the
Novartis Institute of Tropical Diseases. Her
$3,138,294 NIH grant will allow her to
further pursue research in tuberculosis (TB).
“TB kills one person every 20 seconds, ”
she says.
The drug she is investigating, pyrazinamide, is a commonly prescribed TB medication, especially for patients with drugsensitive or drug-resistant disease, which
often occurs in conjunction with HIV. It
has a unique ability to shorten treatment
of active TB and latent infection but its
pharmacological mechanisms are poorly understood. Dartois surmises that TB lesions,
which are at the root of bacterial persistence
because they can reside in remote infection
sites, could be key. She will test the idea that
pyrazinamide reaches and kills persistent
populations residing in the lungs where most
drugs fail to go.
“For the successful treatment of pulmonary tuberculosis, drugs need to penetrate
complex lung lesions and permeate the
mycobacterial cell wall in order to reach their
intracellular targets,” she explains. “Most
currently used anti-tuberculosis drugs were
introduced into clinical use without considering the pharmacokinetic and pharmacodynamic properties that influence drug
distribution,” or how far a drug reaches and
how long it is effective in the body.
With a state of the art mass spectrometry
platform in her lab, Dartois is able to visualize drugs and metabolites in biological tissues. Her team can measure the levels of the
anti-TB agents in various lesion types and
across lung tissue and plasma to see where
and how long a drug is working to sterilize
infection. The results of her research could
ROB FORMAN
Diseases (NIAID) of the National Institutes of Health
(NIH) has selected infectious disease expert David
Perlin, PhD, executive director of PHRI, to lead
a major research effort aimed at developing new
forms of antibiotics to regain the upper hand over
deadly bacteria that have become resistant to
current treatments. With a five-year grant of up to $26 million, Perlin
will participate in the Centers of Excellence for
Translational Research (CETR), a public-private
partnership that brings together prominent scientists
from Rutgers as well as other institutions.
When modern antibiotics were introduced in the 1940s to help control deadly bacterial disease, they were greeted as wonder drugs. Now, bacteria have adapted and become resistant to
many of those drugs.
According to the Centers for Disease Control and Prevention, more than two million people
are sickened every year in the U.S. with antibiotic-resistant infections resulting in at least 23,000
deaths. With few new drugs being developed, many serious infections have become largely
untreatable.
Senior leaders of the research team assembled by Perlin include: Sean Brady, PhD, from
The Rockefeller University in New York City; David Alland, MD, and Joel Freundlich, PhD, from
NJMS; and Richard Ebright, PhD, from Rutgers’ Waksman Institute of Microbiology. The global
biopharmaceutical company Cubist is the first industry member of the consortium. The recently
formed Institute for Infectious and Inflammatory Diseases at NJMS will also play a key role in
the partnership. — ROB FORMAN
guide a more rational approach to designing treatment regimens that ensure drug
exposure at the site of an infection, not just
in cases of TB but in other diseases.
“This technology can be expanded to
a large variety of medications used for an
array of diseases,” she states. “It holds great
promise for the molecular imaging of many
biochemical and pathological changes.”
Dartois has another large, newly funded
NIH grant to examine other TB drugs.
Marila Gennaro, a native of Palermo,
Italy, started focusing on TB in the mid1980s when New York City was experiencing a resurgence of the disease. “At the time,
there were only a handful of labs across
the country working in mycobacteria,” she
remembers. The spread of TB was being
spurred by co-infection with HIV, which
was just emerging. Her most recent grant
of $5,523,914 will move the goal of an accurate, speedy, blood-based diagnostic test
for TB forward.
“TB is a global health problem,” she
states. “It’s one of the great killers of people
but if diagnosed early, you’re able to help.
What greater gratification can there be for a
scientist?” Gennaro and fellow PHRI faculty
members Yuri Bushkin, PhD, Richard Pine,
PhD, and Sanjay Tyagi, PhD, aim to take
this test into preclinical development.
“This test has the unparalleled potential
to distinguish between latent TB infection
and active pulmonary TB,” she states. What
also makes the project exciting is that this
technology may someday be applied to detect other infectious and even non-infectious
diseases.
“In my view, the new test will phase out
current testing, which has been around for
more than 100 years,” comments Perlin.
“Marila has worked nearly two decades to
understand the body’s response to TB infection and this innovative technology is a huge
leap forward. It will be used to screen tens of
millions of people each year.” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
17
njms people…do you know?
K EIT H AND SCOTT PA S I C HO W
A Tale of Two Brothers
Fighting cancer, supporting each other, and making the journey to becoming
physicians
BY MARY ANN LITTELL
Left to right: NJMS student
Scott Pasichow with his brother
Keith, a pediatric oncologist
T
wo boys grow up in suburban New
Jersey. They go to school, watch TV,
play sports, and tussle over the small stuff.
The family takes its abundant good health
for granted…until one of the brothers is
diagnosed with cancer. To hear this news at
any age is one of the most difficult things a
person can face. But when you’re only 15?
When cancer struck Keith Pasichow in
1996, “it was the worst day of my life,” he
says. His brother Scott, who was then 10
years old, agrees: “All I knew was that my
grandfather died from cancer. Now I was
afraid my brother was going to die.”
Keith’s memories of cancer are still fresh:
the intense pain, the fear that he would lose
his leg—where the large, malignant tumor
was located—and even worse, the fear that
18
P U L S E
SUMMER 2014
he would lose his life. Back then, there were
far fewer tools in the cancer arsenal, and a
much greater risk of dying.
He fought hard and survived. But his
recovery was difficult. He underwent treatment so rigorous that it kept him home from
high school his entire sophomore year. Now
18 years post cancer, his story has a happy
outcome. Ironically— or perhaps not—he’s
become a pediatric oncologist, choosing the
specialty that saved his life. Not to be left
out, his brother Scott is also on his way to
becoming a physician, currently in his third
year at New Jersey Medical School (NJMS).
The brothers are convinced that Keith’s
battle with cancer influenced them both
to go into medicine. “We were a close-knit
family, but my brother’s cancer brought us
even closer,” says Scott. “We were so focused
on his illness. It was a huge part of our lives.”
Keith’s cancer began with a sore, swollen
leg. At first the family thought it was muscle
spasms. His doctor did tests but couldn’t
find anything wrong. Keith, who loved acting and the theater, went to performing arts
camp that summer, where his leg continued
to ache and swell. There were visits to the
nurse and phone calls home, but he soldiered
on and finished out the session.
When he came home, his worried mother
brought him back to the pediatrician, then
to a pediatric orthopedist. After two days
of tests and scans, Keith was referred to the
Rutgers Cancer Institute of New Jersey.
There, a biopsy confirmed that he had osteosarcoma, the most common type of cancer
that develops in bone. Most osteosarcomas
occur in children and young adults and
frequently develop in the bones around the
knee — the location of Keith’s tumor.
Keith’s dreams for the future were put on
hold as he underwent a year of difficult treatment. First came 3½ months of chemotherapy, then he had surgery to remove most of
his femur—the long thigh bone — and many
muscles in the thigh. He had a cadaver bone
graft, but it failed to fully heal and fuse with
the remaining bone. In a second surgery, his
fibula, a bone in the lower leg, was moved to
his upper leg. The surgery was successful but
he continued to have pain and a severe limp.
He had to learn to walk again.
“It was a tough period and I remember
being severely depressed my entire sophomore year,” Keith says. “Amputation was
discussed as an option — either the entire leg
or a portion of it. I had a tremendous fear of
the unknown.”
Scott recalls the family spending days in
the hospital with Keith. “That’s when I began developing an interest in medicine,” says
Scott. “I had so many questions. Why did
my brother get sick? How does disease start?”
While Keith slowly recovered, life was
fairly normal for Scott. An enthusiastic but
not particularly proficient athlete, he tried
out for his school basketball team and didn’t
make the cut. The coach suggested that he
K E I T H B R AT C H E R
pursue his love of sports via another route:
the school’s student athletic trainer program.
Students received instruction in first aid
and fitness, then served as student athletic
trainers to the sports teams. “I loved it,” says
Scott. “It combined my interests in sports
and medicine and made me think about
athletic training as a career. It also got me
interested in emergency medicine.”
At 16, Scott joined the East Brunswick
Rescue Squad. “My mom wasn’t thrilled, but
I told her at least I wasn’t running into burning buildings,” he laughs. Along the way, he
became certified as an emergency medical
technician.
Graduating from high school, Keith
stayed close to home, attending Muhlenberg College in Pennsylvania. By now he
knew he wanted to become an oncologist,
but he didn’t have the energy to tackle a
rigorous pre-med curriculum. “I still had
pain and was taking medication,” he says.
“Many people who care about me, including my parents, advised me not to take on
too much. So I majored in my other love,
theater.”
Scott went to Penn State for a year, then
transferred to Rutgers, earning a degree in
exercise science and sport studies. “This
major prepares you to for a career in sports
medicine and rehabilitation, but by the end
of college I was I thinking about medicine
as a career,” he says. As an undergraduate he
joined the Rutgers EMS and went on ambulance runs on campus, at Rutgers sporting
events, and in the community.
By his senior year Keith was able to take
some pre-med courses. After graduating,
he finished his pre-med courses at Rutgers,
took the MCATS, and did well. He applied
to medical school and enrolled in Mount
Sinai School of Medicine, graduating in
2010. Following a residency in pediatrics,
he’s currently in the first year of a three-year
fellowship program at Columbia University
training in pediatric oncology, hematology,
and bone marrow transplantation. He plans
to pursue further training in palliative care
and neuro-oncology. He’s also pursuing a
master’s in public health.
Keith’s bout with cancer gives him a
special bond with his young patients. A
persistent limp causes him some difficulty
walking, so he uses a motorized scooter and
forearm crutch to get around the hospital.
“I feel joy and pride in being a physician
and helping children go through what I
went through,” he says. “But it’s more difficult than I ever anticipated. It brings back
memories, and I feel emotions I didn’t realize
Scott Pasichow skates with the NJMS Medwings. “Very few medical schools have hockey teams, and we actually have
two,” he says.
I still had.” When he tells his patients he
too had cancer, many don’t react. “They’re
more interested in the scooter, so I give them
rides,” he says. “But their parents listen. I
suppose my story gives them hope that their
children will be as fortunate as I was.”
“Being in medicine is something
we share and we talk about it a lot,”
says Scott Pasichow.
“Medical school is very challenging,
and my brother helped me learn
how to get through it.”
Scott followed in his brother’s footsteps,
entering NJMS in 2010. He plans to specialize in emergency medicine. “It’s fast-paced
and challenging,” he says. “You have to
know about every medical specialty and be
able to make quick decisions at a critical
juncture. I thrive under pressure.” He also is
an MPH candidate at the Rutgers School of
Public Health.
He’s still into sports and skates on the
NJMS hockey team, the Medwings. “It’s
a lot of fun,” he says. “Very few medical
schools have hockey teams, and we actually
have two. They’re made up of students and
faculty and play in different leagues. Once a
year we play against each other as a charity
fundraiser.”
Both brothers say the five-year age difference doesn’t seem as large as it did when they
were kids. “Being in medicine is something
we share and we talk about it a lot,” says
Scott. “Medical school is very challenging,
and my brother helped me learn how to get
through it.”
“My brother has always been there for
me,” says Keith. “He helped me get through
cancer, so how could I not help him?” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
19
njms people…do you know?
1
K EV IN CLARKE
Surgical Care Mission
Returns to Ghana
The trip was a true collaboration, including physicians and staff from NJMS,
University Hospital, and Newark Beth Israel Medical Center.
BY KAYLYN KENDALL DINES
T
he international surgical care mission to
Ghana didn’t get off to a good start for
a team of 17 health professionals. After a 12hour flight, the van taking them to a guest
house broke down, leaving them stranded on
the side of the road.
When they finally checked in, the surgeons, anesthesiologist, nurses and support
staff didn’t stay for long. The lights in their
rooms flickered off and on and the water
slowed to a drip, forcing them to pack up
and find lodging elsewhere. These setbacks
didn’t get in the way of their 10-day journey to treat nearly 100 Ghanaian patients
at Tetteh Quarshie Memorial Hospital in
Mampong-Akuapem.
“We pride ourselves on being prepared.
As surgeons, you plan for everything,” said
Kevin Clarke, MD, an assistant professor of
clinical medicine in the Department of
Surgery at New Jersey Medical School
(NJMS). “You try to anticipate every situation, but invariably things always happen
that you don’t expect.”
Clarke was the team leader for the International Surgical Health Initiative’s (ISHI)
second mission to Ghana. He believes
preparation was the team’s linchpin for success when performing about 50 pediatric and
adult operations over five days ranging from
hernias and hysterectomies to soft tissue
mass removal. This mission went smoothly
once they got settled. Breaks were rarely
plugged into their daily 10-hour shift at the
123-bed regional hospital, serving a population of 120,000.
20
P U L S E
SUMMER 2014
ISHI was founded in 2009 as a humanitarian, non-profit organization by Ziad Sifri,
MD, associate professor of clinical medicine
in the NJMS Department of Surgery, and
Asha Bale, MD, an attending surgeon at
Palisades Medical Center in North Bergen.
Through ISHI, these Executive Team members gave credentialed volunteers the chance
to provide surgical care to medically underserved families worldwide. Based in Colonia,
NJ, and Quebec, Canada, ISHI’s volunteers
delivered donated medical supplies, medications, and equipment during missions in
Ghana, the Philippines, Guatemala, Haiti,
Sierra Leone, and Peru.
NJMS general surgery resident Joyce
Alexander Bonitz, MD’09, who earned an
undergraduate degree from Rutgers, felt it
was a privilege to travel with the team for a
second time. A natural curiosity drew Bonitz
to her first ISHI mission to the Philippines
in January 2013, about six months after
marrying her medical school sweetheart, Paul
Bonitz, MD’12, a current NJMS urology
resident. Then, eight months after that mission, she put a research project on hold to
travel to Ghana with ISHI. “You’re sacrificing
for 10 days, but it’s totally worth it because it
makes you realize and appreciate everything
that you have.”
Clarke, who completed a general surgery
residency at University Hospital in Newark
before completing a surgical oncology fellowship at the City of Hope National Cancer
Center in California, said, “Pictures are worth
a thousand words.” ●
7
2
1. Kevin Clarke closing a surgical incision.
2. Left to right: Felicity Amponsah, RN,
and NJMS general surgery resident Joyce
Bonitz interviewing a patient.
3. The group in front of the Tetteh Quarshie
Memorial Hospital in Mampong, Ghana.
4. The surgical team: Kevin Clarke, local
surgeon Dr. Charles Asiedu, Bo Protyniak,
MD (Newark Beth Israel Medical Center),
Joyce Bonitz, Kamalakar Ayyagari, MD
(also from Newark Beth Israel).
5. Meeting with the Nana (tribal chief of the
Aburi region) Hon Otoobour Djan Kwasi.
6. Leslie Osei-Tutu, MD, anesthesiologist
and former NJMS anesthesiology resident,
with University Hospital OR nurse Hannah
Asare-Boateng, RN, overseeing a patient
during a surgical procedure.
7. Surgeon Kamalakar Ayyagari being
assisted by Bo Protyniak and Pushpa
Goel, RN, on a hernia operation.
5
4
3
6
STEPHANIE BURROUGHS AND KEVIN CLARKE
RUTGERS NEW JERSEY MEDICAL SCHOOL
21
Chirag D. Gandhi, MD’00, associate
professor of neurological surgery,
with patient Marjorie Carle.
22
P U L S E
SUMMER 2014
a pipeline to
r e c o v e ry
BY MARY ANN LITTELL
M
eeting Marjorie Carle for the first time, you might not
guess she’s 80. While her silver hair hints at her age, she
walks with the quick step of a much younger person.
She’s got a busy schedule, spending her days driving,
shopping and caring for her 86-year-old husband Bill, who suffers from
dementia, in their home in a retirement community in Lakewood, NJ.
“I’m blessed to be in pretty good health,” she says. “But last year I
wasn’t feeling so great. ”
Her problems began in early 2013 with earaches and debilitating
headaches, which quickly progressed to soreness all across her face. It
was trigeminal pain, a term used to describe serious, acute pain that
affects the trigeminal nerve, which carries sensation from the face to
the brain. Over time, the pain spread to her jaw and neck. Her left eye
drooped and she began seeing double. “Now I was afraid to drive,” she
says. “What was I going to do?”
Over the next few months she made the rounds of physicians. First
she went to an ear, nose and throat specialist, but he saw no sign of
infection or any other potential cause of the earaches. She next saw a
dentist, who found nothing wrong with her teeth or jaw, and then an
ophthalmologist, who sent her for an MRI. These results were sent to
her primary care physician, who called with alarming news: she had a
large aneurysm in her brain, behind her left eye.
JOHN EMERSON
An aneurysm is a weak area in the wall of a blood vessel that causes
it to balloon out. This weakening can be present from birth or caused
by disease or injury. Aneurysms are not always dangerous, but they
can leak or rupture, bleeding into the brain and causing stroke, brain
damage, or even death.
Carle’s physician said she needed to see a neurosurgeon as soon
as possible. He’d heard good things about the endovascular surgery
program at University Hospital, the primary teaching hospital for
NJMS, and referred her to Chirag Gandhi. He is one of two physicians
in the Department of Neurological Surgery at NJMS who is trained
in minimally invasive endovascular surgery. (The other is department
chair Charles Prestigiacomo, MD.)
Traditionally, aneurysms have been repaired in open craniotomy
procedures, which require cutting through the bones of the skull to
reach the brain. Clips are then placed on the aneurysm to close it.
While open procedures are still used, in the past 10 years minimally
invasive endovascular techniques have been developed to repair arteries
in the neck or brain. This type of surgery involves the introduction of
catheters into a large blood vessel, typically the femoral artery. Using
angiography, an imaging technique that visualizes blood vessels, the
catheters navigate through arteries to the treatment site, where a stent
can be positioned. Endovascular techniques offer the opportunity
RUTGERS NEW JERSEY MEDICAL SCHOOL
23
An aneurysm is a weak area in the wall of
a blood vessel that causes it to balloon out.
While aneurysms are not always dangerous,
they can leak or rupture,
bleeding into the brain and
causing stroke, brain damage
or even death.
for a less invasive procedure with faster healing. They are particularly
beneficial to elderly patients who might not survive the rigors of brain
surgery.
“Endovascular surgery is a small percentage of neurosurgery, perhaps
5 percent,” says Gandhi. “There are only about 30 neurosurgeons doing
these procedures in New Jersey.”
Standard stents and coils, tinier than the tip of a pencil, are used to
treat small, garden-variety aneurysms. The coils fill the aneurysm while
the stent stabilizes the artery and holds the coils in place. But what
happens when a physician finds an aneurysm that is very large, has an
exceptionally wide neck, or is situated on the curve of an artery? “For
these complex aneurysms, we use a Pipeline stent, like this one,” says
Gandhi, holding a small jumble of coiled mesh in his palm. While it
doesn’t look very high-tech, the device, recently approved by the FDA,
is an ingenious lifesaver, and Gandhi was one of the first neurosurgeons
in New Jersey to use it.
24
P U L S E
SUMMER 2014
The Pipeline’s design features a braided netting which
diverts blood flow from the aneurysm while still allowing
it to flow freely through the artery. The stent is threaded through the
carotid artery and positioned across the neck of the aneurysm. The
blood already in the aneurysm clots, stabilizing it.
“I used the Pipeline stent on Marjorie Carle’s aneurysm because it
was particularly large, and it has produced great results in other similar
cases,” Gandhi says.
Carle would agree. “Before the surgery Dr. Gandhi showed me the
aneurysm on my angiogram,” she says. “I could see right away how
large it was. He said I’d possibly had it for a long time, but it had to be
treated right away.”
She underwent the procedure on May 31, 2013, at University
Hospital. Gandhi threaded a catheter up her femoral artery to the
location of the aneurysm, where he first took additional angiogram
pictures that showed that the aneurysm had grown even larger in the
previous two weeks. He positioned and then deployed the Pipeline
stent. The procedure took two hours. “I had no pain at all,” she reports.
“In fact, I couldn’t believe I’d just had surgery. The incision in my groin
was remarkably tiny.” She stayed in the hospital intensive care unit
overnight and went home the next day.
Immediately following the surgery she noticed a dramatic
improvement in how she felt, except for some headaches. Gandhi says
headaches following this surgery are fairly common and resolve over
time. Carle is being followed with regular MRIs and angiograms to be
sure the aneurysm remains closed. The chance of recurrence is small,
says the surgeon.
A year later, Marjorie Carle is back to driving, cooking, caring
for her husband, and doing everything she did before the aneurysm
intruded. She considers Gandhi one of the most important people in
her life.
“How happy and thankful I am that I met him,” she says. “Otherwise
I might not be alive.” ●
JOHN EMERSON
Endovascular Stroke Treatment
A
s a detective with the Essex County Prosecutor’s Office, Roberta
Harper has faced her share of criminals, but nothing in her life
laid her as low as the major stroke she had in 2012. A member
of the Special Victims Unit, responsible for investigating sexual assaults,
elder and child abuse, and other serious crimes, she was on duty the
morning of November 20. “It was a Tuesday,” she recalls. “Apart from
all the demands of work, I was having a Sweet Sixteen party for my
daughter in a week. That morning I woke up with a horrible backache,
worse than labor pains. But I disregarded it because my back frequently
acts up when I’m stressed.”
She considered staying home but decided against it. It was her
supervisor’s birthday and the unit had organized a small celebration.
She drove to work, parked her car in the lot, and entered the building
with a co-worker, a clinical psychologist. Coincidentally, a security
guard was also nearby, securing a chain across the gate of the parking
lot. He held the building’s door open for the two women. “Usually I
walk into that building alone, but for some reason that morning there
were people around,” she says.
As she walked up the flight of stairs to her office, Harper began
feeling sick. “I told the security guard I didn’t feel well. I was dizzy —
like I was on a roller coaster,” she recalls, her eyes filling with tears. “My
body temperature rose until I was in a sweat. I was so hot! I heard a
droning sound, like an alarm. Then my hearing shut down.”
The security guard raced to Harper’s side and helped her sit on the
stairs. Then he went to get Alicia Seary, the unit’s sexual assault nurse
examiner. “I later learned that she had left the building just a short time
earlier to attend an all-day seminar, but returned to retrieve something
she forgot,” says Harper.
The nurse sat next to Harper and asked some simple questions: did
she know her name and where she was? When she didn’t get answers,
she quickly called for an ambulance.
“It was truly a miracle that my colleagues were there with me that
day,” says Harper. She remembers the nurse telling her that she was
experiencing total locked-in syndrome, a condition in which a patient
is aware and awake but cannot move, speak or see. This syndrome can
be caused by a stroke affecting the brain stem.
Harper was rushed to University Hospital’s (UH) Emergency
Department, where Chirag Gandhi and the Brain Attack Team waited.
This multidisciplinary team of stroke specialists is on site 24/7. Part
of the Stroke Center at University Hospital’s Neurological Institute of
New Jersey, they take their name from an expression commonly used to
describe stroke: a brain attack.
Harper had a basilar occlusion — a clot in her basilar artery, which
supplies the brain with oxygen-rich blood. “It was a massive stroke,”
says Gandhi. “The clot was preventing blood and oxygen from reaching
the brain. When she came in here she was hours away from dying.”
She was taken into surgery, where Gandhi threaded a catheter
K E I T H B R AT C H E R
through her femoral artery to the location of the blockage. He
administered the powerful blood thinner tPA (tissue Plasminogen
Activator) through the catheter directly to the clot. A standard treatment
for stroke, tPA breaks up clots that block blood flow. To be effective, it
must be administered within three hours of the stroke. He also used
a new generation of devices designed to remove large parts of the clot
with a vacuum suction, called Prenumbra mechanical thrombectomy.
Fortunately, the quick action taken by Harper’s colleagues got her to
the hospital within this short window.
During her hospital stay, Harper underwent physical therapy.
“When I stood up for the first time, I stumbled, and after taking only
a few steps, I was exhausted,” she recalls. “But by my third physical
therapy session, I could walk, open a door and climb upstairs. My
eyesight and hearing were also fine.” After a week in the hospital,
Harper went home. She did not need any outpatient physical therapy.
Remarkably, she went ahead with her daughter’s Sweet Sixteen. “I
took it easy,” she laughs. “It went well. We had a lot to celebrate!”
After several months of recuperation, Harper has made a full
recovery. She went back to work in August 2013. “There are a lot of
things I am thankful and grateful for in my survival,” she notes. “I’m
fortunate that my colleagues were nearby and that the ambulance came
quickly, and most of all, that I was cared for by Dr. Gandhi, the Brain
Attack Team, and the staff at University Hospital.” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
25
The
Newest
Virus Buster
BY EVE JACOBS
A six million dollar grant ($5,959,585 to be precise) is nothing to
sneeze at in today’s research world — especially when it comes at
a pivotal time in the development of a new drug. NJMS faculty
members Sergei Kotenko and Joan Durbin, working with a biotech
partner, pooled their research discoveries and scientific knowhow to
win this award from the National Institute of Allergy and Infectious
Disease. The grant was awarded under the funding opportunity called
“Partnerships for Development of Therapeutics and Diagnostics for
Biodefense,” which encourages collaboration between laboratory
researchers in academia and an industry-partner to develop drugs,
vaccines, technologies and diagnostics to respond to threats presented
by bioterrorism and emerging infectious diseases. The funding came at
a perfect time for this group.
26
P U L S E
SUMMER 2014
RUTGERS NEW JERSEY MEDICAL SCHOOL
27
Left to right: Sergei Kotenko, PhD, Russell
Durbin, PhD, and Joan Durbin, MD, PhD
Just ask Vince Smeraglia, executive director of Rutgers’ Office of
Technology Commercialization. He was so impressed by Kotenko’s
research that he asked him to present his findings at a New JerseyPennsylvania conference of biotech companies. Not only did Kotenko
win the award for best poster presentation, but a biotech company
showed immediate interest in developing interferon (IFN)-lambda3, a
discovery “with the potential to become a blockbuster drug,” according
to Smeraglia.
Interferon alpha and beta are well-known superheroes in the battle
against certain hard-to-combat viruses, like hepatitis B and C, and
cancers, such as leukemia, lymphoma and melanoma. Interferon beta is
also used to treat multiple sclerosis, an autoimmune disease. Interferon
was discovered more than 50 years ago, but first became commercially
available in 1986. (Commercially available interferon is predominantly
manufactured using recombinant DNA technology.) But it took a
scientist long-schooled and practiced in this field to look for and find
a new type with new properties —when few researchers believed there
were any more types of interferon to be discovered.
Kotenko, a professor of biochemistry and molecular biology at
Rutgers New Jersey Medical School (NJMS) and a researcher with a
decades-long portfolio in interferon research, was awarded a patent —in
partnership with the university — for IFN-lambda3 in 2010. His research
team, collaborating with investigator Grant Gallagher, PhD, identified
three novel, closely related interferons, named them IFN-lambda (IFNlambda1, IFN-lambda2 and IFN-lambda3), and discovered that “this
28
P U L S E
SUMMER 2014
new type of interferon signals through a different receptor complex than
interferon alpha and beta, yet its antiviral action is similar.”
“Interferon lambda has strong antiviral activity, like interferon
alpha,” Kotenko explains. “But interferon alpha acts on all cells of the
body, resulting in serious side effects.” The researcher says IFN-lambda
has been shown to cause fewer and milder side effects and is produced
in the body mainly in mucosal and epithelial tissue (which covers the
body and organs, lines the body’s cavities and forms glands).
“This is where you need the most antiviral protection because this is
where most viruses enter the body,” he states.
Interferon works by boosting the body’s innate immune response
to infectious agents and cancers. “In animal studies, this interferon also
has strong anti-tumor properties,” he says.
The work is moving along rapidly. It is now the beginning of year
two of the five-year grant. Smeraglia says in order to make the protein
more usable as a medicine, IFN-lambda3 needs to be modified and
produced according to good manufacturing practice (GMP) guidelines
for drug production established by the FDA. The team is concentrating
on that aspect now.
Kotenko’s finding is big. IFN-lambda1 was discovered by two
groups at the same time and is currently being developed by Bristol
Myers Squibb. The researcher says: “IFN-lambda3 has the strongest
antiviral potency amongst IFN-lambda. Also, the interferon produced
by recombinant technology mimics the IFN-lambda3 produced by the
body. Our product may be better.”
JOHN EMERSON
Kotenko’s NJMS group continues to investigate the many
interesting aspects of interferon lambdas. “Some of the biology is not
well known,” he explains. “As we work, more questions and research
directions emerge.”
High on the researcher’s list of exciting prospects is the potential for
IFN-lambda3 to play a role in biodefense. “We want to find out how
well it protects against respiratory and gastrointestinal viruses,” he says.
“It may work as a preventative against respiratory viruses such as SARS
and pathogenic flu viruses and could also be effective as a treatment
after infection with a virus.”
IFN-lambda3 may be a new player on the pharma scene, but its
potential is huge.
In fact, it could be the next “wonder drug”— perhaps even serving
as a prophylactic to flu during the flu season. Meanwhile its inventor
continues to humbly toil in the NJMS labs each day, working to find
out just how far-reaching IFN-lambda3’s medicinal effects might be. ●
Is There a Silver Lining to the Devastation of Superstorm Sandy?
M
ost New Jerseyans have nothing good
to say about Superstorm Sandy. But
Sergei Kotenko is among the few who do.
The force of Sandy drove a brilliant scientist
to his door and changed his research team
for the better.
Joan Durbin, an experimental pathologist with an MD/PhD from Rutgers
Robert Wood Johnson Medical School and
Rutgers Graduate School of Biomedical Sciences, and her husband
Russell, a virologist who often partners with her on research, were
firmly ensconced at New York University when Superstorm Sandy
hit this area on October 29, 2012. “Our labs were hit very hard,”
says Durbin. “We lost our mouse strains and all our cell lines. Years
of work were destroyed. It was tough.”
Life did not return to normal in their building after the storm
subsided. Researchers scattered—looking for suitable space to
continue their work. The Durbins came to RBHS Newark, where
they first moved into temporary quarters and then were invited to
stay. They accepted.
“There is a big emphasis on immunity to pathogens of all
kinds here, particularly respiratory pathogens. I have worked on
respiratory pathogens for a long time and knew a lot of the people
from meetings. I have a big group of colleagues here,” she says.
There was one colleague in particular whom she wanted to know
better. “I had read about Sergei Kotenko’s discovery and knew his
finding was huge,” she says.
In fact, Durbin herself had done years of research on alpha
interferon. She was interested in the question of why influenza
causes such a strong interferon response, but respiratory syncytial
virus (RSV), an infection that most often strikes children but can
also infect adults, does not. “There’s no vaccination for this disease.
It’s a big problem. We wanted to know why RSV is so good at
evading or inactivating the interferon response,” she says.
She was anxious to meet, and possibly work with, Kotenko;
and when that meeting happened, it proved fortuitous. Their
JOHN EMERSON
shared interest in the unique role of lambda interferon in lung and
epithelial cells cemented a partnership that has already yielded a
major grant and may soon win another.
“There are so many questions to be answered,” says Durbin.
“Lambda interferons probably have a unique role in the portals of
the body. They have to turn on quickly and turn off quickly. What
is their role in regulating immune responses?”
It is the basic biology of lambda interferons that intrigues her.
“Lambda is induced where alpha can’t be,” she says. “But why does
the body need two interferon systems with distinct functions? These
interferons are so important that the body did it twice.”
Durbin’s enthusiasms are many. She has funding to develop
a vaccine against RSV, which she hopes can also serve to protect
against otitis media, or middle ear infections, a major source of
misery for many children. Otitis media is often the result of viral
plus bacterial infections, she says. She is excited about working with
Kotenko and gaining a better handle on the anti-proliferative effects
that interferon has on many cell types.
But Durbin is also a pathologist and in that role she helps
researchers get specimens that are useful. “I see myself as a resource
in experimental pathology,” she says, “and, in return, I get to work
with people outside of my sphere.”
Her hospital work also means that she continues to be involved
with clinical disease. “It reminds me that there is so much that is
inexplicable in the human condition,” she comments.
“A researcher’s work is hypothesis driven. You see something you
don’t understand, you devise a theory and you test it,” she says. “As
a physician, you can’t make an assumption. You proceed along a
certain methodology and come up with a hypothesis at the end.
When you work at an intersection of the two, it’s great!”
And in her new professional life at NJMS, lambda interferon is
never far from her thoughts. “There are some powerful antivirals,
but our bodies develop resistance very quickly. Interferon lambda is
natural and it doesn’t make you as sick as alpha,” she says. “If only
we could develop lambda 3 into a broad-based antiviral, then the
world would be a much better place to live.” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
29
30
P U L S E
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Anne Mosenthal, MD
Woman
at the
TOP
By Eve Jacobs
Effecting positive change as a surgeon, teacher, researcher and leader. Serving as a role model for
future surgeons — female and male. Providing comfort and direction at the bedside of critically ill
patients and their families. Flying in the face of old established traditions that no longer work. And,
of course, teaching future surgeons the art and science of surgery. That’s what Anne Mosenthal is
about. She says hard work and supportive and amazing partners are the reasons she has excelled.
It’s 2014 and there are still only six women surgery chairs in all 141
medical schools in the U.S. Anne Mosenthal is one of them. As the
recently named head of the Department of Surgery at Rutgers New
Jersey Medical School (NJMS), she is a living, breathing example of the
changing face of this specialty. Was her goal to climb the steep ladder
to the very top of a male-dominated field? Absolutely not, she says. “I
set out to become a trauma, critical care surgeon.” Is she happy to be
there? Oh yes, she smiles.
Mosenthal exudes quiet determination and focus, but she’s nothing
like the archtypical hospital surgeon of bygone days. “The old ways of a
single man at the top of a department or operating room just don’t work
anymore,” she says emphatically. “It’s about building a strong team.”
That is exactly what she has set out to do in her leadership role at
JOHN EMERSON
NJMS and as a member of the highly touted University Hospital Level
1 Trauma Center surgical team that has earned a remarkable reputation
for saving those torn up by guns and near-fatal car wrecks. This woman
of action, a 1985 graduate of Dartmouth Medical School, says there
were just 15 women in her class of 65, and “less than a handful of them
chose surgery.”
“Surgery is not for women,” she remembers being told. “Well,
maybe plastics.” But plastic surgery did not interest Mosenthal at all.
She wanted the pace and demands of “taking care of really sick and
critically injured patients” and she wanted an academic career as well.
“When I was a medical student, my sense was that women in
surgery were pariahs, that they were taken less seriously than men, but
I was determined to defy the stereotypes,” she states.
RUTGERS NEW JERSEY MEDICAL SCHOOL
31
And defy she did — with eyes wide open. She applied to be a surgery
resident but remembers worrying if a “quiet, unassuming person,” like
her, would be accepted by “the classic surgical personality of the time —
confident, arrogant, never in doubt, usually right.” Lucky for her, the
University of Massachusetts Medical Center, where she was accepted
into a general surgery residency, “was very tough, but it was very tough
for everybody.”
She amends her statement a little: “It wasn’t professionally harder for
women, but it was personally harder. Many of the men were married,
and some had children, but very few of the women were married and
none had children.” With no limits on hours and “on call” required
every other night, Mosenthal says a social life was next to impossible.
Three of her fellow female surgery residents dropped out, leaving
just two women in her year. “It would have been much harder if we
didn’t have each other,” she says. The department had just one female
faculty member at the time.
“When I was a medical student,
my sense was that women in surgery
were pariahs, that they were taken less
seriously than men,” says Mosenthal.
“I was determined to defy the stereotypes.”
Mosenthal finished her residency in 1990 and fellowships in critical
care and surgical endoscopy in 1992, and was recruited to NJMS in that
year by founding chair of the Department of Surgery, Benjamin Rush,
MD. She describes him as a visionary, ahead of his time in recruiting
talented women and minorities into the department long before other
medical schools.
Life was busy. Not only were the surgeries long and challenging, and
the teaching responsibilities demanding, but by this time Mosenthal,
now in her 30s, was married to surgeon Peter Rice, MD, and they were
thinking of starting a family.
“It’s hard for women in surgery, particularly in the surgical
specialties,” she says. “The training is so long and women are just not
ready to give up their childbearing years.” She comments that there
is an ongoing perception of surgery being more brutal than the other
specialties, but “what is true is that the training for all surgical specialties
is more demanding in terms of time.”
When her own children came along in the mid- to late-’90s, the
pace of her life became even more dizzying. “There were many times
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SUMMER 2014
that I was gone from home for 36 hours at a time. If it hadn’t been
for my husband, who provided a lot of child care and took care of
everything when I wasn’t there, I would not have made it,” she states.
“This kind of partnership is rarely talked about, but it is such a crucial
element of success for women in demanding professions,” she says.
Professional camaraderie during the working years is difficult
to find for women surgeons, comments Mosenthal. “There are way
fewer women than men who are colleagues who have a home life and
children.”
Over the years, she developed that camaraderie with fellow trauma
surgeons, primarily men. But it was her professional partnership with
Patricia Murphy— an advanced practice nurse with a doctorate in
ethics and bereavement — and their creation of a palliative and endof-life care program that took her career in a new and personally
satisfying direction. Launched in 2000, the program answered a huge
unmet need of critically ill patients and their families and helped to
define Mosenthal as a pioneer and a surgeon whose humanity would
consistently be front and center.
“I have always liked to converse with patients and answer their
questions, but I felt unprepared to handle bereavement and the sudden
life changes of trauma patients and their families,” she says. “In reality,
13 percent of our trauma patients admitted to the surgical ICU will die,
many with unknown pain and suffering at the end of life, and many
with families in crisis.”
“Other patients will go on to have significant disability and impaired
quality of life,” she continues. “We saw that components of palliative
care — such as relief of pain and symptoms, good communication,
bereavement support and appropriate withdrawal of life support — are
essential to the care of trauma patients.”
“This has become one of the great services we offer here,” Mosenthal
says, “and it is one of my greatest contributions.”
The program — adopted in hospitals throughout the country—
helped to propel her into a leadership position locally and nationally. In
2011, she was asked by NJMS Dean Robert Johnson to lead the strategic
planning process for the medical school, a “very exciting effort” that
lasted a year and a half and “taught me the power of building a team.
We had a lot of different people on the team and a lot of opinions, and
our charge was to bring it all together,” she says.
Whether taking care of patients or working with a health care team,
Mosenthal’s style is participative and inclusive, and she strives to be
“direct, transparent, honest and fair. ”
This trauma surgeon calls surgery “the most intimate relationship.
Patients put all their trust in the surgeon.”
“There have been studies showing that women interact differently
with patients — they listen more and it’s better for the patients,” she
states. “Women bring that to the practice of surgery.”
“And women are better at relationships,” she says. “The critical mass
of women who have gone through medical school in the last number
of years has already changed the practice of medicine. Surgery is bound
to follow suit.” ●
ALUMNI FOCUS
news of special interest to njms and gsbs graduates
Message from the
Alumni Association President
PAUL BOLANOWSKI, MD’65
ALUMNI ASSOCIATION PRESIDENT
Dear fellow alumni,
I
wrote my first letter to you shortly after
the integration with Rutgers University
that occurred on July 1, 2013. Since then,
while discussions continue with the Dean’s
Office and the Rutgers University Foundation regarding our future relationship with
them, the NJMS Alumni Association has
maintained its dedication and commitment
to the work that we have supported for the
past 30 years.
We continue to fulfill our mission and
concentrate our efforts on our primary focus,
which is the support of our medical students
through scholarships and sponsorship of
student programs. Over the past few years,
despite economically challenging times, we
are proud that the Association has successfully supported an average of $150,000 in
scholarship awards that benefit more than
100 students each year. I extend my sincere
thanks to our alumni who have generously
ANDREW HANENBERG
supported the scholarship program in the
past and continue to do so now. It is these
committed alumni who deserve the credit
for our accomplished history of providing
support to our medical students and to the
university.
In addition to being president, I also have
the pleasure of serving as chair of the Alumni
Association Scholarship Committee. When I
read and review the student scholarship applications and essays, I am always impressed
by the caliber of students we have at NJMS.
Many of them not only excel academically
and match in some of the most competitive
and desirable residency programs, but also
actively participate in many SHARE (Student Health Advocacy Resources and Education) service groups that facilitate learning
opportunities in community health and
educational outreach programs in Newark
and surrounding areas.
One of the SHARE groups that the
Association supports is the Student Family
Health Care Center (SFHCC). Involvement in this group is an opportunity for the
students, under the supervision of faculty,
to learn from one another and provide free
health care to underserved members of the
Newark community. Upon graduation, our
students are thankful to have received a quality medical education that not only prepares
them for their residency and beyond, but
also teaches humanism in medicine and the
importance of serving the community.
This year our scholarship program boasts
49 Endowed Scholarships and 33 Named
Scholarships, in addition to the International
Study Scholarships for first- and fourth-year
students and Summer Student Research
Grants that are also awarded annually. With
the rapidly rising costs of education, I would
like to encourage all alumni to join me in
the support of our scholarship program and
Annual Fund, and help us make a difference
in our students’ lives. No matter how big
or small your donations may be, each one
counts and enables the association to assist
and impact our much deserving student
body as they pursue their dreams of becoming physicians.
I am always available to talk and encourage alumni to contact me, or the Alumni
Office staff, with questions about our scholarship program or to become involved in the
Alumni Association in another way. I can
be reached through the Alumni Office at
973-972-6864. ●
LIFETIME MEMBERSHIP
Scholarship
Opportunity
The Alumni Association of New Jersey
Medical School is proud to announce the
creation of The Alumni Association of
the New Jersey Medical School Lifetime
Member Endowed Scholarship. This
scholarship was made possible through the
generosity and commitment of our Alumni
Association Lifetime dues members. This is
a permanent scholarship that will provide
financial support, through Alumni Association Scholarships, to Rutgers New Jersey
Medical School students for perpetuity.
Alumni Association Scholarships are
awarded annually to medical students in
recognition of academic achievement and
community service. The Alumni Association invites New Jersey Medical School
alumni to support this permanent scholarship with a $1,000 membership payment. To add your name to the 196 initial
supporters, or for more information, please
contact Dianne Mink or Emily Birkitt in the
Alumni Office at 973-972-6864.
RUTGERS NEW JERSEY MEDICAL SCHOOL
33
ALUMNI EVENTS
NJMS Alumni Association Celebrates
Golden 50th Reunion Weekend
Members of the class of 1964
On the weekend of May 2 – 4, the Alumni Association had the pleasure of
celebrating a Golden 50th anniversary class — the class of 1964, which began
with 76 medical students. In 25 years, class size more than doubled. The class
of 1989, which gathered as well to celebrate their milestone 25th anniversary,
graduated 157 doctors. Alumni traveled from near and far to celebrate and reconnect with friends and colleagues.
Two alumni lectures, a luncheon and
campus tours kicked off the weekend on May
2. Glenn Fennelly, MD’87, chair of the Department of Pediatrics at Rutgers New Jersey
Medical School, delivered the 25th Annual
Stuart S. Stevenson Memorial Lecture for Pediatric Grand Rounds; and the 46th Annual
Harold Jeghers, MD, Memorial Lecture was
given by Steven Dubinett, MD’80, chief of
the Division of Pulmonary and Critical Care
at UCLA’s David Geffen School of Medicine.
A personalized tour of the Montclair
Art Museum was the featured activity on
Saturday afternoon. Saturday night’s Gala
Dinner started off with an elegant display of
wines and pairings and the rare opportunity
to taste and learn about wines from various
34
P U L S E
SUMMER 2014
regions. Guests enjoyed dinner, dancing, and
lots of reminiscing.
The Alumni Association has taken pride
in honoring alumni, faculty and friends for
their contributions to the medical school
since 1971. This year’s recipient of the Distinguished Professor Award is Dorian
Wilson, MD’82. This annual award recognizes an NJMS professor for outstanding
dedication to teaching New Jersey Medical School students. As a physician, he has
shown great respect, sensitivity, and commitment to his patients, and as director of
the Center for Humanism in Medicine at
NJMS, he conveys to students the importance of caring for the entire patient.
Wilson’s parents and son Brennis were pres-
ent to see him receive this special honor.
Joseph Benevenia, MD’84, chair of the
Department of Orthopaedics, received
the Charles L. Brown Award. This award,
dedicated to the memory of the first dean of
the medical school, is given to an individual
who has made outstanding contributions to
NJMS and who has demonstrated the high
ideals exemplifying the medical profession.
His family, friends and colleagues joined in
the celebration as he was honored for his
dedication to teaching and patient care.
The Honorary Alumnus Award, the
highest honor given to a non-alum, was
presented to Purnima and Shailesh Shah
in recognition of their generous support of
medical students through establishment of
an endowed scholarship. This permanent
scholarship benefits NJMS students as they
pursue their dreams of practicing medicine
and making a difference in their communities. The Shah’s children, Kushyup, Ravi, and
Radhika, all aspire to become doctors and
earn their degrees at NJMS. Ravi and
Kushyup are current students and will be
graduating in 2015 and 2016. Radhika will
join her brothers at NJMS this fall, after she
receives her pharmacy degree at the University of the Sciences in Philadelphia.
More recent graduates and future alumni
were also on hand to celebrate the honorees,
meet graduates of years past and learn what
life has been like for practicing physicians.
Alumni President Paul Bolanowski,
MD’65, looks forward with great anticipation to celebrating his 50th reunion. Please
join him in his effort to bring as many of his
classmates together as possible. He welcomes
your ideas and participation and hopes to
hear from you. To contact him, call the
Alumni Office at 973-972-6864. ●
Members of the class of 1964
Dr. Joseph Benevenia receiving his award from
Dr. Paul Bolanowski
Dr. Dorian Wilson with parents
Wilbur and Owena Wilson
The Shah family
Residents, guests, and future alum
Bonnie Buechel’17, seated center
PETER BYRON
RUTGERS NEW JERSEY MEDICAL SCHOOL
35
ALUMNI PROFILES
EL IZ A BETH ALG ER, M D ’6 4
Alger’s Amazing Adventure
BY MARYANN BRINLEY
T
he distance from Newark, NJ, to Doha,
Qatar, is 6,678 miles but Elizabeth
Alger, MD’64, made it with ease flying every
two weeks for three months in 2004. In fact,
that was the summer she officially retired
from NJMS. It was hardly a time of relaxation or withdrawal from the professional
adventures that had kept her engaged and
excited for 45 years.
“You go from New Jersey Medical School
to the Middle East when you are lucky
enough to have your phone ring with the of-
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P U L S E
SUMMER 2014
fer of an amazing opportunity,” she explains.
The invitation from Weill Cornell Medical
College to help set up the only American
medical degree program offered abroad came
via a headhunter. She didn’t dare hang up.
“At that point, I had been out of the dean’s
office for three years.” She had been associate dean of education for 20 years, where
she coordinated the initiative to revise the
curriculum and update teaching methods. “I
finally had some time for myself,” she recalls.
Curriculum consultations spent in far-flung
places like Egypt, Thailand, Uganda, and
Indonesia had given her a taste for international travel. But the thought of moving
overseas at age 65 was another matter.
Her destination for the next six years? Not
a piece of geographic or professional cake by
far. Not only was she pressed for time on this
project — the school had to be up and running in less than three months — but the position itself also had its challenges. Qatar is a
desert peninsula of 5,000 square miles where
economic activity had centered on camel
breeding, fishing and pearl diving until the
20th century, when the discovery of oil and
gas reserves put it at the top of the list of
the world’s highest per capita countries. She
would soon be living in a 4,500-square-foot
villa on a lagoon and flying business class.
She is often asked if she had to wear a long,
black abaya and head scarf or shayla. “No,”
she replies, “just modest western clothes.
The abaya is considered national dress and is
worn with a great sense of style, often with
embroidered cuffs and matching designer
shoes and handbags.” While she would be
making other cultural adjustments, “The
Qataris were extraordinarily polite, warm
and hospitable.”
In spite of the rush and the distance from
home, Alger was excited about the possibilities. “This was a start-up with a broad job
description that included student affairs and
faculty development. They were things I
had done. I also had a lot of respect for the
Cornell curriculum and faculty. Such good
people to work with. It was just amazing
how so much of what I had learned and
experienced in my career at NJMS would
translate to Qatar.”
She was so determined to make this new
position work that at first she juggled two
jobs, flying back and forth between Newark
and Doha that first summer. It was June
and “the first medical school class in Doha
was scheduled to start in August. I had to
interview and select prospective students
who came from throughout the Middle East
along with getting everything else set up.”
Continued on page 39
ANDREW HANENBERG
G ER AR D MALAN G A, MD ’8 7
Non-Surgical Solutions
to Sports, Spine and
Orthopaedic Injuries
BY TY BALDWIN
G
erard Malanga, MD’87, chose his career in medicine after a chance accident
at the Jersey shore that could have left him
paralyzed. He was a junior in college at the
time. “While bodysurfing, I dove through a
wave and hit a sandbar with my head,” he
recalls. “I broke my neck and was transiently
quadriplegic. Some parts came back more
quickly than others, but I didn’t move my
right hand for about three weeks.”
That accident was a transformational
experience for Malanga, who is a clinical
professor of physical medicine and rehabilitation at NJMS and a founder and partner
of New Jersey Sports Medicine and New
COURTESY OF GERARD MALANGA
Jersey Regenerative Institute (both in Cedar
Knolls, NJ). “I could have drowned or been
permanently paralyzed,” he says. “It’s just the
grace of God that spared me a lot of things.”
Malanga grew up in Montclair, NJ, the
son of Italian immigrants who’d come to
the U.S. from farming villages just south of
Naples. He always enjoyed the sciences and
as a high school student, considered a medical career, but it was just one option among
many. After his accident, however, Malanga
made his decision. He returned for his senior
year at Villanova University and matriculated at NJMS the following fall.
“Initially, I had thought I would go into
pediatrics,” he says. “But I wasn’t sure. I was
interested in neurology and also liked some
aspects of orthopaedics. One of my classmates was interested in physical medicine
and rehabilitation, and he told me about it
and gave me some information. At that time,
the field was not well-known, but when I
learned more about it, I knew that’s what I
wanted to do.”
After graduating from medical school,
Malanga did a year-long internship at Morristown Memorial Hospital, returning to
NJMS for a three-year residency in physical
medicine and rehabilitation. A fellowship in
sports medicine at the Mayo Clinic led to his
joining the staff there, and he stayed in
Minnesota for the next three years.
One of Malanga’s former mentors recruited him to return to NJMS and the
Kessler Institute for Rehabilitation (an
NJMS affiliate) in 1996. He’s currently a
clinical professor of physical
medicine and rehabilitation
at NJMS. “I wanted to come
back to New Jersey to practice
and teach,” he says. “It’s something I really enjoy.”
Atlas of Ultrasound-Guided
Musculoskeletal Injections,
Malanga’s most recent book,
was published earlier this year.
“Historically, physicians have
injected a variety of areas —
joints, tendons, ligaments,” he
says. “We’ve always done it by feeling around
and thinking we know where we are. But the
research shows that, doing it that way, we
miss our target up to 30 or 40 percent of the
time.”
Over the last five years, ultrasound technology has greatly improved. Visual imagery has been enhanced, and the machines
themselves are smaller and more affordable,
so that now they’re more readily available in
physicians’ offices.
“With ultrasound, you’re able to actually
watch the needle go exactly where you want
to place your medication,” Malanga explains.
“It enables you to be highly precise, to make
sure you get the medicine where you want it,
and not where you don’t. This textbook is the
first to include all these different procedures.”
The most common sports injuries,
Malanga says, are to the tendons. “The
treatment for such injuries has changed dramatically over the past few years and is still
changing. We used to inject cortisone. We’d
do that just based on touching a spot and
putting a needle into it.”
But recent research has shown that cortisone can be harmful to tendons. “Now we’re
able to use people’s own growth factors —
something called platelet-rich plasma — and,
with ultrasound guidance, we can inject
problem areas and deliver these growth factors precisely where they’re needed to reduce
pain and inflammation and help heal the
tendon.” From Olympic and professional
athletes all the way down to weekend warriors, “these treatments have become real
game-changers for patients at all levels.” ●
RUTGERS NEW JERSEY MEDICAL SCHOOL
37
ALUMNI PROFILES
Y V O N NE FAR NACI O , M D ’0 9
A Career That Fits
BY EVE JACOBS
Y
vonne Farnacio was a high school and
college science star who rolled into
medical school with no worries. She positively excelled at the basic sciences in her
first two years at Rutgers New Jersey Medical
School (NJMS) and sailed through Step 1 of
the Boards (United States Medical Licensing
Examination) that students generally take at
the end of year two. But not one of the clinical specialties in her third- and fourth-year
rotations called to her. She was lost.
“I almost quit medical school in my
fourth year,” she remembers. Instead, she
turned for advice to her friends and immediate family (all nurses — mother, father, sister
and brother) and they all told her to apply
for a residency in internal medicine, where
she would have a lot of options. She did that
and was accepted at Rutgers Robert Wood
Johnson Medical School (RWJMS) in New
Brunswick for a one-year internship.
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P U L S E
SUMMER 2014
It was during that year that she first
learned about the preventive medicine/public health residency at NJMS. She applied
and was accepted; and started the program
in July 2012. It proved to be a good fit. “I
am very interested in chronic disease and injury management, particularly prevention—
but I didn’t know this residency program
or specialty even existed,” she says. “Our
medical system is not structured to prevent
disease.” She completed the residency program in June 2014.
Farnacio was the third resident to choose
an eight-week integrative medicine rotation
jointly offered by NJMS and the Rutgers
School of Health Related Professions as part
of her NJMS residency program. “I didn’t
know what integrative medicine was when I
started,” she states. “What I learned is that it’s
not yoga or acupuncture or what we typically
think of as alternative medicine. It’s about
working with patients and their caregivers to
deliver a full range of therapies — psychological, social, physical, preventative. It’s really an
approach to patient care that is different from
what most physicians are accustomed to.”
She points out that some physicians are
so focused on physical symptoms that they
may miss some things that a patient is trying
to tell them. “And patients are shy to discuss
what’s really going on in their lives — and
what other therapies they are trying. Most
people in the U.S. use some nontraditional
care,” she says.
Farnacio advocates incorporating emotional and social well being, values and
patient perspectives into the health care
treatment plan. “If a patient wants to use
an alternative or complementary therapy,
physicians need to try to understand that,”
she comments.
The integrative medicine rotation will
change the way she practices medicine — she
is quite sure. “When I meet patients, I’ll first
ask what matters to them,” she muses. “For
instance, you can’t just tell an overweight
person to lose weight. It won’t usually work.
Now, I would try to incorporate patient
values into motivating behavior changes. If
the person is very family-minded, I might
suggest that weight loss could translate into
more years to spend with grandchildren.”
She points out that preventive medicine
doctors are the lowest paid, but have the
most job satisfaction and are the least likely
to burn out. For Farnacio, the opportunity to spend the time to get closer to her
patients is pivotal to her choice of specialties.
“In occupational medicine, I think that will
be possible,” she says. “I also like the detective work — being out in the field investigating a disease cluster or outbreak.”
Farnacio started a two-year fellowship in
occupational medicine — a subset of preventive medicine — at RWJMS in July. Occupational medicine focuses on preventing,
evaluating, and treating health issues caused
by the workplace environment.
“I didn’t think I could fit into the health
care environment and the role of being a
doctor,” she concludes, “but now I do.” ●
K E I T H B R AT C H E R
CLASS NOTES
Elizabeth Alger
Continued from page 36
The most pressing task was replicating the
Cornell New York curriculum hour for hour,
activity for activity. The clinical skills lab had
to be renovated and a standardized patient
program set up. The pathology professor
tackled the enormous job of scanning hundreds of microscope slides so students could
access them by computer. “We also had to
arrange for lectures to be sent by streaming
video or for faculty to visit from New York.
It was such a scramble but the nicest thing
about it was that everyone was so committed to making the program work. I didn’t
need to beg for anything to get done and the
speed with which it all happened was amazing.” They started with 18 students and class
sizes are now in the mid-40s.
When the Qatari students were ready
for clinical training in a hospital at the end
of year two of med school, Alger realized
that local physicians weren’t experienced in
American teaching methods. She reached out
to Stanford because it had the best clinical
faculty training program. “I looked at their
model and wrote to the director explaining
what had to be done and fast.” In her letter,
Alger asked, “How would you like to train
six of us here in Qatar for a month?” The
reply: Of course.
Doing workshops with physicians at the
hospital was great fun. “They had a wonderful sense of humor and there were lots of
laughs during the role-play scenarios,” she
recalls. Few of the hospital physicians are
Qatari although that will change as the Cornell graduates join their ranks. Most doctors
in Qatar come from elsewhere in the Middle
East and having done postgraduate training
in the United Kingdom or the U.S., English
is the common language. Some are longtime
residents of Qatar while others, like Alger
herself, are on short-term contracts. “The
different backgrounds of the people I worked
with made the time there so much richer.”
Friendships were close between Alger and
her colleagues, Ibrahim and Samar, who ran
the clinical teaching workshops. When she
and two Qataris went to Stanford in 2008
for a refresher course, the three made an
overnight road trip to Yosemite National
Park. “Ibrahim took over driving and after a
stop for junk food, he turned the radio dial
until he found a country music station.”
Later, Alger learned that he had done his
fellowship in Texas. And when they returned
to Doha, Alger was invited later to the wedding of Samar’s niece, which offered her “a
glimpse into a highly privileged lifestyle.”
The last time the three met was in 2010
but they still exchange greetings at holidays.
“They wish me Merry Christmas and I wish
them a Blessed Eid,” she says.
At age 75, Alger is still a wise presence on
the Newark campus where she teaches as a
clinical professor of medicine. Looking back
on her adventures, she says, “You can’t call
medicine just a career. It’s a stepping stone
to so many other possibilities, to anything.”
For her, Qatar was the high point. “It was
uniquely rewarding and offered so much.” ●
1960s
William Boutelle, MD’67, writes that he retired
from the position of Chief of Staff at the Northampton, MA Veterans Administration Medical Center in
2005. He has since been working as a general psychiatrist at ServiceNet in Northampton and as a geriatric
psychiatrist for New England Geriatrics.
James F. Mayhew, MD’69, who practices in Jackson,
MS, is double board certified in anesthesiology and
pediatrics, and just recently became a Lifetime Member of the Alumni Association–NJMS.
Charles F. Mess, MD’64, and wife Marilyn, of
Olney, MD, traveled to NJ to celebrate the 50th
Anniversary and wrote us to say that they had a truly
great time.
James Phelan, MD’68, continues to teach Advanced
Trauma Life Support and has an adjunct professorship at the University of Texas Medical Branch at
Galveston, TX, teaching Aerospace Otolaryngology.
Leo M. Pisculli, MD’60, writes that he is still practicing at the age of 80.
1970s
Serena Friedman, MD’75, and husband Michael are
the parents of four daughters and are producing wine
at the Four Sisters Ranch in Paso Robles, CA. They
also lecture on the health benefits of wine.
1990s
Join the Alumni Association of
New Jersey Medical School
General Dues
$75.00
Resident in Training
$15.00
Lifetime Membership
$1,000.00
Visit njms.rutgers.edu/alumni, click on Alumni
and Alumni Association and then Online Dues
Payment to pay your dues online.
The Lifetime Membership is being offered to our
alumni as a means to perpetuate the goals of the
Alumni Association and enable its members to
sustain their support in a more meaningful way.
All categories of membership will afford you the
opportunity to keep connected with us. You will
continue to receive all membership benefits,
including Pulse magazine, information about upcoming events and reunions, and on-site library
privileges.
Alumni Association of NJMS, 185 South Orange
Avenue, MSB–B504, Newark, NJ 07101–1709.
Photos are welcome. You can also send your news
via e-mail to: [email protected] or fax
us at 973-972-2251.
Carla Martin, MD’97, is a med-peds physician at
the Blackstone Valley Community Health Center in
Pawtucket, RI, working with the underserved. She
has 6-year-old twin sons and a 9-year-old daughter.
2000s
Imran Khan, MD’04, PhD, has been promoted to
medical director at Janssen Research & Development
LLC, of Johnson & Johnson, in Raritan, NJ. Dr.
Khan is also an admissions interviewer for NJMS.
IN MEMORIAM
Ken B. Carnevale, MD’94, passed away in
November 2013. He practiced ophthalmology with Ophthalmic Consultants of Long
Island and was an assistant clinical professor of
ophthalmology at the New York Presbyterian
Hospital in Manhattan. As a student at NJMS,
he was elected to the Alpha Omega Alpha
Honor Medical Society. He is survived by his
wife, Sima, and two daughters.
RUTGERS NEW JERSEY MEDICAL SCHOOL
39
focus on philanthropy
Bringing
Health Care
to the
Homeless
BY CYNTHIA M C CHESNEY
I
n 1984, a small group of Episcopal
churches from Newark and the suburbs
joined together to help found The Apostle’s
House, a shelter dedicated to the needs of
homeless women and their children. (It has
since developed into a full social services
agency.) Thirty years later, one of those
churches, Christ Church in Short Hills,
is beginning a unique collaboration with
Rutgers New Jersey Medical School (NJMS)
and other community partners to make it
possible to provide homeless women and
children with on-site primary and preventive
health care services at the shelter. Named
“The House Calls Project,” it will operate
as a satellite of the medical school’s Student
Family Health Care Center (SFHCC).
The idea originated about a year ago
when Josephine Orrico, then a second-year
NJMS medical student and volunteer at The
Apostle’s House, chatted with a fourth-year
student who had helped set up and
organize a satellite clinic
at Fairmont Health Services, a homeless shelter.
Orrico, who volunteered
at The Apostle’s House as
part of the NJMS Humanism Center’s studentoutreach activities, realized
that with some work, a
similar satellite could be set
40
P U L S E
SUMMER 2014
From left to right: Josephine Orrico, NJMS Class of 2015, Reverend Tim Mulder of
Christ Church, Cynthia McChesney, formerly of Rutgers University Foundation, and Judy
Bennett, executive director of The Apostle’s House, in one of the newly refurbished
patient rooms. Orrico and Bennett are holding tiles created by children from both the
shelter and the church that are part of the church’s fundraising efforts for this program.
up at The Apostle’s House — and in this
case it could serve pediatric patients, as well
as their mothers. Orrico took her idea to
Cynthia McChesney, formerly of the Rutgers
University Foundation, and together they
started to plan.
A few months later, Orrico and
McChesney, together with Judy Bennett,
executive director of The Apostle’s House,
went to Christ Church in Short Hills to present the plan after the Sunday service. Some
of the parishioners had been part of the shelter’s founding 30 years before, so there was
already some interest. But when the group
heard about Orrico’s idea from the student
herself, the excitement grew.
Several members of
the church made donations that same day.
Within a few weeks, the
church— through a commitment of outreach
grants and proceeds from
a rummage sale — had
pledged more than
$25,000 to help get the
program started. Before
long, other community supporters appeared,
all attracted by the vision of medical school
students providing primary and preventative health care services to homeless mothers
and their children. One of those community
groups, the Carpenter’s Club — a group of
expert craftsmen and craftswomen — volunteered their time to do all of the renovations,
from painting to carpentry, for free.
Renovations were recently completed, and
later this summer, the first “House Calls”
will begin. “This was a wonderful way for
our church to help change lives in Newark
by providing seed money to get this program
started,” says Dr. Timothy Mulder, rector
of Christ Church, “and it’s so exciting to see
what can be created when different groups
work together toward a common purpose.”
Fundraising in support of this outreach
program to the homeless continues and is
necessary in order to fund ongoing physician
supervision. To donate to the house calls
program, go to http://support.rutgers.edu/
housecalls or contact Dale Evanson at
973-972-9474. ●
ThE paTh is
slighTly DiffErEnT.
ThE gOal is ExaCTly
ThE samE.
New Jersey Medical School is now part of one of the
nation’s largest research universities, a move that
enhances the school’s core mission of innovation and
excellence in education, discovery, patient care, and
community service.
When you give to the medical school, you can still
designate your gift to support the same programs and
initiatives. And now your contributions, which are
channeled through the Rutgers University Foundation,
also support Our Rutgers, Our Future, the university’s
historic $1 billion fundraising campaign.
Contact Dale Evanson at 973-972-9474,
Or visit support.rutgers.edu/rbhs to learn more.
185 South Orange Avenue
Newark, New Jersey 07103
http://njms.rutgers.edu
Non-Profit
Organization
U.S. Postage Paid
Rutgers University
Permit 5287