From dancersto divas, pianoprodigies topop stars, aWeill Cornellcenter offersspecializedcare for artists

weillcornellmedicineTHE MAGAZINE OF WEILL CORNELL MEDICAL COLLEGE AND WEILL CORNELLGRADUATE SCHOOL OFMEDICAL SCIENCES

SPRING 2010

CommandPerformance

VISIT OUR NEW

Discoveries that Make aDifferenceCampaign Website

www.weill.cornell.edu/campaignLearn about the exciting research at Weill Cornell Medical College.

Read about the generous donors supporting our new Medical Research Building and their latest gifts to the Medical College.

Find out how you can help advance medicine and enhance health by giving to research at Weill Cornell.

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weillcornellmedicineTHE MAGAZINE OF WEILL CORNELL MEDICAL COLLEGE AND WEILL CORNELLGRADUATE SCHOOL OFMEDICAL SCIENCES

SPRING 2010

26 THE SHOW MUST GO ON

BETH SAULNIER

At Weill Cornell’s Center for the Performing Artist, pros in a variety offields can find comprehensive care. Established in 2008, the Centeroffers the expertise of some thirty specialists—treating conditions thatmay seem arcane to laypeople, but can threaten a career.

32 THE PIONEERS

ANNA SOBKOWSKI

Ten years ago, the Medical College graduated its first class trained in aproblem-based curriculum, a radical departure from traditional medicaleducation. Weill Cornell Medicine checks in with Class of 2000 alumni,who reflect on their roles in the vanguard of a new era.

38 THE HARD PART

BETH SAULNIER

More medical schools are teaching new MDs how the American health-care system actually works. Weill Cornell is ahead of the curve; it has longrequired fourth-years to take a two-week clerkship in health policy, offer-ing insights into such topics as Medicare and prescription drug costs.

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Weill Cornell Medicine is produced by the staff of Cornell Alumni Magazine.

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Beth Saulnier

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Published by the Office of Public AffairsWeill Cornell Medical College and Weill

Cornell Graduate School of Medical Sciences

WEILL CORNELL SENIOR ADMINISTRATORSAntonio M. Gotto Jr., MD, DPhil

The Stephen and Suzanne Weiss Dean,Weill Cornell Medical College; Provost for Medical Affairs,

Cornell University

David P. Hajjar, PhDDean, Weill Cornell Graduate School

of Medical Sciences

Myrna MannersVice Provost for Public Affairs

Larry SchaferVice Provost for Development

WEILL CORNELL DIRECTOR OF PUBLICATIONS

Michael Sellers

WEILL CORNELL EDITORIAL ASSISTANT

Andria Lam

Weill Cornell Medicine (ISSN 1551-4455) is produced four times a year byCornell Alumni Magazine, 401 E. StateSt., Suite 301, Ithaca, NY 14850-4400for Weill Cornell Medical College andWeill Cornell Graduate School ofMedical Sciences. Third-class postagepaid at New York, NY, and additionalmailing offices. POSTMASTER: Sendaddress changes to Public Affairs, 525E. 68th St., Box 144, New York, NY10065.

Cover photograph: Fotosearch

2 DEANS MESSAGESComments from Dean Gotto & Dean Hajjar

6 LIGHT BOXBoning up

8 SCOPETanzanian president speaks. Plus: GHESKIO wins $1 million GatesAward, sleep center gets new digs, international affairs office established,new Sackler Prize, and a novel surgical imaging system.

12 TALK OF THE GOWNQ&A with Dean Sheikh. Plus: cancer vaccine, the drawing board, royalhonors, eye-opener, valve replacement, night at the opera, cultural com-petency, buddy system, a rare syndrome, and student party planners.

44 NOTEBOOKNews of Medical College alumni and Graduate School alumni

46 IN MEMORIAMAlumni remembered

48 POST-DOCOn the chopping block

DEPARTMENTS

2 W E I L L C O R N E L L M E D I C I N E

Our Global Mission

Deans Messages

Antonio M. Gotto Jr., MD, DPhil, Dean of the Medical College

What struck me most about PresidentKikwete was his genuine concern for the peopleof Tanzania. He demonstrated this concern whenhe and his wife took the bold step of undergoingHIV tests on national television to destigmatizetesting and promote public health. While thismay seem almost passé in our modern culture, itwas a monumental step forward in Tanzania,where suspicion over HIV testing and treatmentis rampant.

President Kikwete also made clear his eager-ness to bring high-quality medical education toTanzania so its citizens can study to become doc-tors and nurses and, in time, treat their fellowTanzanians. “Most certainly I can appeal to you,and to other prosperous countries around theworld, to send us doctors and nurses,” he said.“As helpful as that would be, it is only a tempo-rary solution. We need medical schools in ourown country so that our young people can trainto become doctors and nurses. This is the onlyway our country can have a chance at long-termsurvival.”

I assured President Kikwete that Weill Cornellis committed to teaching and practicing medi-cine in a global context, and that we cherish ourrelationship with the people of Tanzania and thelearning opportunities that have grown from ourcollaborative work at Weill Bugando UniversityCollege of Health Sciences and KilimanjaroChristian Medical Center, where many of ourstudents spend a summer rotation. While theremay be a temptation to imply that they aremerely privileged medical students spending asummer in Africa to “help out,” this is most def-initely not the case. Returning students tell mewhat a life-changing experience it is to practicemedicine in less-than-ideal conditions—discover-ing that without MRIs or lab tests, they mustdepend on their Weill Cornell training to helptheir patients. It is literally life and death inmany cases, and that experience changes themfor the better.

One thing is certain: enhancing the visibilityof global health at Weill Cornell reinforces themessage that the fusion of social justice andmedicine is not just a casual pursuit, but a legiti-mate concern for tomorrow’s doctors and med-ical leaders. As I told President Kikwete, we arecommitted to helping our neighbors, both nextdoor and around the world.

I had the honor and pleasure of meeting HisExcellency President Jakaya Kikwete of theUnited Republic of Tanzania on April 16.

President Kikwete came to Weill Cornell at theinvitation of students in our Global Health pro-gram to speak at a Grand Rounds about the sig-nificant health-care challenges facing Tanzania.

President Kikwete did not mince words whenexplaining the realities of health care in hiscountry: one doctor for every 2,000 citizens in acountry of 43 million people; more than1,400,000 people, 10 percent of them children,living with HIV/AIDS; close to 100,000 deathseach year from AIDS; and the disturbing realitythat deaths from curable diseases such as malar-ia and dysentery are commonplace.

AMELIA PANICO PHOTOGRAPHY

Foreign relations: Tanzanian President Jakaya Kikwete (left), Dean Gotto, and WeillCornell Director of Spinal Surgery Roger Härtl, MD.

Building for the Future David P. Hajjar, PhD, Dean of the GraduateSchool of Medical Sciences

The end of the academic year is alwaysgreeted with enthusiasm at an institu-tion of higher learning, as students

and faculty conclude their work and look forwardto a little relaxation and reflection.

This year, however, the faculty and staff ofWeill Cornell Medical College and GraduateSchool of Medical Sciences are looking forward tosomething much more exciting than a few weeksoff. On May 26, Weill Cornell changed the land-scape of scientific discovery by breaking groundon its new Medical Research Building. Located on69th Street between York and First Avenues, this480,000-square-foot facility will have sixteen pro-gram floors and become the hub for significantlyexpanded bench-to-bedside research initiatives.

With this one facility, Weill Cornell doublesits current research space—a level that took 100years to attain. The pace of research will now beaccelerated; breakthrough treatments that willsave lives and the prevention of disease will bewithin our grasp. The leading minds who willusher in these breakthroughs will be attracted toWeill Cornell because of this tremendous capitalimprovement. Initially, thirty new scientists willbe recruited to work in this building, fosteringfurther collaboration with Ithaca and other insti-tutions around the world.

But Weill Cornell is hardly erecting an ivorytower of biomedical education. The very businessof science is to identify and solve some of theworld’s most complex problems. That noble call-ing cannot be fulfilled if researchers are lockedaway from the world they are trying to help. So,as excited as I am about the new MedicalResearch Building, I am just as thrilled when ourgraduate students act as ambassadors of sciencefor the next generation of researchers.

For example, PhD candidates Romulo Hurtadoand Steven Lianoglou recently led David Coneely’seleventh-grade advanced biology classes atBrooklyn International High School in an excitingexperiment. It focused on transforming bacteriawith a Green Fluorescent Protein (GFP) plasmidunder the control of a sugar-inducible gene switch,which related to the topics of bioengineering andtranscriptional regulation that the students hadrecently learned about in class.

The session started with Lianoglou giving abrief lecture on the history and functions of GFPand how it relates to gene switching. He and

Hurtado stressed that this was a chance for thehigh schoolers to put science to use. “Today youwill get to work with something someone wonthe Nobel Prize for,” Hurtado told them. “You cango home and say, ‘I worked with GFP today.’”

On 69th Street, Weill Cornell is building theresearch building of the future. And in Brooklyn,David Coneely and his fellow teachers are train-ing the next generation of scientists. It is thatcombination of premier facilities and humanbrainpower that will enable us to discover newand better ways to treat disease, relieve humansuffering, and save lives.

Next generation: Grad studentsSteven Lianoglou (left) andRomulo Hurtado led an experiment for an eleventh-grade biology class.

JOHN ABBOTT

T H E P R O M I S E O F P E R S O N A L I Z E D C A N C E R T R E A T M E N T

While practicing as a clinical oncologist, Ari Melnick, MD, grew frustrated by thelimitations of chemotherapy. Now working with a multidisciplinary team of scientists under his leadership as director of Weill Cornell’s Raymond andBeverly Sackler Center for Biomedical and Physical Sciences, Melnick focuses onindividualized therapies based upon a tumor’s particular biology.

Cells contain complex commands—called “epigenetic” instructions—beyondthe genetic code, and unlike the DNA sequence, the epigenome can change inresponse to such factors as age, food, chemicals, and inflammation. Humantumors harbor extensive epigenetic abnormalities, which may explain why tumorsbehave differently from normal tissues.

Working under this premise, Melnick and his colleagues recently identified amolecule necessary for the functioning of a protein, called BCL-6, that causes themost common type of non-Hodgkin’s lymphoma. “BCL-6 mediates its cancer-causing actions by attaching to other proteins,” says Melnick. “Traditionally, protein-protein interactions have been viewed as being too difficult to block withsmall-molecule drugs.”

Melnick’s team identified a critical “hot spot” offering promise for designing an effective drug and then created an inhibitor specific to the BCL-6 protein. The compoundrepresents a new class of drugs. In animal trials, Melnick says, “we observed almost complete tumor regression.” It was also non-toxic and significantly prolonged survival.

“This means that if given as a therapeutic agent, the compound would be unlikely tohave ill effects on healthy normal cells, and therefore would not be expected to have signif-icant side effects,” Melnick says. And since emerging data implicates this protein in othertumors, this new class of drugs could benefit many patients beyond those with non-Hodgkin’slymphoma. “I fully expect these approaches to revolutionize the diagnosis and treatmentof cancer in the near term, and lead to more potent and less toxic treatments,” he says.

The three researchers featured here are among those at Weill

Cornell Medical College offering profound hope to patients

diagnosed with some of our most daunting diseases. The College’s

Discoveries that Make a Difference Campaign is focusing on

bench-to-bedside translational research that promises to lead to

breakthroughs in prevention, treatment, and even cures. The heart

of the Campaign is the new Medical Research Building that will

double our research space and make possible even more

collaboration among scientists such as these.

Discoveries that Make a Difference

‘I fully expect these approachesto revolutionize the diagnosisand treatment of cancer.’

ARI MELNICK, MD Associate Professor of Medicine,

Division of Hematology and Medical Oncology,

Director, Raymond and Beverly SacklerCenter for Biomedical and Physical Sciences

H O P E I N T H E B A T T L E

A G A I N S T A L Z H E I M E R ’ S

By establishing a link between vascular health and neurological disorders, CostantinoIadecola, MD, is turning current understanding on its head and laying the groundworkfor new ways to diagnose and treat stroke, dementia, and Alzheimer’s. “There’s an interesting revolution going on,” says the George C. Cotzias Distinguished Professor of Neurology and Neuroscience. “The world is kind of turning upside down.”

Iadecola and his neurobiology research group, now located in Weill Cornell’s newestlaboratory facility, the Gertrude and Louis Feil Family Research Building, were the firstto discover that whenever something threatens the cerebral blood supply, such as hyper-tension or an injury, it increases the brain’s susceptibility to neural diseases. “We foundthat even before the neurons start to suffer in these mouse models of Alzheimer’s, theblood vessels of the brain stopped working correctly,” Iadecola says. “So this suggeststhat the blood vessels play a role in Alzheimer’s—not as a consequence of neuronal problems, but as a primary event. It’s the blood flow that comes first, especially at the onset of the disease, when treatments have the greatest chance of success.”

The major implication of his work—that Alzheimer’s is not just a disease of neurons—has enormous potential for treatment and prevention. “If you want to prevent it,” saysIadecola, “you need also to prevent blood vessel problems, because that’s part of the cause.”

For more information on opportunities for giving to theCampaign, please contact Lucille Ferraro, Campaign Director,at 646-962-8721 or at luf2003@med.cornell.edu.

Please visit our web site at www.weill.cornell.edu/campaign

‘This study will have a majorimpact on the treatment of anyblood-related disorder thatrequires a stem cell transplant.’

SHAHIN RAFII, MD Arthur B. Belfer Professor in Genetic

Medicine, Professor of Medicine, Directorof the Ansary Stem Cell Institute, Howard

Hughes Medical Institute Investigator

‘There’s an interesting revolution going on. The world is kind of turning upside down.’

COSTANTINO IADECOLA, MDGeorge C. Cotzias Distinguished

Professor of Neurology and Neuroscience

A S T E M C E L L B R E A K T H R O U G H

Shahin Rafii, MD, developed the groundbreaking concept that both tumors and organsrecruit stem cells hibernating in the bone marrow in order to build new blood vessels.

This spring—on the road toward making stem cell therapy widely available—Rafii announced that his lab had discovered a way to culture adult stem cells by usingendothelial cells, the vascular system’s most basic building blocks. The researchers also discovered that endothelial cells could not only propagate stem cells but instructthem to create differentiated forms, such as immune cells, platelets, and red and whiteblood cells. “This study will have a major impact on the treatment of any blood-relateddisorder that requires a stem cell transplant,” says Rafii, the Arthur B. Belfer Professorin Genetic Medicine, Director of the Ansary Stem Cell Institute, and a Howard HughesMedical Institute Investigator.

Rafii’s research sets forth the innovative concept that blood vessels are not just pas-sive conduits for delivery of oxygen and nutrients, but are also programmed to maintainand proliferate stem cells and their mature forms in adult organs. Rafii says theseadvances “establish a new arena in stem cell biology” and “highlight the potential of vas-cular cells for generating sufficient stem cells for therapeutic organ regeneration, tumortargeting, and gene therapy applications.”

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Light Box

Student bodies: On Accepted StudentRevisit Weekend inApril, prospectivemembers of the Classof 2014 got a closerlook at the MedicalCollege as they decided whether toaccept Weill Cornell’soffer of admission.Their stops includedthe Gross Anatomylab, where theywatched dissections—some even opted towield a scalpel—andgot a tour from associate professor of clinical anatomyEstomih Mtui, MD.

6 W E I L L C O R N E L L M E D I C I N E

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8 W E I L L C O R N E L L M E D I C I N E

At Global Health Grand Rounds, TanzanianPresident Chronicles a ‘Daunting’ Task

ScopeNews Briefs

T he president of Tanzania visited WeillCornell in April, describing hisnation’s health-care achievements andchallenges in a Global Health Grand

Rounds Lecture. “Medical supplies as simple asbandages, gloves, syringes, sterile needles, andmany others which you take for granted here inAmerica are scarce,” President Jakaya Kikwetetold his listeners. “This complicates the work ofhealth practitioners and affects the quality of theservices they lend.” Kikwete has worked to makequality health care available to people in devel-oping countries; in an effort to destigmatize HIVtesting, he even took the unusual step of beingscreened for HIV on national television. As hetold his audience, many hurdles remain toimproving care in the developing world. “Therearen’t many medical schools to train doctors, ornursing schools to train nurses and other healthprofessionals,” said Kikwete. “Sadly enough, thefew that we have don’t enroll many students. It

Aid for Africa: President Jakaya Kikwete told his audience that the key to improving medical care indeveloping nations is for the countries to train more native-born health professionals.

follows therefore that the challenge of closingthe gap of health professionals is dauntingindeed.”

The Medical College has especially close tiesto one of the few institutions that train health-care professionals in Tanzania: Weill BugandoUniversity College of Health Sciences, whichgraduated its first MDs in 2008. Its foundersinclude Father Peter Le Jacq, MD ’81, a physicianand Maryknoll priest, and it is named in honorof Medical College foremost benefactor SanfordWeill. Numerous Weill Cornell students havegained clinical and research experience at theCollege’s affiliated Bugando Medical Centre aswell as the nation’s Kilimanjaro ChristianMedical Center. “The problems facing Tanzaniaare not ours alone,” Kikwete said. “They arehumanity’s challenges, but through the relation-ships and partnerships we’ve built here at WeillCornell and elsewhere, we are facing and over-coming those challenges.”

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Gates Foundation HonorsGHESKIO With $1 Million PrizeThe Bill and Melinda Gates Foundation hasgiven its 2010 Gates Award to the Weill Cornell-affiliated GHESKIO clinic in Haiti. The honor,which recognizes the clinic’s efforts to aid earth-quake survivors, carries a $1 million prize. Thewinner was chosen from 179 nominees by ajury of international health leaders.

“No organization deserves this recognitionmore than GHESKIO,” U.S. Health & HumanServices Secretary Kathleen Sebelius said at theannouncement, during a World HealthAssembly symposium. “It has been a pioneer indeveloping comprehensive HIV/AIDS research,training, and services in Haiti. And in the imme-diate aftermath of the January earthquake,GHESKIO responded by opening its doors,mobilizing its staff, and working side by sidewith U.S. medical and surgical teams to providerelief to the people of Port-au-Prince.”

While the devastation from the earthquakehas largely faded from the daily news, GHESKIOhas continued to help refugees while maintaining treatment of its regular patients. In the weeks followingthe disaster, GHESKIO aided some 7,000 homeless Haitians camped on and near its grounds in downtownPort-au-Prince, offered emergency surgery and rehabilitation care to 3,000 trauma victims, provided TBscreening and treatment for 2,000 people, and continued HIV services for 22,000 patients. The clinic hasbeen updating the Weill Cornell community via reports on the website of the Department of Global Health(weill.cornell.edu/ globalhealth), which has been raising funds for the ongoing relief effort.

“On the GHESKIO campus, we have provided basic necessities including shelter, security, nutrition,water, sanitation, education, jobs, and primary medical care,” the clinic announced in its March 22update. “Every family now has a tent and clean water. Each person has been vaccinated, and we screeneveryone in the camp daily for signs of communicable disease, and provide primary health-care servic-es.” The clinic has also offered supplementary food to pregnant women and children under five and pro-vided residents with employment opportunities such as digging drainage ditches and collecting garbage.

GHESKIO has been fighting a constant battle against the spread of multi-drug-resistant TB, a majorconcern given the city’s crowded living conditions and the difficulty of keeping patients on treatment reg-imens amid the chaos of the rebuilding effort. “A measure of success of the GHESKIO ‘refugee camp’ willbe the speed with which we return people back into their own, ideally healthier, communities and closethe camp,” the clinic said in the update, noting that most residents came from the 100,000-person Villageof God neighborhood across the street. “As we rebuild, we will improve the health of the entire neighbor-hood by improving nutrition, clean water, sanitation, and education.”

GHESKIO was founded in 1982 by Jean Pape, MD ’75, a native Haitian who is now a professor of med-icine, and his mentor, infectious disease professor Warren Johnson, MD. “It started with a rehydration unitfor infants, progressed to AIDS/TB, and continues with the earthquake and its devastation,” says Johnson,director of the Weill Cornell Center for Global Health. “The challenges never diminish, but continue to bemet by the indomitable spirit of GHESKIO and its partners. The award is a hard-earned honor.”

International Affairs Office EstablishedDean Antonio Gotto, MD, has announced the establishment of an Office of International Affairs, whosemission is “to identify and create opportunities to expand Weill Cornell’s tripartite mission globally.” TheOffice will be guided by a business advisory board comprising the Overseer Committee on InternationalAffairs, led by Ambassador Hushang Ansary, and a medical advisory board, made up of key leaders in aca-demic medicine and global health. Jeanie Faulkner, assistant secretary of the Board of Overseers, will leadthe Office’s administrative and operational components. “During the remainder of this academic yearand into summer, I have asked Ms. Faulkner to initiate plans for the Office, including a survey and anumber of small group meetings, in order to identify interests and ideas for expanding our global mis-sion,” Gotto announced. Members of the Weill Cornell community are encouraged to e-mail their ideason strengthening the Medical College’s global outreach to internationalaffairs@med.cornell.edu.

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Temporary homes: Therefugees at GHESKIO havebeen provided with tents,clean water, and medical care.

WARREN JOHNSON, MD

1 0 W E I L L C O R N E L L M E D I C I N E

Scope

Surgery clinical fellow Elaine Cheng,MD, named an associate scientific advis-er to the journal Science TranslationalMedicine.

Ophthalmology chairman DonaldD’Amico, MD, elected president of theClub Jules Gonin. Limited to the world’smost distinguished retinal specialists,the society is named for the Swiss pio-neer in retinal surgery.

Joseph Fins, MD, chief of the Division ofMedical Ethics, and public health professorInmaculada de Melo-Martín, PhD, whoserved as guest editors for a special issue ofthe journal Technology and Society. Theyjointly wrote an introduction and eachcontributed essays.

Pediatrics chairman Gerald Loughlin, MD,named senior associate dean for interna-tional clinical program planning. He willwork closely with Qatar’s Sidra Medicaland Research Center to guide developmentof WCMC-Q programs at the facility.

Surgery chairman Fabrizio Michelassi,MD, who served as the Oliver H. BeahrsVisiting Professor of Surgery at the MayoClinic in February. His duties includedleading Surgical Grand Rounds.

Medicine professor and GHESKIO co-founder Jean Pape, MD ’75, winner ofthe Carlos Slim Award for LifetimeAchievement in Research for his effortsto combat HIV and other infectious dis-eases in Haiti.

TIP OF THE CAP TO. . .

Rest stop: In late March, the Center for Sleep Medicine marked the opening of its newhome, an 1,800-square-foot facility on East 61st Street. It features twelve hotel-qualityrooms—with private bathrooms, cable TV, and wireless Internet—where patients stay forovernight sleep studies. A joint effort of the medicine, neurology, and neurosciencedepartments as well as the Division of Pulmonary and Critical Care Medicine, the Centertreats sleep disorders arising from such conditions as apnea, restless-legs syndrome,stress, and more.

JOHN ABBOTT

Gastro Center EstablishedThanks to $65 million from the HelmsleyCharitable Trust, NYP/Weill Cornell hasestablished a Center for Digestive Care offer-ing innovative treatments for numerousconditions from obesity to gastrointestinalreflux to colon cancer. The Center willemphasize integrated care, with nurse coor-dinators guiding patients from initial diag-nosis through treatment and recovery. It willoffer programs dedicated to colon and rectalsurgery, gastrointestinal health, inflamma-tory bowel disease, and more, as well ashousing a state-of-the-art endoscopy suite.

Weill Cornell, Columbia toAdminister New Sackler PrizeA major gift from the Mortimer D. SacklerFoundation has established an annual awardin memory of its namesake, a pioneer indevelopmental psychobiology who passedaway in March at age ninety-three. To beawarded every two years by the two SacklerInstitutes for Developmental Psychobiology—one at Weill Cornell, the other atColumbia—it will recognize researchers whohave advanced understanding of how earlybrain development influences the mind andbehavior throughout life. Weill Cornell willpresent the first $100,000 prize in 2010, withthe institutions alternating biennially; win-ners will give Grand Rounds at both schoolsand lead workshops at both institutes.

Building a BiomedicalNetworking SystemWeill Cornell is one of the partners in a$12.2 million project to create a system tonetwork researchers across the country,allowing biomedical scientists to shareinformation and find collaborators. Theproject, called VIVOweb, expands on a sys-tem created at Cornell’s Ithaca campus in2003 as a life sciences networking service.(Located at http://vivo.cornell.edu, itdirects users to researchers as well as grants,publications, facilities, undergraduatemajors, graduate fields, and more.) TheVIVOweb effort is led by the University ofFlorida, with Cornell University andIndiana University, Bloomington, as majorpartners; Weill Cornell will serve as animplementation site. The project was fund-ed by the NIH’s National Center forResearch Resources as part of the ObamaAdministration’s economic stimulus plan.

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FROM THE BENCH

Can Vitamin B3 HelpPrevent Spinal Damage?With a $2.5 million grant from the New YorkState Spinal Cord Injury Research Board, WeillCornell scientists are exploring the efficacy of avitamin B3 precursor to prevent paralysis whenadministered at elevated levels. The naturallyoccurring substance, nicotinamide riboside, hasalready been proven to protect against celldeath and axonal degeneration in cultures andmodels of spinal cord injury. Researchers willconduct a lab study to see how well it works oncells stressed to the point that they will diewithin several hours; in a separate project, sci-entists at the Weill Cornell-affiliated BurkeRehabilitation Center will test it in mice withspinal injuries. “We hope to show that a naturalcompound that can be produced cheaply andefficiently could be the key to preventing per-manent injury,” says Anthony Sauve, PhD, associate professor of pharmacology. “We alsobelieve that the compound would be perfectlysafe to use in humans, since it is a vitaminthat has not been shown to have negativeeffects on the body when artificially elevated.”

Smoking Leads toSubstance Abuse in TeensAttitudes toward smoking affect the chancesthat adolescents will use drugs or alcohol, newresearch has found. “If teenagers feel smoking issocially acceptable and widely practiced, theyare much more likely not only to smoke, butalso to drink and possibly use marijuana,” sayslead author Jennifer Epstein, PhD, assistantresearch professor of public health. The findingsvaried according to gender: girls are more heavi-ly influenced by the attitudes of their closepeers, while boys were affected by their largerage group, not just their friends. “While the dif-ferences between how boys and girls are influ-enced by these social factors are subtle, theycould help us develop new gender-specific edu-cational tactics for preventing these behaviors,”she says. The work was published in the Journalof Child and Adolescent Substance Abuse.

A Genetic Link BetweenHeart and ThyroidIn work published in Nature Medicine,researchers have discovered that mutations ofthe proteins KCNE2 or KCNQ1—already knownto be involved in arrhythmias—may also causethyroid problems. “It has long been known that

the thyroid influences cardiac function and cardiacarrhythmias,” says senior author Geoffrey Abbott,PhD, associate professor of pharmacology in medi-cine, “but our findings demonstrate a novel genet-ic link between inherited cardiac arrhythmia andthyroid dysfunction.” The discovery was based ontests with mice engineered to lack the KCNE2gene. As Abbott notes, “Much additional work isrequired before we can fully understand howinherited mutations in the genes coding theseproteins affect human thyroid function, how thisin turn influences the health of the human heartand other tissues, and how useful our discoverieswill be in developing therapies to treat thyroidand thyroid-related human disease.”

Why Statins Work Better forSome PeopleThe ability of statins to protect against both highcholesterol and colorectal cancer varies accordingto individual genetics. An article in CancerPrevention Research by associate professor ofgenetic medicine Steven Lipkin, MD, PhD, and col-leagues reported that statins are not as effectivein about 44 percent of Caucasians because theyhave inherited a particular gene variant. Theresearchers were testing the hypothesis thatpatients who don’t see a drop in cholesterol onstatins also don’t benefit from the drugs’ recentlydiscovered cancer-protecting properties. “Giventhat approximately 25 million individuals world-wide currently use statins, we anticipate this dis-covery may prompt development of more precise,personalized, and cost-effective cancer risk reduc-tion strategies,” Lipkin says.

In Praise of the Digital RxIn a study of more than 7,000 prescriptions—roughly half of them electronic, the other halfwritten by hand—Weill Cornell researchers foundthat the old-school versions were seven timesmore likely to contain errors. They discovered thatnearly two in five of the prescriptions, written byproviders in community practices, included errorssuch as incomplete directions or a missing quanti-ty. “Although most of the errors we found wouldnot cause serious harm to patients, they couldresult in callbacks from pharmacies and loss oftime for doctors, patients, and pharmacists,” sayssenior author Erika Abramson, MD, assistant pro-fessor of pediatrics. “On the plus side, we foundthat by writing prescriptions electronically, doctorscan dramatically reduce these errors and thereforethese inefficiencies.”

Lyden Protégé Named Intel FinalistA high school student mentored by pedi-atric cardiology professor David Lyden, MD,PhD, was named one of forty finalistsnationwide in the prestigious Intel ScienceTalent Search. Rachel Cawkwell, a senior atByram Hills High School in Armonk, NewYork, spent two summers plus time duringthe academic year working under Lyden,learning lab techniques and developing herown research. Her work for the Intel com-petition involved studying how tumor cellscommunicate with white blood cells to pre-vent them from fighting cancer. As Lydensaid of Cawkwell in her Intel submission:“In the history of my lab, there has neverbeen a student at the high school, universi-ty, or medical school level as gifted as she.”

Cardiology Professors EditClinical TextsFaculty in the Division of Cardiology haveco-edited two books reviewing clinical top-ics in the field. Published by DemosMedical, the volumes are Topics in StructuralHeart Disease and Topics in Arrhythmias andIschemic Heart Disease. They’re part of theEmerging Concepts in Cardiology Series,edited by Craig Basson, MD, PhD, directorof cardiovascular research at Weill Cornell,and cardiology chief Bruce Lerman, MD.

NYP Embraces SurgicalImaging SystemNewYork-Presbyterian Hospital has installedfive Siemens Artis zeego medical imagingsystems—improving safety and outcomesby providing faster, more accurate 3-Dimages of the body than conventionalmethods. The new technology could funda-mentally change surgery, offering a betterway to assess patients, devise surgical plans,and provide more targeted treatment.

“This technology is a major step for-ward,” says Jeffrey Milsom, MD, chief ofcolon and rectal surgery at NYP/WeillCornell. “Previously, to obtain such images,we had to bring patients to a separate radi-ology suite. Now, high-quality imaging isavailable right in the operating room, giv-ing us an amazingly clear picture of thepatient’s anatomy from any angle.” Thefirst hospital in the U.S. to use the Artiszeego for neurological and colorectal sur-geries, NewYork-Presbyterian has more ofthe systems installed than any other med-ical center in the world.

1 2 W E I L L C O R N E L L M E D I C I N E

Talk of the GownInsights & Viewpoints

Javaid Sheikh joined Weill Cornell MedicalCollege in Qatar in 2007 as vice dean forresearch. A native of Pakistan, he earnedhis MD from Lahore’s King EdwardMedical College and an MBA from GoldenGate University in San Francisco. He cameto WCMC-Q from Stanford, where hecompleted his residency and two research

fellowships before serving as an associate dean andpsychiatry professor. Sheikh (his name, as he likes toput it, is pronounced like “shake and bake”) becameinterim head of the Qatar campus in early 2009,succeeding founding dean Daniel Alonso, MD. Hewas appointed to the post on a permanent basis inJanuary following an international search. He livesin Doha with his wife, Asma, and two children.

Weill Cornell Medicine: The Qatar branchgraduated its first class of MDs just two yearsago. What are the challenges of leading such ayoung institution?Javaid Sheikh: The biggest challenge is that weneed to put our name out, both for residencyprogram directors to become more familiar withus and to establish clinical exchanges with otherprograms in the U.S. We need to get the wordout that we are recruiting first-rate faculty andthey are publishing in journals like Nature andthe New England Journal of Medicine. You have tobe patient. We are creating history as we go, butthat is part of the excitement. In a larger way,we’re part of the renaissance of science and high-er education in this part of the world.

WCM: What do you see as WCMC-Q’s greateststrengths and weaknesses?JS: The strength is obvious, which is that this isthe only branch campus of an American medicalinstitution in this region. The weakness I view asa challenge, which is to attract world-class, first-

rate faculty. We have started that process, and itwill continue for several years.

WCM: Could you describe WCMC-Q’s five-year strategic plan, which you’re now chargedwith implementing?JS: Our vision is to fully integrate our tripartitemission for education, research, and clinicalexcellence. We also want to get internationalaccreditations in postgraduate training and forour affiliates, Hamad Medical Corporation andSidra Medical Research Center. We want to createan international hub for collaboration and, inaddition to producing physician leaders, con-tribute significantly to the biomedical workforcein Qatar.

WCM: How might we see closer collaborationbetween the students and faculty of the Dohaand New York campuses?JS: We need to have much better studentexchange programs with both New York andIthaca. Now that we have research capacity, weneed to provide fellowship opportunities—if stu-dents want to experience another culture, theycan come here for clinical rotations and research.We have close relationships with some facultyresearchers in New York, but we need to domore. We also can establish centers of excellence,which can be jointly funded and managed. Forexample, Dean Gotto and I have been talkingabout an international center on obesity, dia-betes, and metabolic syndrome, which wouldhave a presence in both Doha and New York.

WCM: What lessons have been learned duringthe first decade that will shape WCMC-Qgoing forward?JS: We have created a profile—quantitative andqualitative—of students who succeed here, so

Javaid Sheikh, MD. Opposite: The campus in Doha.

Meet the DeanQuestions for WCMC-Q’s Javaid Sheikh, MD

WCMC-Q

S P R I N G 2 0 1 0 1 3

we’re focusing on that in our admission processwhile keeping the same New York standards. Weare also trying to attract more outstanding stu-dents from all over the world. To promote diver-sity, we need to attract more from Europe andNorth America.

WCM: How does being from the Middle Eastyourself give you special insight in leadingWCMC-Q?JS: Local and regional cultures impact the work-ings of any institution, and we are no different.So I think that having a deep understanding ofthe local culture and having spent thirty years inthe U.S. makes me a truly international person. Ithink I relate to both sides well, and I try to buildbridges wherever there are cultural gaps.

WCM: You speak five languages; is that partic-ularly helpful in your job as dean?JS: My mother tongue is Punjabi, and the nation-al language of Pakistan is Urdu. I manage inEnglish, and I can read and write Arabic andPersian quite well. Since we’re an American insti-tution, our instruction and business are conduct-ed in English, so it is more about a largerunderstanding of the cultural context. Languageis only a part of it.

WCM: Has it been particularly challenging tosucceed Dr. Alonso, since he played such aninstrumental role in establishing the college?JS: I was fortunate to have the chance to workwith Dr. Alonso for two years before he retired, somy transition has been reasonably smooth. If Ihad come from outside, not understanding theculture and history of the College, that wouldhave been difficult.

WCM: How would you describe your leader-ship style?JS: It’s very much about consensus-building. I liketo work with teams of people and get their input.In academia, you have to bring people together;success is harder to come by if you just issueorders to very talented people.

WCM: What are your favorite and leastfavorite parts of the job?JS: My favorite thing is to come to work and findnew challenges every day, and recognize that weare part of a truly historic venture. The leastfavorite is to sit in numerous meetings, but thatis part of the job of being a dean.

WCM: Do you enjoy living in Doha? JS: It’s a family friendly and safe community. Youdo not, of course, have the cultural opportunitiesthat you have in New York City or Silicon Valley.

My primary hobby is reading, on a wide range oftopics—particularly historical, cultural, andgenetic influences on human behavior—and Ifind it easy to read in this relaxed environment.

WCM: What books do you have on yournightstand at the moment?JS: The Language of Life: DNA and the Revolutionin Personalized Medicine by Francis Collins, thenew NIH director. Also The Neuro Revolution byZack Lynch and Byron Laursen and a couple ofother books on the role of neuroscience inhuman behavior.

WCM: Does your training in psychiatry aidyou in running the college?JS: I would say so. In general, it helps you listento people carefully and understand them, to bet-ter relate to faculty, staff, and students. I also havea business background, and that helps me look at organizational behavior in a more systems-oriented fashion.

WCM: Specifically, you’re an expert in anxi-ety disorders. Does that come in handy incoping with the vicissitudes of academia?JS: It does. On difficult days, I can do somerelaxation exercises.

— Beth Saulnier

‘Having a deepunderstandingof the local culture and having spentthirty years inthe U.S. makesme a truly internationalperson.’

WCMC-Q

1 4 W E I L L C O R N E L L M E D I C I N E

Internal Defense

Drafting the immune system into the war against cancer

Talk of the Gown

The case was hopeless: an inoperablesarcoma had invaded sixteen-year-oldJohn Ficken’s abdominal wall, pelvis,

and bladder. The boy’s belly protruded with thegrowth, and the pain was unrelenting. YetFicken’s young surgeon and oncologist, WilliamColey, MD, harbored cause for optimism: anexperimental bacterial cocktail intended tojump-start his immune system and eradicate thecancer. Over the course of four months in thewinter and spring of 1893, the New York Cityphysician injected Ficken’s tumor with anincreasingly potent dose of Coley vaccine. Each

treatment induced inflammation, chills, andfever. But slowly, the tumor shrank. By the timeFicken’s treatment ended in May, the cancer hadshrunk by 80 percent. As the summer drew to aclose, the tumor was barely perceptible. Fickenlived another quarter-century, dying of a heartattack in 1919.

A century after Coley’s pioneering work waseclipsed by sterile surgical techniques combinedwith the emergence of radiation and chemother-apy, scientists have again turned their attentionto the role of the immune system in the waragainst cancer. “We are trying to find things thatare produced by the tumor, yet recognized by theimmune system as foreign,” says Weill Cornellmolecular pathologist Yao-Tseng Chen, MD, PhD’86, “so that the immune system would generatea response and destroy the tumor cells.” Unlikevaccines such as Gardasil, which prevents theviral precursor to cervical cancer and thus avertsthe associated malignancy, the approach taken byChen and his collaborators echoes Coley’s work:prompting the immune system to mount anattack against an existing tumor.

Nasser Altorki, MD, director of the Divisionof Thoracic Surgery at NewYork-PresbyterianHospital/Weill Cornell Medical Center and oneof Chen’s collaborators, says oncologists andpatients desperately need new, less toxic comple-ments to the conventional trifecta of surgery,radiation, and chemotherapy. “Recruitment ofthe immune system can probably result in ananti-tumor effect with minimal side effectsbecause it targets the tumor and not healthycells,” he says. “In lung cancer, we’ve seen thatalthough chemotherapy produces some results,they are by no means spectacular. Good resultsoccur in far too few patients—and for somepatients, the treatment has side effects withoutbenefits.”

In 1996, Chen and his graduate mentor,immunology professor Lloyd Old, MD, publishedtheir discovery of NY-ESO-1—a protein commonto many forms of melanoma, lung cancer, andovarian cancer—isolated from a patient ofAltorki’s with esophageal cancer. In August 2009,scientists at Cornell’s Ithaca-based BioproductionFacility announced that they had successfullycreated a vaccine based on the protein for PhaseI trials in patients with melanoma and ovariancancer. The trials began last fall at New YorkUniversity Medical Center and the Roswell ParkCancer Institute in Buffalo, New York. “I would

Yao-Tseng Chen, MD, PhD ’86 JOHN ABBOTT

S P R I N G 2 0 1 0 1 5

Second-year medical student Monica Payne likes to keep her hands moving as shetries to wrap her mind around her coursework. “I’m not an auditory learner, so Ifind my attention wandering sometimes during lectures, especially if the lecturer

doesn’t use many pictures,” says Payne. “But when I draw, I stop daydreaming and listen.”She fills her notebooks with illustrations of difficult science concepts, which help her releasesome creative energy and get a better grasp of the material. But what she has long considereddoodling has caught the attention of her peers and professors alike.

Anatomy professor Ahmed Khan likes her work so much that he’s using it to illustratehis article “Variations in the Palm and Arch of the Hand,” which he hopes to publish in theJournal of Clinical Anatomy. “Her drawings are absolutely marvelous—she has a great gift asa medical illustrator,” says Khan, who met Payne when she volunteered to help with hisresearch.

When she was a child, Payne pored over Grey’s Anatomy and other medical referencematerials. Although she considered a career in art, she ultimately decided to go to medicalschool—but she hasn’t given up hope that her two interests may merge. Someday, she says,she’d like to author a medical textbook in the form of a graphic novel. “There are a lot ofapplications for art in medicine,” she says. “One thing that impresses me is how a textbookillustrator can clarify a concept through a good drawing.” In the meantime, Payne continuesto practice her art, painting murals in her apartment, doing the occasional portrait, and evensketching her classmates’ heads during class. “I have to,” she says, “because it’s hard to findpeople who will sit still for that long.”

— Rebecca Coffman

Hands-On Learning

Drawing her way to an MD

be cautiously optimistic that in another tenyears, we would indeed see this becomingmore relevant in clinical care,” says Chen.

Chen, who received his medical degreein Taiwan and became a tumor immunolo-gist at Weill Cornell, credits the rapid paceof discovery to funding and support fromthe Cancer Vaccine Collaborative—a jointventure of the nonprofit Ludwig Institutefor Cancer Research and the CancerResearch Institute, which Coley’s daughterfounded in 1953 to extend her father’swork. (Coley died in 1936, many of hisfindings unpublished and his data insuffi-ciently detailed to satisfy scientist-physiciansseeking insight into why his treatmentsworked.) Soon after publishing their NY-ESO-1 findings, Chen and Old—a formerdirector of the Ludwig Institute and long-time director of the Scientific AdvisoryCouncil of the Cancer Research Institute—tapped Carl Batt, PhD, Cornell’s LibertyHyde Bailey Professor of Food Science andan expert in the production of recombinantproteins. “We had a core capability to maketherapeutic agents, to make proteins inmicrobial systems,” says Batt. “This was anoutstanding opportunity to partner anddevelop long-term relationships to see ourwork make its way into the clinic.”

Chen notes that because the researchersneeded to generate material that could beinjected into the human body, FDA rulesprohibited them from producing it at thebench. Typically, investigators license theirintellectual property to a pharmaceuticalcompany certified in the appropriate manu-facturing practices, in the hope that thefirm will ultimately pursue clinical trials.But, he notes, “if you do that, you lose con-trol of the pace of development and designof the clinical trial.” In 2001, the LudwigInstitute funded the construction of theBioproduction Facility, located next to Batt’slab in Ithaca’s College of Agriculture andLife Sciences. It is operated in accordancewith federal standards and staffed by under-grads, graduate students, and postdocs.Funds from the Ludwig Institute, AtlanticPhilanthropies, and the Cancer ResearchInstitute defray operating costs. “Here wehave the opportunity to discover and pro-duce clinical-grade materials tested in clini-cal trials without restrictions on academicfreedom,” says Altorki. “If it’s successful, itcan then be released to the pharmaceuticalindustry for large-scale development. It putsus in a whole different boat in terms of eco-nomic and academic freedom.”

— Sharon Tregaskis

Doodling in class: Doing line drawings gives MonicaPayne ’12 a better grasp of the course material.

1 6 W E I L L C O R N E L L M E D I C I N E

Talk of the Gown

Practicing in paradise:Carol McIntosh, MD ’87, atthe clinic she founded inCarriacou, Grenada.Opposite: Clad in herBuckingham Palace finery,McIntosh displays the OBEshe received from PrinceCharles.

PROVIDED

Carriacou, the middle-sized of the three islandsthat make up the British Commonwealth nationof Grenada. In June 2009, she went toBuckingham Palace to receive the award—pre-sented by Prince Charles himself. Beforehand,she was schooled in protocol: She must curtsy.The prince would speak to her, and she shouldaddress him as “Prince Charles” or “Sir.” Sheshould speak until he extended his hand, signal-ing the end of the conversation, and then moveon. “It was amazing, the pomp and circum-stance,” says McIntosh, who earned an under-graduate degree from the Ithaca campus in 1983.“Prince Charles in his kilt; soldiers in theirregalia, standing so still you think they’re stat-ues—it was breathtaking.”

Island TimeWork in Grenada earns an ob/gyn an honor from the Queen

C arol McIntosh, MD ’87, recalls thephone call with a mixture of wryamusement and lingering wonder.

The office of the Governor General of Grenadawas on the line, and the conversation wentsomething like this:

“Dr. McIntosh, you’ve been awarded theOBE.”

“The OB what?” “From the Queen.”She still didn’t get it. The queen? What queen?

And then it hit her: Elizabeth. The Queen ofEngland.

McIntosh had been honored with the MostExcellent Order of the British Empire for herwork in establishing a medical clinic in

S P R I N G 2 0 1 0 1 7

British friends back in Grenada had told herthat she absolutely must wear a hat, so she pro-cured one to match the beige embroidery on hersky-blue dress-and-jacket ensemble. She broughtalong her parents and an aunt, and they watchedas more senior honorees were knighted withCharles’s ceremonial tap of a sword on theirshoulders. (McIntosh’s award gives her the rightto put “OBE” after her name, but does not conveythe honorific “Dame.”) When it was her turn, hepinned the medal on her chest and inquiredabout the lingering damage from Hurricane Ivan,which devastated Grenada in 2004. “It really wasamazing,” she says again. “You’re thinking, I’mtalking to Prince Charles.”

It was a long way from Grenada—and fromBrooklyn, where McIntosh was born, the daugh-ter of American citizens who’d been raised onCarriacou. On a trip to the island for Carnival sea-son in 1993, McIntosh—by then a board-certifiedob/gyn in private practice in Manhattan—met asix-year-old boy whose painful sickle cell crisiswas being treated only with children’s Tylenol; inthe U.S., she knew, he’d likely get morphine. Theexperience inspired her to ask physician friendsto donate medication, which she ferried back toGrenada. It was the beginning of a decade of twice-a-year pro bono trips that grew to comprise morethan forty doctors, nurses, and nonmedical vol-unteers. But as gratifying as the work was, shechafed at its limitations. “It was just triage,” shesays. “We weren’t providing long-term services.We’d tell a patient, ‘You need to get this test,’ andthey would wait six months or a year until wecame back to go over the results. People weren’tgetting excellent care, because they were waitingfor us.”

With the help of another physician and alocal contractor, she founded Carriacou HealthServices; the clinic broke ground in 2003 and—after a year-long delay due to Hurricane Ivan—opened in 2005. With a rotating roster of visitingspecialists in fields like pediatrics and oncology,it offers primary care and a host of services (likeX-ray, ultrasound, and surgery) that previouslyrequired traveling to the main island of Grenada.While it’s not a free clinic, no one is turnedaway. “If people can’t pay,” she says, “theymight come in the following week with a dozeneggs, a chicken they just killed, or some vegeta-bles from their garden.”

For a year or so, McIntosh maintained her NewYork practice, spending one week a month in

Grenada. When the splitpatient load became toomuch, she sold her practiceand moved to Carriacou full-time. These days, she staysthere for three-month stretch-es, coming back to the U.S.for regular two-week visits.(She holds dual citizenshipand is licensed in bothplaces.) Although a city girlborn and bred—on return vis-its, she still savors a hot dogfrom a cart and the burgersat Jackson Hole—she haslearned to love island living.“Imagine a place that’s thir-teen square miles surroundedby beach, and that’s Carria-cou,” she says. “You can seethe water from just aboutevery point. You wake up andhear a rooster outside, see goats and sheep walkingalong with the cars. Everyone knows everyone—and if you’re from Carriacou, you’re probablyrelated to everyone. It’s not a rich place, but it’s aspecial place. You walk down the street and every-one says good morning.” She laughs when sherecalls her first few nights on the island; shecouldn’t sleep because it was just too quiet. “Butyou get used to not having the hustle and bustle—to knowing that you have to get somewhere, butyou don’t have to move that fast.”

Despite the slower pace, she says, being adoctor on Carriacou is just as challenging asworking in an urban hospital or running a busypractice, though for different reasons. “Anyonecan walk in at any time, and you have to pro-vide treatment,” says McIntosh, who cites poor-ly controlled diabetes and hypertension as theisland’s most common health concerns. “Youcan’t just order a CT scan or ask a resident toevaluate a patient—it’s all on you. You learn todo clinical work as opposed to medical tests. Yougo with your gut, and you know when to say,‘We don’t have the resources to handle this; youhave to go to the mainland.’ And after you fin-ish work, you can sit and watch the stars.”

— Beth Saulnier

For more information, go to: www.CHS-Health.com

PROVIDED

1 8 W E I L L C O R N E L L M E D I C I N E

Talk of the Gown

In 2008, surgeons performed more than 40,000 corneal transplants inthe U.S.—aiming to restore sight to patients in whom the “window”of the eye is opaque or otherwise damaged but the optic nerveremains functional. But as aspiring ophthalmologist Michael Klufas

’10 notes, “There are certain conditions where a traditional corneal transplant simply will not function properly.”

In Plain SightA medical student weighs the promise of an artificial cornea

Last fall, under the mentorship of assistantprofessor of ophthalmology Christopher Starr,MD ’98, Klufas studied a promising alternative totransplantation: the artificial cornea known as

the Boston Keratoprosthesis, or KPro. Klufas hadthe opportunity to observe surgeries in whichStarr implanted the device into patients atNewYork-Presbyterian Hospital/Weill Cornell

JOHN ABBOTT

Mentor and student: Assistant professor Christopher Starr, MD ’98 (above), hasbeen guiding Michael Klufas ’10 (left, doing an eye exam at KilimanjaroChristian Medical Center in Tanzania) in his ophthalmology research.

PROVIDED BY MICHAEL KLUFAS

S P R I N G 2 0 1 0 1 9

Medical Center, the leading referral site for theKPro in the New York metro area. Klufas evenauthored a paper with Starr on the subject, pub-lished in Cataract & Refractive Surgery Today.

The experience inspired Klufas to continuehis studies on the device. “He’d read all the liter-ature on the procedure,” Starr says, “and at thatpoint he was so knowledgeable about the KProthat he wanted to keep going.” So Starr arrangedfor Klufas to go to the Massachusetts Eye and EarInfirmary for an eight-week elective under hisown mentor—Claes Dohlman, MD, the KPro’sdesigner and the founder of modern corneal sci-ence. It was a rare chance to study a medicaldevice while working under the physician whoinvented it. Klufas even took a tour of the facto-ry—really, a small machine shop—that manufac-tures the KPro, an experience that showed himthat “there isn’t so much of a leap from conceptto reality in medicine.”

His work in Boston earned Klufas lead-author credit on a paper set to appear in anupcoming issue of International OphthalmologyClinics. As in his previous publication withStarr—in which they wrote that the KPro “isquickly becoming the first artificial cornea towarrant mainstream status”—Klufas found thatthe KPro “is no longer the treatment of lastresort,” and in fact has proven to be the pre-ferred option for many conditions.

The KPro is the latest iteration of an idea firstproposed more than 200 years ago—an artificialreplacement for a damaged cornea. While moresuch devices are currently in development, theKPro is one of three most commonly used.Dohlman began experimenting with artificialcorneas in the Sixties and got FDA approval forthe KPro in 1992. In 2002, surgeons implantedfewer than fifty in the U.S., but by last year thenumber had grown to more than 1,100. Therecent success of the device, and the growingbody of literature surrounding it, has encouragedsurgeons to begin considering implanting it as aprimary procedure. “In the old days, you had tofail with four or five transplants before you final-ly said, ‘OK, let’s take a risk with keratoprosthe-sis,’” says Starr, who directs the ophthalmologyresidency program at Weill Cornell. “But in recentyears—with the refinement of the technique,post-operative medications, and design improve-ments—it’s a much more successful surgery.”

Artificial corneas like the KPro offer an alter-native for patients whose eye tissue is too fargone for the conventional procedure. As Starrexplains, “You need a certain mixture of healthyocular surface, tears, and blood supply to keep

the cornea transplant alive.” Thus, for example,keratoprosthesis gives hope to patients withautoimmune conditions, burns, or pediatriccorneal opacities who have low success rateswith standard corneal transplantation. Artificialcorneas also have the potential to help patientsin developing countries, where eye banks arerare and diseases that lead to corneal blindness,such as trachoma, are much more prevalent.And in places where cultural or religious moresprohibit donating and transplanting human tis-sue, Klufas says, “the KPro is attractive, as thepatient’s own diseased cornea could be used tosuture it into place.” This spring, during anoth-er eight-week elective, Klufas gave a lecture onthe KPro to the ophthalmology department atthe Kilimanjaro Christian Medical Center inMoshi, Tanzania.

The KPro consists of front and back plateswith an optical cylinder in the middle. It issutured into the patient’s cornea in a mannersimilar to the standard transplant, so surgeonsshould be able to transfer their knowledge toimplanting a KPro with relative ease. In situ thedevice is quite noticeable, though contact lensescan address cosmetic issues. Post-op care remainscritical, including indefinite use of a protectivecontact lens and daily antibiotic prophylaxis.Nevertheless, for a certain cohort of patients theoutcome can be tremendous; in one study, near-ly one in five had vision better than 20/40.

Starr, like several of his colleagues at theMedical College, trained as a resident underDohlman. Now he in turn has become a mentorto Klufas, who begins his ophthalmology resi-dency at Weill Cornell in 2011 after therequired one-year medicine internship (at Sloan-Kettering), during which the two will continuetheir work on the KPro. “You take off the patch,and the majority of these patients start to cry,”says Starr. “They say, ‘Oh my God, it’s miracu-lous. I haven’t seen anything for years, and Ican see your face.’ ”

— Andrea Crawford

Clear vision: A cornea before and after implantation of the KPro.

PROVIDED BY CHRISTOPHER STARR, MD ’98

2 0 W E I L L C O R N E L L M E D I C I N E

Open-heart surgery was firstperformed in 1952—and forsix decades it has remainedthe gold standard for repair-

ing all manner of mechanical heart defects.But over the past year, cardiothoracic sur-geons at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have per-formed multiple operations using an artifi-cial aortic valve, already in widespread useabroad, whose insertion requires only asmall incision.

The surgeries are part of a NorthAmerican trial evaluating the technique, inwhich the new valve is navigated to theheart through the arteries—offering notonly a potential re-evaluation of the goldstandard, but new hope for many elderly orweakened patients considered unfit for tra-ditional open-heart surgery. Says KarlKrieger, MD, vice chairman of cardiotho-racic surgery at NYP/Weill Cornell: “It hasthe potential to change the way we do allvalvular heart surgery.”

A healthy aortic valve has three tinyflaps of tissue that control the flow of oxy-genated blood out of the heart—a vitalfunction that, over time, can wear out thevalve and lead to aortic stenosis, a narrow-

year-old Donald Casey, whose diagnosis ofaortic stenosis only confirmed what healready knew. “When you can walk onlytwenty-five yards and have constant pain inyour chest, you know something’s wrong,”says Casey, who is retired from the textileindustry and splits his time between NewJersey and Florida. Having undergonebypass surgery eight years earlier, Casey wasadamant about finding another option. InFebruary, he successfully underwent theprocedure at Weill Cornell, one of twentysites in the U.S. and Canada where thestudy is being conducted by the FDA.

“What’s interesting about this device isthat it’s already commercially approved foruse in Europe and Asia—the procedure hasbeen performed on 5,000 to 10,000 patientsin Europe alone,” says Arash Salemi, MD’97, the assistant professor of cardiothoracicsurgery who operated on Casey. “We don’thave access to the long-term follow-up dataon these patients yet, but the initial datafrom Europe, and the studies we’ve donehere, have shown that the risks are equal toor less than what we expected. All the caseswe’ve done here have gone smoothly.”

Researchers have been on the lookoutfor bleeding at the incision site, damage tothe artery, and stroke, but no such problemshave been reported. “I’ve been surprised athow well the patients have done,” saysKrieger. “We have done the procedure onsome very elderly and sick patients whoprobably wouldn’t have survived a tradi-tional operation. They are usually homewithin two days and have noted a dramaticimprovement in their symptomatology andfew side effects.”

The trial (called PARTNER, for Placementof AoRTic traNscatheER valves) is also test-ing two possible insertion sites for thecatheter: through the femoral artery at thegroin and directly through the chest. Kriegerestimates that the device and correspondingoperation will be FDA approved in abouttwo years—but in the meantime, the trial isstill accepting new patients. “Some studiessuggest that 20 to 30 percent of patientsdiagnosed with aortic stenosis are nevergiven an option for any kind of invasivetherapy,” he says. “It’s our hope thatinternists or cardiologists might think, I’vegot patients in my practice whom I neverfelt were surgical candidates, but they mightbe candidates for this.”

As far as Casey is concerned, the benefitsare obvious. “I’m alive, I can walk, and I canplay golf,” he says. “I’d say that’s pretty good.”

— Liz Sheldon

ing and calcification that is often fatal.The most common type of valvular ill-ness, it’s nearly impossible to treat with-out physical intervention. “In the lasttwo years at Weill Cornell, the operativemortality was less than 1 percent for[conventional] aortic valve replacement,”says Krieger. “But there’s a certain per-centage of patients who don’t presentuntil they’re in their eighties or nineties;because of their age or other complica-tions, they aren’t offered surgery as anoption. Treated conservatively, they willusually develop congestive heart failureand die.”

Enter the Edwards Sapien valve.Made of bovine heart tissue, the valve isconstructed around a compressed wiremesh support, which is deployed to theheart intravenally and inflated by a pres-surized balloon once in place. Whereastraditional open-heart surgery typicallytakes three to four hours and weeks ofrecovery, this minimally invasive opera-tion implants the new valve in ninetyminutes using standard cardiac catheteri-zation techniques—putting much lessstrain on the patient.

Such was the case for eighty-three-

Valve Job

Talk of the Gown

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Among the potential lessons of DonGiovanni, he says, is an example ofambivalence, which the students may seein patients faced with treatment deci-sions. He cites the character of DonnaElvira, who has conflicted feelings aboutthe infamous lothario of the title, whohas loved her and left her. “On one hand,she totally fell for him and she’d go tohim if he gave her the least encourage-ment,” Murray says. “On the other hand,she is furious at him for abandoning her.In a number of arias she sings aboutwanting to leave him—but the music hasa repetitive quality that keeps returningto the same point. Ultimately, she keepsgoing back to him, even though she’s

singing about rage and vengeance.”One of the students who spearheaded

the City Opera trip was Jennifer Salant ’13,an avid singer in high school and collegewho hopes to stay involved with musicduring medical training. She and Murrayplan to schedule future outings, perhapsforming an opera club for students and fac-ulty and taking advantage of the newlyestablished partnership between WeillCornell and Juilliard. “Opera shows us theepitome of human emotion,” Salant notes.“We see love, anger, jealousy, hatred, allmanifested in tangible ways. They’re realemotions that we as doctors are going tohave to contend with.”

Beyond using the genre as a teachingtool, Murray admits that as a longtimeopera buff, he has another agenda: passingon his passion to the next generation. “It’sthe not-too-subtle point that I’m trying toget across,” he says. “If you’re living in NewYork, you’d be crazy not to take advantageof a night at the opera.”

— Beth Saulnier

MDivasStudents explore medicine through opera

To the many subjects covered at WeillCornell, add a few others: dueling,seduction, deception, eternal damna-

tion. Those and a variety of other humanfoibles were on display last fall, when psychi-atry professor Joseph Murray, MD, took adozen first-years to a production of DonGiovanni as part of an informal program link-ing opera and medicine.

The trip was the latest in a series ofMedical College offerings exploring theconnection between medicine and the arts;others have included a field trip to the FrickCollection to practice visual diagnosis and amock competency trial for the title charac-ter in King Lear. The opera elective lets stu-dents broaden their cultural horizons whilebuilding on lessons stressed in the introduc-tion to doctoring course known as Medi-cine, Patients, and Society, mandatory forfirst-years. “One of our main emphases iscommunication skills—to get students com-fortable with patients, but also how to listento the patient’s story,” says Murray. “Itdawned on me that opera is an interestingway of examining how to listen to a charac-ter; in many ways it’s parallel to how to lis-ten to a patient.”

Last year, Murray took students to aSaturday matinee of Gluck’s Orfeo edEuridice, performed by the MetropolitanOpera and simulcast at a movie theater. ForDon Giovanni, they attended a live perform-ance at New York City Opera, which recastMozart’s classic to the modern day. (“Theway they staged it was kind of hilarious,”observes Rula Green-Gladden ’13. “In thesecond act, the two male leads spent mostof the time in their underwear.”) In bothcases, Murray invited the students to hisapartment for a three-hour seminar beforethe performance; a pianist since childhood,he gave them an orientation and performedselections from the opera. “What does acharacter express not only through thewords, but also music and body language?”Murray muses. “What does the music con-vey about the character? And does the com-poser convey things that the charactermight not even be aware of—is somethingbeing communicated both consciously andunconsciously?”

Music lessons: Medstudents took in amodern production ofDon Giovanni at CityOpera.

CAROL ROSEGG

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A mother comes in with a sickbaby. On exam, the physiciannotices that the infant’s back and

chest are covered in striped bruises. Should thewoman be reported for child abuse?

First—especially if the family is of SoutheastAsian descent—the doctor should inquire if thebaby has undergone coin rubbing, a traditionaltherapy in which patients are vigorously mas-saged with hot oil and the edge of a coin orspoon. It’s not abuse; it’s an ancient form of heal-ing meant to balance yin and yang.

That’s just one lesson in multiculturalunderstanding that Weill Cornell MedicalCollege in Qatar (WCMC-Q) aims to impart.Since last year, the Qatar branch has been giv-ing its students training in cultural compe-tence—a vital topic in a polyglot nation wheremany residents are expatriate workers.According to a 2007 survey, only 45 percent ofthe Qatari population speaks Arabic; the restspeak Hindi, Urdu, Bengali, Farsi, Tamil, and ahost of other tongues. In 2008, a random sam-pling of some 1,600 patients at Hamad MedicalCorporation, WCMC-Q’s teaching hospital,

found more than three dozen languages spoken.“Students must be able to work with thesediversified populations,” says Maha Elnashar,who is directing the branch’s Center forCultural Competence in Health Care. “Many ofWCMC-Q’s students will do their residencies inthe States, so they need to be able to deal withdifferent populations and work in any setting.”

In addition to offering patient interpretationservices in several major languages, the Centerconducts workshops for medical students, whoreceive about ten hours of training in each oftheir first three years. Among the lessons: inQatar, female patients often refuse to see a maledoctor, particularly for ob/gyn—so male physi-cians shouldn’t consider it a referendum on theirabilities. “We speak about the importance ofinvolving the family and understanding familydynamics,” Elnashar adds. “For example, a femalepatient might like to check with her family abouta procedure—it is considered a shared decision.”

Third-year student Nadia Merchant hasfound such training highly valuable, calling it a“great opportunity” for students to put their clin-ical experiences into a larger context. Born inHouston to an Indian mother and a Pakistanifather, Merchant lived in Texas and Saudi Arabiabefore enrolling as a pre-med in WCMC-Q’saccelerated program. “Even though I have trav-eled all over, attended several internationalAmerican schools, and have friends from aroundthe world, I still found it difficult to understandthe spectrum of cultures we see in the hospital,”says Merchant, who hopes to do a residency inpediatrics and genetics in the U.S.

She recalls the case of a patient, extremelysick with stomach cancer, who didn’t speakArabic, English, or Hindi—the three most com-mon languages in Doha—and had no family inthe city. “I found it difficult to communicatewith the patient to explain his prognosis andmanagement,” says Merchant. “Even though wetried to give him the best care we could provide,I felt empathy toward him since he was unableto express his concerns and questions. The cul-tural competence course helped in discussing sit-uations such as these and showing us how weshould go about dealing with them.”

The workshops and talks teach students that

Border CrossingIn a polyglot nation, WCMC-Q trains students to treat

people of many cultures and creeds

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S P R I N G 2 0 1 0 2 3

W hen Danny Lee ’12 was matched with his “buddy,” a seven-year-old bone cancer patient from Brooklyn, he assumed that theirrelationship would revolve around the boy’s medical condition.

“At first I thought, He’s on chemo, I’m going to feel bad for him,” recalls Lee, a NewYork City native with an interest in gastroenterology. “But although his illness wasalways in the background, that wasn’t all there was to him—and you can lose sight ofthat when you’re a doctor. You can forget the humanistic side, putting a person in thecontext of their life.”

Lee spent time with the boy last year through Kids in Cancer Support (KICS), aWeill Cornell group that pairs medical students with children and adolescents under-going cancer treatment. Volunteers generally spend an hour or so at a time withpatients as they’re undergoing chemotherapy infusions—coloring, playing games, orjust chatting. “It’s nice for the kids to have someone who’s relatively young—not theirparent or a sibling, just somebody who wants to hang out with them,” says KICS co-president Molly Smith ’12, who often talked baseball with her nine-year-old buddy. “Itdistracts them from their treatment. We’re medical students, but we’re not there forany medical purpose. We’re not wearing a scary white coat, and we’re not there topoke them. We just want to talk to them and have a little fun.”

The program provides the volunteers with modest gift cards to buy snacks or othertreats; Lee would come armed with the car magazines his buddy enjoyed. “Thepatients sit there for two to three hours while they get their treatment, so it’s prettyboring,” says Lee, who also visited his buddy in the hospital when complicationsrequired an inpatient stay. “There’s a TV, but there’s not much else to do.” Both heand Smith note that the visits play another vital role: offering parents a brief respitefrom the demands of caring for a sick child. “My buddy always came in with hismother, and it gave her some time off,” says Lee, who earned a BS in hotel adminis-tration from the Ithaca campus in 2003. “She tended to go to the bank, because shenever had time to run errands.”

The program also benefits the dozen or so Weill Cornell students who participateeach year—there are always more volunteers than patients, Smith says—offering botha break from academics and a view of medicine from the family’s perspective. “Itreminded me why I came to med school,” says Lee. “In the first two years you spendso much time learning basic sciences, it can be a real drag. Being able to take yourselfout of that, to put a face to what you’re doing, really motivates you.”

— Beth Saulnier

language, religion, and nationality aren’t theonly issues that can complicate patient care.Third-year student Nasser Mohamed, a native ofQatar, cites the case of a middle-aged laborer whocame into Hamad’s coronary care unit after suf-fering a heart attack. Considering the patient’shistory, Mohamed recalls, doctors recommendedan arterial stent followed by a lifelong regimen ofanticoagulant drugs—but he refused. “One of themajor areas covered in the cultural competencecourse was considering the patient’s socioeco-nomic status in choosing a treatment option,”says Mohamed, who’s contemplating a psychia-try residency in the U.S. “After further question-ing, we realized that the patient could not paymore than half of his salary every month to buythe drugs.” (Ultimately, Mohamed says, thepatient was treated free of charge.)

Although Qatar’s diverse population makescultural competence a particularly pressing issueat WCMC-Q, it is becoming a priority on everymedical school campus. In 2000, the AmericanAssociation of Medical Colleges’ LiaisonCommittee on Medical Education underscoredthe importance of schooling future physicians incultural nuances when it issued a new standardon the subject for its member institutions. “Thefaculty and students must demonstrate an under-standing of the manner in which people ofdiverse cultures and belief systems perceivehealth and illness and respond to various symp-toms, diseases, and treatments,” the standardreads. “Medical students should learn to recog-nize and appropriately address gender and cul-tural biases in health-care delivery, whileconsidering first the health of the patient.”

The AAMC has created an instrument for med-ical colleges to gauge how well their curricula fur-ther those goals. Known as the Tool for AssessingCultural Competence Training (TACCT), it quanti-fies whether courses and clerkships address suchtopics as stereotypes, health-care disparities, tradi-tional healing systems, and ways to combat bias.As the AAMC notes in its guide to cultural compe-tence education, “The TACCT permits gaps to beidentified, as well as planned and unplannedredundancies that will allow schools to make thebest use of opportunities and resources.”

At WCMC-Q, Elnashar and colleague HudaAbdelrahim are creating an instrument to assesspatient care. With a three-year grant from theQatar Foundation, they’re developing a tool forgauging how patients from different backgroundsview the quality of their health care, to be admin-istered in Arabic, English, Hindi, and Urdu. “Eachpatient is unique; hence, it is important to under-stand their culture and values while treatingthem,” says Merchant. “We cannot impose our val-ues—or the values of the country—on the patient.”

— Beth Saulnier

Just for KICS Group pairs student

volunteers with young cancer patients

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In 1960, Susan B. was ten years old when aNew York City dermatologist referred her toJames German, MD, for a chromosome

analysis. The unusually small but generally well-proportioned child weighed less than thirtypounds—the size of an average three-year-old—and she had a sun-sensitive redness of the skinextending from the bridge of her nose across hercheeks.

The dermatologist was David Bloom, MD,who had written an article in the AmericanJournal of Diseases of Children about three indi-viduals who bore a striking resemblance toSusan B.—in fact, she was one of the three. Shehad what is generally referred to today asBloom’s syndrome.

A year earlier, a Parisian scientist had report-ed that people with the mental deficiency

Genetic AnomalyA physician’s half-century-long effort to

understand cancer by studying a rare syndrome

JOHN ABBOTT

James German, MD

known at the time as mongolism did not havethe usual forty-six chromosomes but one more—an “extra” copy of trisomy 21, one of the small-est. Bloom wondered whether the syndrome hehad observed might also be caused by an extra orabnormal chromosome—thus his call toGerman, who was the first in New York City tostudy human chromosomes using a new tech-nique invented in the Texas laboratory where hehad developed his lifelong interest in the cell.

“Even though the cause of Bloom’s syndromewas unknown, I didn’t think the study of thechild’s chromosomes was indicated,” recallsGerman, who was fairly certain that the condi-tion was a recessively inherited genetic disor-der—which would mean that the chromosomeswould be normal in both number and structure.At the time, German was a junior member of thefaculty at the Rockefeller Institute; Bloom hadgotten his name from a private patient who hap-pened to be one of German’s senior colleagueson the Rockefeller faculty. So the young physician-scientist—who had just begun the study ofhuman chromosomes in Rockefeller’s Laboratoryof Heritable Disorders in Man—drew some ofSusan’s blood, stimulated the white cells to pro-liferate in culture, and put some of the dividingcells under his microscope.

What German saw would launch a half-century of investigation that has yielded newinsights into both fundamental genetics and thecause of human cancer. Like all people withBloom’s syndrome, Susan had the standard twenty-three pairs of chromosomes. But unlike anyother human chromosomes that he had ana-lyzed, hers often had gaps and breaks. “I wantedto know what it meant,” says German, a profes-sor at Weill Cornell since 1963. “The geneticmaterial itself, the DNA, was being damaged. Itseemed highly improbable that such a dramaticthing would not have some important biologicalsignificance.” German asked Bloom if he knew ofother people with the syndrome, so he couldexamine their blood. When he did, he foundthat they too had what he began to call “chro-mosomal breakage” and today is known asgenetically determined genomic instability.

In 1963, Susan developed acute leukemia;within six weeks, she was dead. Then others inthe small cohort of individuals with Bloom’s syn-drome that German had assembled began to suc-cumb to cancer, and he began speculating aboutthe role of all the chromosomal damage that wastaking place in their cells.

In a collaboration that would persist untilBloom’s death in 1985, German and Bloom trav-eled together to Appalachia, Philadelphia,

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Social StudiesStudent party planners help classmates

balance work and play

JOHN ABBOTT

Every two weeks, first-years at Weill Cornell are tested on their medical knowledge.After the quizzes and exams are over, they have a little something to look forwardto: ice cream parties, happy hours, or other social events, all organized by fellow

students who serve as party planners. Part of the class council, “social chair” is an elected position that students hold through

their four years of med school. Each class’s team of four social chairs is allotted $1,000 peryear to fund the events, which can range from small wine-and-cheese parties to larger gath-erings like a school-wide Halloween bash or a mixer open to all New York City medical stu-dents. “We can organize a party in the lounge for after a big test,” says social chair AdamFaye ’13. “If there’s a season premiere of a TV show that everyone wants to watch, or a foot-ball game like the Super Bowl, we can pay for the pizzas. We had a ‘Sundae Sunday’ wherepeople brought in bowls and spoons, and we supplied the ice cream and toppings.”

Given the stress and workload of medical school, says social chair Matthew Inra ’13, suchoutlets are vital to morale; they also offer a way for students to get to know each other andbond as a class. “It’s good to have a balance so we don’t go crazy,” he says. “With all the testsand labs, it’s easy to get burned out, and social events give us a release.”

— Erica Southerland

Big event: Performers at this year’s class show, always among the most popular ways toblow off steam for first-year medical students

Baltimore, Boston, Toronto, Mexico City,Paris, Tel Aviv, and Jerusalem, interviewingthe parents and physicians of those withthe condition. Traveling solo, Germanmade forays to Western Europe, Israel, andJapan. “We searched far and wide for peo-ple with this very rare disorder,” he says.Today, his records hold files of 267 peoplewith Bloom’s syndrome, with clinical casehistories, genetic histories, and experimen-tal laboratory records for every persondiagnosed with the syndrome anywhere inthe world.

Those records have yielded a wealth ofinsights. First, German was right aboutrecessive inheritance. Nearly a third of thepeople with the syndrome are, like Susan,Ashkenazi Jews. Another third are theprogeny of first-cousin marriages, whichincrease the risk of rare recessively inherit-ed traits. And also like Susan, who died atthirteen, people with Bloom’s syndromedie young—mean life expectancy is justtwenty-five years.

In 1969, German published his theoryon the role of genetic mutation in cancer,but it wasn’t until the mid-Nineties thathe and his colleagues could identify theso-called primary defect of Bloom’s syn-drome, thanks to recombinant DNA tech-nology. They mapped the Bloom’s gene toa specific band on chromosome 15 andthen cloned that gene, thereby identifyingthe protein whose normal biological func-tion is absent in the syndrome. “That pro-tein, named BLM, is present also inbacteria, yeast, vinegar flies, mice, amphib-ians, and even plants,” says German. “Ithas been tenaciously conserved through-out evolution because it plays such animportant role in maintaining the stabilityof the genetic material.”

Today, German continues his investi-gations in collaboration with MaureenSanz, PhD, a Weill Cornell colleague whois also on the faculty of Molloy College.He also serves on the scientific advi-sory board of the Bloom’s SyndromeFoundation, established in 2004 by aHollywood producer and his wife whoseson has the condition. German nowdevotes most of his time to writing TheBloom’s Syndrome Story, a book that, hesays, “will emphasize that even in the ageof molecular biology, clinical investigationis definitely still alive and well.”

— Sharon Tregaskis

Paul Schaefer had been in the Broadway production ofThe Phantom of the Opera for nearly three years when hehad his first full-scale rehearsal for the title role. Thetenor-baritone had performed various parts in theensemble and understudied Raoul, the viscount who

battles the Phantom for the love of the beautiful Christine. Then, on aThursday in December, he had a “put-in” rehearsal as the Phantom—those precious hours when an actor runs through a role he’s under-studying, not just with a stage manager or musical director but onstagewith the entire cast.

TheShowMustGoOn

By Beth SaulnierPhotographs by John Abbott

The Center for the Performing Artist offers comprehensive care for creative types, from ballet dancers to rock stars

It was a lucky thing, too. In a twist straight out of a stage-doordrama, the actor playing the Phantom called in sick that afternoon.Schaefer had to go on that night—and a half-dozen times over thenext few days. “Vocally, the Phantom is so difficult—it’s one of themost difficult parts I’ve ever sung,” says Schaefer, a veteran per-former whose credits include the national tour of Thoroughly ModernMillie. “He’s very intense; he has a huge range and he sings all thishigh stuff. He comes in, and right away he starts blasting at the topof his range.”

It’s a role that would challenge any singer, and Schaefer’s abilityto pull it off only underscored how far he’d come. Two years earlier,

Music of the night: After successful vocal cord surgery, Paul Schaefer hasbeen understudying the titlerole in Broadway’s ThePhantom of the Opera.

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just months into his tenure in Phantom—hisBroadway debut—Schaefer had experiencedvoice problems so severe they had required sur-gery. “When I was able to do the role—not onlydo it, but for five or six shows in a row and stillfeel strong—I felt like I had reached a land-mark,” he says. “My voice was solid; it wasn’ttaxed. I couldn’t believe that I had finally gottenback to that.”

In large part, Schaefer credits his vocal recoveryto the surgeon who operated on him: LucianSulica, MD. An associate professor of otorhino-laryngology, Sulica is among the specialists at theCenter for the Performing Artist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.Established in 2008, the Center offers comprehen-sive care for performers in a variety of fields—cel-lists to ballet dancers, opera singers to rockmusicians, piano prodigies to Broadway stars. Itcomprises some thirty physicians—in such special-ties as neurology, gastroenterology, pulmonology,rheumatology, and psychiatry—who see patientsthrough their individual practices; it also offersphysical therapy, speech pathology, and audiology.“‘Center’ is probably the best word, but it doesn’tfit particularly well,” observes orthopaedist RobertHotchkiss, MD, an expert in disorders of the handand upper extremity, who notes that care occursthroughout the medical center.

One of a handful of programs of its scope

around the country—another is located at theWeill Cornell-affiliated Methodist Hospital inHouston—the Center is geared toward the needsof serious artists. (Although some such practicesrequire professional certification such as a unioncard, NYP/Weill Cornell’s is less restrictive, andsome patients are dedicated amateurs.) “Onething that often happens with artists is that theyget fragmented care,” says otorhinolaryngologychairman Michael Stewart, MD, MPH, seniorassociate dean for clinical affairs and the Center’sdirector. “They go to this specialist and thatsuper-specialist, and they get good individualcare, but each physician doesn’t know what theother has done. They don’t have a connectedmedical record, and there’s no ‘captain of theship’ who knows what’s going on. So our Centerprovides not only expertise for specific problemsrelated to performing artists but coordinatedcommunication among the doctors.”

A s Stephen Sondheim wrotein the Broadway musicalSunday in the Park withGeorge, art isn’t easy. Acareer as a professional

artist is highly demanding, not only psychologi-cally and emotionally but often physically aswell. At the Center, the most common condi-tions requiring treatment are voice and speech-related problems in actors and singers; hearingloss and neurological conditions like tremorsand dystonias (abnormal muscle movements) inmusicians; and bone and joint problems indancers, typically of the foot, ankle, hip, or knee.“They’re an interesting group of patients,” Sulicasays. “They force you to be on your game. Forsomebody who is an average voice user, you cando an OK assessment and an OK surgery andtheir result is fine. But with somebody who singsor speaks for a living, you’ve got to do the bestpossible job. It’s a unique challenge.”

Professional artists, Sulica says, are exquisite-ly sensitive to subtle problems or changes thatcan affect performance—and appreciating that isessential to treating them successfully. “Artistsare frequently sidelined or bothered by com-plaints that in the general medical scheme ofthings seem trivial or quixotic,” he says. “Ifphysicians aren’t keyed in to that level of sensi-tivity, patients are not going to get much help.Voice disorders are a perfect example. If some-body comes in and is audibly hoarse, has troubleswallowing, and smokes three packs of cigarettesa day, every physician’s going to take that seri-ously. But if somebody comes in and says, ‘I’mhaving trouble completing my eight-show-a-week schedule, and I’ve lost a bit of control in

Lucian Sulica, MD

S P R I N G 2 0 1 0 2 9

the upper end of my range,’ that’s a threat tothat person’s career—but many otolaryngolo-gists are going to roll their eyes, or shrug andsay, ‘I don’t know what to do.’ ”

As an example, Sulica cites the current epi-demic of acid reflux diagnoses; the condition, hesays, has become a common scapegoat for vocalproblems. “Too often somebody goes to the doc-tor with a complaint of voice change, and theotolaryngologist looks at the vocal cords anddoesn’t see anything, because some of theseissues are very subtle and require specializedinstrumentation,” he says. “And when theydon’t see anything they say, ‘You need refluxmedicine.’ They’ll even recommend people togastroenterologists rather than take a carefullook at the vocal folds. It’s not malice; they’rejust not aware that there can be things that sub-tle on the vocal cords.”

Schaefer sought treatment when, in themidst of a brutal rehearsal schedule after joiningthe cast of Phantom, he developed “tons of respi-ratory infections” and serious problems with hisnormally robust singing voice. He went to Sulicafor a second opinion, feeling that his problemmight not have been diagnosed correctly. At theCenter, Sulica examined him with strobolaryn-goscopy, in which a strobe light is triggered by amicrophone, capturing images of the vocal cordsas they vibrate; the physician calls it a “game-changing technology” that provides a far moredetailed picture than a traditional laryngoscope.

When strict vocal rest didn’t help—“Mywife became good at reading my lips,” saysSchaefer, who’s married to a fellow thespianwho danced in the Broadway revival of AChorus Line—he underwent a three-hour opera-tion in which Sulica removed a large hemor-rhagic polyp from beneath his vocal fold. Aspart of his rehabilitation, Schaefer also hadspeech therapy through the Center. “Not onlydid I have a speech therapist, I had a speechtherapist who was an opera singer,” he says.“She was able to focus not only on my speak-ing, but on retraining my voice. You don’t wantto develop the same problems again.”

While Schaefer is open about having under-gone vocal cord surgery, many performers aremore reticent. In contrast to injured sports stars,Sulica says, artists rarely see their ailments asemblems of valor. “If a football player gets hurt,there’s a positive vibe—you injured yourselfbecause you played hard, not because youplayed badly, and the doctors are going to dowhat they can to get you back on the field,” hesays. “Different scenario: a singer injures herselfduring a performance. The first assumptionmade by the singer is, ‘What am I doing wrong?’And frequently the answer is, ‘Nothing, you’rejust doing eight shows a week.’ The other

assumption is that it’s a career ender.”As a result, Sulica says, vocal cord problems

are stigmatized; performers in demanding showsmay fear that if they admit they’re having trouble,they’ll be replaced by one of the many aspiringactors desperate to make it to Broadway. “Whathappens in that environment is that when peo-ple have successful vocal cord surgery it’s hush-hush—and when people have a bad result, youhear about it,” he says. “Everybody’s heard theJulie Andrews story. So when they come to thedoctor, they’re cranked up with anxiety andthink they’re on the brink of career disaster.”

The Center’s physicians know that whenartists seek treatment for performance-relatedproblems, they’re entrusting them with theirlivelihood. That makes caring for singers, actors,dancers, and musicians a highly gratifyingfield—but one where the stakes are high. Andwhile mainstream patients tend to see theirlong-term health as the primary concern, per-formers are often willing to take a calculated riskfor the sake of their art. “It’s like taking care ofprofessional athletes; they want to play,” saysStewart. “The risk-benefit ratio may say that youdon’t want to take a chance, but they want to beout there on the stage. If they see somebodywho is not used to taking care of artists, they’regoing to get a conservative view—‘The bestthing to do is cancel the show’—but the artist

Robert Hotchkiss, MD

Michael Stewart, MD

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won’t go for that. You need to understand theartist’s psyche: it’s important that the show goon, so how can we get you through it withoutendangering you?”

For Hotchkiss, one of the field’smost interesting aspects is work-ing with performers at varyingmoments in their careers and tai-loring their care accordingly.

Consider, for example, a musician with a com-pressed nerve in the hand that could lead to per-manent damage if left untreated. Does she havethe luxury of a month’s downtime, having justrecorded an album—or is she about to go out ona long-scheduled world tour? Even everyday ail-ments—from a wrist broken in a fall to the nor-mal effects of aging—are much more fraughtwhen the patient’s body is a finely tuned instru-ment. “This is a different group of patients,”Hotchkiss says. “We all have insights into thefrailty of the human condition, but this is a dif-ferent kind of frailty.”

While some physical conditions are commonto artists at all levels of success—from carpal tun-nel in string players to lung and larynx problems

Richard A.Friedman, MD

Singers can have problems with their vocal cords; dancers can suffer injuries of the muscles, joints, and bone; musicians can have hearing loss and nerve damage. But forsome of the patients seen by Richard A. Friedman, MD, the trouble can be traced toanother part of the body: the mind.

One of three psychiatrists affiliated with the Center for the Performing Artist, Friedman has treat-ed many cases of performance anxiety. He recalls one patient, a promising young pianist whomFriedman had happened to see perform. “I was struck by the fact that his report on his experienceplaying was completely unlike what you would see as a member of the audience,” says Friedman, aprofessor of clinical psychiatry at Weill Cornell. “What he projected was confidence, calm, and mas-tery; what he experienced was terror, anxiety, and inhibition. It was the opposite of his public per-sona, which goes to show you how distorted social anxiety makes people.”

Friedman calls performance anxiety a common condition that has little to do with technical com-petence; rather, it’s an emotional problem. “Psychologically, what’s at the root of it is a series ofbeliefs—usually false—about how terrible things are going to go,” he says. “‘I’m going to embar-rass myself and it will be the worst thing in the world. My career will be over. One false move, onebad note, and I’m finished.’ And of course, that provokes more anxiety—and the more anxiety, themore negative and distorted your thinking becomes. So in a way, you’re your own worst enemy.”

Performance anxiety can be treated psychologically, with methods like cognitive behavioral ther-apy to break the cycle of negative thoughts. Patients are guided in contemplating the actual conse-quences of making a mistake—what’s the worst thing that could happen, really?—or to questionwhether the audience is as hypercritical as they fear. It can also be addressed medically, with betablockers like propranolol to curb such symptoms as sweaty palms, jitters, and “butterflies” in thestomach. “Social anxiety is a fundamental, hard-wired response,” Friedman says. “It’s part of thefight-or-flight response. Everyone has it to some extent; it’s there to help you identify dangers andescape them. We’re hard-wired to respond to the saber-toothed tiger, and there aren’t any. Yes, afew critics in the audience have their knives sharpened—but it’s not most people.”

Stage Fright

There’s no tiger

in the audience;

it’s just performance

anxiety

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SEA

RC

H

In January, Friedman lectured on performance anxiety as part of a continuingmedical education event, held at Carnegie Hall and sponsored by Weill Cornell’sCenter and the Methodist Center for Performing Arts Medicine in Houston. The firstof what is envisioned as an annual event, the course was attended by some fiftyphysicians from as far away as London. The speakers included Weill Cornell ortho-paedist Robert Hotchkiss, MD, a specialist in disorders of the hand and upperextremity whose talk touched on another psychological issue affecting performingartists: the phenomenon of the prodigy.

In some highly driven young performers, Hotchkiss says, stress can manifestitself in somatic conditions, as they push themselves—or are pushed by their par-ents—to practice for hours on end. “When you have young people saying that theirhands are going numb, we always treat these complaints seriously,” he says. “Butwe also have to be aware of the pressure they’re under. Many of them have beengroomed from an early age to be professional musicians—and it’s a pretty steeppyramid.” A different breed of problems can crop up as prodigies mature. Ascourse director and Weill Cornell otorhinolaryngology professor Lucian Sulica, MD,puts it: “There’s a psychological challenge to suddenly not being exceptional. Thehard thing about being a prodigy is that eventually the rest of the world catches upwith you.”

in those who play wind instruments—Hotchkiss notes that treating a star has itsown special challenges. For one thing, therecan be wider considerations at play, since thehealth of one celebrity can affect the liveli-hoods of many people. It’s not easy to cancela tour when you have agents, managers, con-cert promoters, roadies, and backup singerscounting on you, not to mention legions ofticket-buying fans. Then there’s the fact thata star patient often comes with a coterie ofadvisers, all with their own opinions andinterests. Says Hotchkiss: “You have to becomfortable with the fact that, in general,these patients have enormous numbers ofpeople helping—and, maybe unwittingly, notin a very helpful way.”

And there’s an all-too-human danger:that the physician might get star struck.Although being invited backstage after a per-formance can be gratifying and flattering,Hotchkiss says, it’s important not to compro-mise the doctor-patient relationship—tobecome less a physician than a fan. “Fame iscertainly a mixed blessing,” he observes.“Part of your role is to normalize the relation-ship. At one level, you have to be acutelysensitive of who they are—but in your inter-actions, you almost have to pretend that youdon’t care.” •

‘You need to understandthe artist’s psyche:it’s important that theshow go on, so how can we get you through it withoutendangering you?’

3 2 W E I L L C O R N E L L M E D I C I N E

Even before the Class of 2000 matriculated inAugust 1996, it was already unique. So manyapplicants had accepted the Medical College’soffer of admission that the school took theunusual step of asking for volunteers to defer

enrollment in return for a year’s free tuition. “Normally, theadmissions process is finely calibrated and the school knowsexactly how many students to accept to fill a class of 101 to104,” says Carol Storey-Johnson, MD ’77, senior associate deanof education. “That year, after only a handful volunteered forthe deferment, the class expanded to 114 students. Just fromthe perspective of sheer size, the Class of 2000 was in a class ofits own.”

ThePioneers

By Anna Sobkowski

Ten years ago, Weill Cornell graduated itsfirst class of doctors trained in a problem-based curriculum—a radical departure fromtraditional medical education. How has itshaped their careers?

The major reasons for this spike in inter-est, says Storey-Johnson: a new curriculum,inaugurated that fall, that called for stu-dents to spend less time in formal classroomsettings and emphasized low faculty-studentratios—plus the opening of the WeillEducation Center, with twenty-two class-rooms, each configured to accommodateten students for small-group learning andoutfitted with state-of-the-art electronics tosupport the new curriculum. “I rememberthat some of the furniture was still wrappedin plastic when we arrived for classes,” saysEdgar Figueroa, MD ’00, who has beendirector of Student Health Services at WeillCornell since 2006. “The facilities werebrand new, the curriculum was brand new, JO

HN

ABB

OTT

Doodnauth Hiraman, MD ’00

3 4 W E I L L C O R N E L L M E D I C I N E

and the students were brand new. We were start-ing out on an exciting adventure together.”

But like all adventurers, the members of theClass of 2000 weren’t sure what lay around thenext bend—so their excitement sometimes min-gled with anxiety. “All of us were used to theway we were taught in college—sitting in largelecture halls, memorizing loads of material, tak-ing big midterms and finals,” says MiriamHoffman-Kleiner, MD ’00. “Now we were learn-ing in small groups, taking frequent smallerquizzes, finishing with lectures and classes by 1p.m., shadowing doctors, and having a greattime. Was this medical school? We were havingso much fun, we wondered: are we being ade-quately prepared to pass our boards?” Theanswer was yes—the Class of 2000 performedexceptionally well on Step 1 of the USMLE andon all subsequent steps of the licensing exams.

Until 1996, Cornell’s curriculum, like that ofmost other medical schools, was largely basedon full days of lectures and labs. Interaction withprofessors tended to be minimal. Under the lead-ership of Daniel Alonso, MD, senior associatedean of education at the time, and other facultyand administrators, Weill Cornell moved awayfrom the lecture-based model to a hybrid thatcombined Problem-Based Learning (PBL) ses-sions, some lectures, weekly or biweekly quizzes,and journal clubs, where articles related to theissues being studied were critically assessed.

PBL, as it applies to medical school, askssmall student groups to address issues related tocarefully designed hypothetical patient cases. Inthe process, students gain both basic science andclinical knowledge, improve problem solvingabilities, and enhance diagnostic skills. Studentsassume increasing responsibility for their ownlearning, making them more motivated and rais-ing their sense of accomplishment—setting thepattern for becoming independent, life-longlearners. Traditional teacher-student roles changeas well: the faculty become tutors and evalua-tors, guiding the students in their problem solv-ing efforts.

It was a big change—and some of the studentsin the vanguard of the new program had trouble

adjusting. “I was always someone who studiedhard and did well on tests, so it was a shockwhenever I got a so-so grade during that first yearin medical school,” says Christina Cellini, MD’00. “I wasn’t used to a situation where I could get100s on all the quizzes but then have my gradebrought down because I didn’t participate thatmuch in the small group settings.”

Cellini, who earned an undergraduate degreefrom the Ithaca campus in 1996, says she wasparticularly unnerved the first time she took a“Triple Jump” exam. These tests, given at theend of each of the basic science courses taught inthe first and second years, are named for thethree hurdles that students must clear duringtwo days of testing. In the first phase, they ana-lyze a case similar to one they’ve seen in a PBLsession and have two to three hours to answeressay questions. Then they receive the secondpart of the case and gather in groups to reviewboth parts; the goal is to work as a team in amanner similar to the clinical consultationprocess. The next day, for the third jump, eachstudent sits for an individual oral exam with a

2000 SAMARITAN

2000 SAMARITAN

PROVIDED

Miriam Hoffman-Kleiner,MD ’00

Graduation day: ChristinaCellini with her parents in1996, when she earned herundergraduate degree fromCornell.

Christina Cellini, MD ’00

S P R I N G 2 0 1 0 3 5

‘Even thoughwe complainedabout it, it turns out thatwhat welearned in MPS informsthe way wepractice medicine tothis day.’

Edgar Figueroa

faculty preceptor. “It was stressful for me to getthe results from the problem-based part of theexam and find out I had gotten some thingswrong just as I was preparing for the oral partthe next day,” Cellini recalls. “I started to ques-tion whether this type of learning, which I feltin some ways was subjective, was right for me.Maybe this wasn’t a curriculum I could shine in,and that would have a negative effect on mychoice of residencies.”

Gradually, though, thingsturned around. “After awhile I began to realizethat I was going to have toovercome the biggest hur-

dle, which was my reluctance to speak in agroup, because that was affecting my grades,”Cellini says. The watershed moment came earlyin her first year, when Cellini’s interest waspiqued by GI medicine. After shadowing a gas-troenterologist at Weill Cornell, she was pairedwith a colorectal surgeon at Sloan-Kettering—where she gleaned the importance of makingherself heard. “On rounds, no one knows whatyou know unless you tell them,” she says. “Thisis especially true in surgery, where residents andattendings are constantly rushed and you havefewer opportunities to explain to them what youknow. Being exposed to this reality early onhelped me later during clinical rotations, on oralexams, and as an attending myself.”

Cellini went on to a general surgery residencyat Weill Cornell and spent three years doingresearch in pediatric surgery, concentrating onfetal nutrition. After completing a fellowship atWashington University in colorectal surgery, sheis now an assistant professor at the University ofRochester. “I try to reach out to quiet students,”she says, “because I have vivid memories of whatit was like to feel swallowed up by people whowere more comfortable speaking in public.” Sheadds that in hindsight, the early clinical exposure,working in teams, and being forced to adjust herapproach to learning had a profound impact on

her choice of specialty and the way she practices.“By the end of med school,” she says, “I became amore confident and stronger person.”

The course that was introduced with the newcurriculum—Medicine, Patients, and Society(MPS)—was often slammed as too “touchy-feely”and “non-science-y” by the Class of 2000.Figueroa says he hears the same concerns fromthe students he now cares for. “Even though wecomplained about it, it turns out that what welearned in MPS informs the way we practicemedicine to this day,” says Figueroa, who did hisresidency at NewYork-Presbyterian Hospital/Columbia University Medical Center and isboard-certified in family medicine. “Medicalethics, communication, physical diagnosis andmental status examination, nutrition, clinicalepidemiology/biostatistics, evidence-based medi-cine, health systems—those subjects are all cov-ered in MPS. They make up a body of knowledgeand skills that a physician must be comfortablewith, no matter what specialty he or she windsup in.”

For many members of the Class of 2000, thehighlight of the MPS course was the one after-noon each week they spent in physicians’ officesthroughout the New York metro area. Hoffman-Kleiner shadowed a pediatrician on Long Islandand an internist on Manhattan’s Upper East Side.“Today, the idea of a student at such an earlystage of training going into doctors’ offices is notso novel, but at the time it was,” says Hoffman-Kleiner, who did her family medicine residencyat NYP/Columbia and is board-certified in fami-ly medicine. “The doctors were wonderful aboutintegrating us into their practices even thoughwe were novices. For us, putting on a white coatonce a week and interacting with patients anddoctors was a transforming experience.”

As a student, Figueroa covered a wide rangeof specialties: he shadowed an internist/endocri-nologist in a solo practice in Brooklyn, a urolog-ic oncologist at Sloan-Kettering, a pediatrician ina group practice on the Upper West Side, and abehavioral neurologist at NYP/Weill Cornell. “Byobserving doctor-patient interactions I under-stood the attributes that I hoped to emulate as a

2000 SAMARITAN

Student days: EdgarFigueroa, MD ’00, withhis future wife, CathyCabrera-Figueroa

3 6 W E I L L C O R N E L L M E D I C I N E

Group. “I felt our curriculum offered the perfectmix of lectures and small group learning,”Hiraman says. “We had course outlines, and it wasup to our small groups to go off, learn about atopic, and bring information back to our fellowstudents. We covered everything, but in non-tradi-tional ways. This way of teaching encouraged usto be independent thinkers.”

Every Monday, each student in aPBL group receives a hypotheticalpatient scenario and, without theprofessor’s guidance, is asked toresearch the clinical problem. In

the next session, the professor elaborates on thescenario, challenging the students: “You’ve done‘abc’ and the patient is getting sicker. Whatnow?” By the third session, the students areexpected to come to conclusions about the prob-lem; at this point the professor offers guidance.The dry-erase boards in the classrooms fill upduring PBL sessions as students brainstorm ideas.

Finishing classes by early afternoon allowsample time to study course materials independ-ently and to research topics assigned for PBLgroups, as well as to participate in extracurricu-lars. Hoffman-Kleiner volunteered for a programthat trained her as a labor coach for teenagemothers, which meant she had to carry a beeperand be on call at all times, and also helped directand write class shows for three years. Her classwas “incredibly bonded” as it went through itsfour-year journey, she says, helping each otherand interacting closely with faculty. “If we com-plained about something, the faculty and admin-istration really listened,” she says. “Since we werethe first, they encouraged our feedback.”

physician, as well as some of the behaviors Ihoped I could avoid,” he says. “As I becamemore skilled, I was able to assist the physiciansand interact more closely with patients, whichbuilt up my confidence, because I was usuallypretty shy and quiet in class.”

For Doodnauth Hiraman, MD ’00, whoearned a bachelor’s degree from Cornell in 1996,having the opportunity to work with patients inhis first year was a major draw. “Even as anundergrad, when I volunteered with the localEMS in Ithaca, I knew I wanted to be an ER doc-tor—so the fact that I could jump right into see-ing patients early on was exciting,” saysHiraman, an attending in emergency medicineat NYP/Weill Cornell. Finishing classes by 1 p.m.left Hiraman time for activities such as theEmergency Medicine Interest Group. “I know alot of students may have felt they needed moretime studying ‘real’ subjects, but I found greatvalue in learning how to take a patient’s history,help with smoking cessation, and breaking badnews—some of the topics covered in the MPScourse,” he says. “These are things that mostcurriculums don’t spend much time on, but Icall on this early training every day in the ER.”

After graduation, Hiraman completed a four-year residency in emergency medicine atBellevue—rotating through pediatrics, the PICU,pediatric and adult anesthesia, and the cardiacICU, among other specialties. He returned to WeillCornell as an attending in 2004 with a passion forteaching. Recently, he began night shifts in the ERso he’d have more time to work with students inthe Clinical Skills Center—including the MPScourse—and as director of medical simulation forthe Department of Emergency Medicine. He alsomentors emergency medicine residents and is fac-ulty adviser to the Emergency Medicine Interest

‘The fact that Icould jumpright into seeing patientsearly on wasexciting.’

Doodnauth Hiraman

PROVIDED BY DR. CRISTA JOHNSON

Gowned up: Crista Johnson,MD ’00 (left), at commencementwith Keisha DePass, MD ’00

2000 SAMARITAN

S P R I N G 2 0 1 0 3 7

Today, as a family physician and director ofthe family medicine clerkship at BostonUniversity School of Medicine, Hoffman-Kleinersays the problem-solving and teamwork skillsshe learned at Weill Cornell form the backboneof her approach. “Our practice is set up inteams—in addition to physicians, we have anurse practitioner, nurse, medical assistants, andmedical students,” she says. “Medicine isincreasingly moving away from silos; a lot of lit-erature and evidence on patient safety andimproved outcomes points to the benefits of ateam-based approach. I feel lucky that I wasintroduced to this method of practice early onin med school.”

“Lucky” is also a word Crista Johnson, MD’00, uses—noting that Weill Cornell gave her theopportunity to identify her specialty early in herstudies. In the summer of 1997, Johnsonreceived a Barr Research Fellowship, an awardgiven to Weill Cornell students to pursueresearch between their first and second years.She went to Buffalo to study how Somali immi-grant women who had undergone genital cut-ting in their native land were faring in theAmerican health system. “The trajectory of mycareer started that summer,” says Johnson. “Theexperience cemented my interest in developingbetter health care for immigrant women.”

After finishing her ob/gyn residency atGeorge Washington University Medical Center,Johnson wanted to conduct rigorous research onhow to improve sensitivity in the health-carecommunity to the unique issues of this popula-tion. She won a Robert Wood Johnson grant tospend a year at UCLA studying the psychologi-cal and sexual impact of circumcision onwomen. From 2005 to 2008 Johnson was at theUniversity of Michigan, where she studied howto train physicians to overcome barriers to car-ing for vulnerable populations and earned anMS in health and health-care research.

Today, Johnson is an ob/gyn at the MaricopaIntegrated Health System in Phoenix and direc-tor of its Refugee Women’s Health Clinic.Launched in 2008, the clinic is the first inArizona, and only the second in the country, tofocus on African immigrant women’s health.Johnson describes her training at Weill Cornell as

“truly extraordinary, especially for the attentionpaid to developing our clinical acumen and decision-making ability. I still value that training.I find that when I do presentations to medicalstudents and faculty, I intersperse a real-life sce-nario of a case they may encounter in their ownpractice with a hypothetical clinical scenario. Iguess that early training has never left me.”

A century ago, education reformer AbrahamFlexner issued a report arguing that medicalschools should be more scientific and rigorous. Inrecent years, many have criticized medical educa-tion for going too far in that direction, emphasiz-ing scientific knowledge over clinical reasoningand the development of compassion and integri-ty. As the new century continues, medical curric-ula—including Weill Cornell’s—will continue tobe re-examined. “We are now in the process ofassessing which courses in the first two yearsshould change,” says Storey-Johnson. “Althoughwe get a high caliber of students, they come to uswith different levels of preparation, so our nextcurriculum revision will address that.”

She cites the first-year Molecules, Genes, andCells course as one that students from liberal artsbackgrounds often find helpful, while otherswith science backgrounds may find too easy. Asfor the current hybrid curriculum, Storey-Johnson says, “It will remain largely intact,because both students and faculty feel it is doingan excellent job training students to becomestrong diagnosticians, as well as compassionatephysicians. Each year, our classes match intosome of the best residency programs in thecountry.” The Class of 2000, she says, “helped usgain a better understanding of what works andwhat doesn’t—and subsequent classes have ben-efited from their experiences and insight.” •

PROVIDED BY DR. CRISTA JOHNSON

In practice: Crista Johnson(right) at the MaricopaIntegrated Health System inPhoenix with JeanneNizigiyimana, program manag-er for the Refugee Women’sHealth Clinic

3 8 W E I L L C O R N E L L M E D I C I N E

The lecturer launches a PowerPoint presentationand a rather gloomy photo fills the projectionscreen. It depicts a balding man hunched overa desk in a room filled floor to ceiling withpatient records—so many that it looks as if he’s

buried in manila folders. “Does anyone know what movie thisis from?” she asks. A student identifies it as American Splendor,an indie picture starring Paul Giamatti as a beleaguered filingclerk who gains fame as an underground cartoonist. But thecitation doesn’t matter as much as the image—one guy drown-ing in an ocean of paperwork. The headline on the PowerPointslide: “Most of the American health-care system today.”

The HardPart

By Beth SaulnierPhotographs by John Abbott

On the path to becoming a doctor, master-ing clinical medicine is comparatively easy. A required clerkship teaches fourth-yearssomething more difficult: how to navigate the U.S. health-care system.

S P R I N G 2 0 1 0 3 9

Body electric: Assistant professor Jessica Ancker, PhD,lectures on the advantagesand disadvantages of computerized medical records.

In a seminar room in the building that’shome to Weill Cornell’s public health depart-ment, Jessica Ancker, PhD, is giving a talk titled“Health Information Technology: Promises,Pitfalls, and Research Questions.” For the nexthour, the assistant professor in the Division ofQuality and Medical Informatics teaches sometwenty students about the plusses and minuses ofelectronic medical records. She outlines the hur-dles the technology could help overcome—fromthe statistic that up to 30 percent of lab tests areredundant to the fact that for every one hundredpatients, a typical physician communicates withninety-nine colleagues in fifty-three practices.But the benefits of easier data-sharing come with

perils, such as compromised confidentiality.“It makes it easy to access data you shouldn’t

necessarily be looking at,” one student observes,citing the temptation to nose into the records ofcelebrity patients.

“Couldn’t you do that with paper files?”Ancker asks.

“You could,” he says, “but this way it’s mucheasier.”

On this Monday afternoon in February,Ancker is a guest lecturer for an innovativecourse that grounds fourth-year medical studentsin the workings of the American health-care sys-tem. Taught by professor of clinical public healthMadelon Finkel, PhD, the required two-week

Back to School

It’s nicknamed POX, a pithier spelling for POCHS:Perspectives on the Changing Health-CareSystem. Five times a year, about a dozen inter-nal medicine residents put their clinical obliga-

tions aside for a solid week to attend a requiredblock rotation on health policy. “This is a bit of areturn to the classroom, which for residents isunusual,” says course co-director Oliver Fein, MD, aprofessor of clinical medicine and clinical publichealth who also serves as associate dean for affilia-

tions. “It’s a fairly rigorous, lecture-basedcurriculum, but with a number of otherthings. We’re trying to expose young doc-tors in training to a variety of ways in whichmedicine is going to be practiced in thetwenty-first century.”

The course’s lectures cover a variety of subjects, such as Medicare and Medicaid, risk man-agement, and the “pitfalls and pleasures” of academic medicine. Participants go on a half-daysite visit to the Westchester Medical Group, a 160-member, multiple-specialty practice in WhitePlains, New York, where residents take a tour and meet with the group’s president and medicaldirector. They also attend that week’s David Rogers Health Policy Colloquium and MedicineGrand Rounds and get practical tips on topics like negotiating their first employment contractand planning their entry into practice. Each block rotation also includes two debates, in which

the residents argue for and against topics like the “public option” in health-care reform. “As a resident, it’s incredibly important to learn this stuff,” says Lee Shearer, MD, a third-year bound

for a fellowship in adolescent medicine through the Weill Cornell-Columbia combined program. “We spendeighty hours a week for three years learning how to practice medicine—how to take care of patients andprescribe medications, when to order tests, how to manage care. We don’t have as much exposure tohow the health-care system actually works. How do hospitals run? Who funds them? What implications dothe political changes have on me and my career? What kind of advocacy do I want to be involved in? It’sbeing exposed to the nitty-gritty, day-to-day practice of medicine—taking us out of the ivory tower andteaching us some of the practical things that we need to know.”

Except for one evening in their respective continuity clinics, the residents have no patient responsibil-ities and are not on call. That allows them to focus on the intricacies of the health-care system—a fac-tor that many see as particularly valuable. “When you’re in the hospital, your mind is with your patients,”says Shearer. “And while we try to carve out time for dedicated learning, to some extent you’re alwaysworrying about a sick patient, the discharge paperwork that needs to get done, or your pager going off.So it’s nice to be a student again, to be granted the leeway to just absorb and learn.” Carving out thatkind of dedicated time for exploring the health-care system is rare, Fein says. “I don’t know of anotherresidency program that does this the way we do it. Sometimes a program will take an hour every fourthweek and devote a conference to it, but I don’t think you get the intensive, overall picture.”

When the rotation was established in 1997, it lasted two weeks; it has since been cut in half dueto financial and logistical constraints. While it’s currently limited to residents in internal medicine—plusthe occasional pediatric resident, geriatric fellow, or chief resident from an affiliated hospital who isallowed to participate—it may someday expand to other departments. Fein notes that when the rota-tion began, organizers weren’t sure how it would go over. “We were nervous, frankly, because it’s notclinical,” he recalls, “and there’s the whole attitude that residents have—or so we thought—that some-thing that is not clinical is not valuable.” But like the required clerkship for fourth-year medical stu-dents, the block rotation has gotten rave reviews from participants; Fein says that on a scale of 1 to 5,it averages a score of 4.6 or higher.

Among its enthusiastic alumni is Johanna Martinez, MD, who took the rotation as a resident fouryears ago. Now an assistant professor of clinical medicine at Weill Cornell, she co-directs the programwith Fein. “Being an internist and a primary care provider, I see myself as an advocate for my patients,helping them navigate the health-care system and all of its intricacies, so the course was extremelyenlightening to me,” she says. “If it’s complex for a physician who works in the system, you can justimagine how complex it is for a patient.”

For one intensive week,

senior medicine

residents get some

‘nitty-gritty,

day-to-day’ lessons

Oliver Fein, MD

‘Students willhave to navigate thehealth-care system, with allthe myriadinsurance policies, and itreally is a nightmare.’

clerkship has been offered since the MedicalCollege curriculum was overhauled in the mid-Nineties. “I always say that clinical medicine isthe easiest part of being a doctor,” says Finkel.“Students will have to navigate the health-caresystem, with all the myriad insurance policies—private, state, federal—and it really is a night-mare. Physicians don’t understand it, andpatients certainly don’t. So we felt that by pro-viding an introductory overview of how the U.S.health-care system is set up, organized, adminis-tered, and financed, it would help the studentsbe better doctors—to be advocates for theirpatients and also for themselves.”

The course offers insights into such topics asMedicare and Medicaid, prescription drug costs,health-care disparities, and the public insurancesystems of such countries as Canada, Australia,and the U.K. That sort of comprehensiveoverview is rare among Weill Cornell’s peers,according to Finkel. “We are very much ahead ofthe curve,” she says. “This is unique. Most med-ical schools do not have this built into their cur-

riculum. The excuse is there’s no time, the cur-riculum is already packed with required courses,et cetera. We are one of the few who include this,and not just as an elective. This is required; youcannot graduate without passing this course.”

Giving new MDs a basic understanding ofhow the health-care system works is seen asincreasingly vital—not only by medical studentsand faculty but also the national body governingmedical colleges. In July 2004, the AAMC issued“Educating Doctors to Provide High QualityMedical Care: A Vision for Medical Education inthe United States,” a report by an ad hoc com-mittee of deans. Under the missions of the medical education system, the report listed theneed to promote “an understanding of theorganization, financing, and delivery of healthcare in the United States.” Five years later, anarticle in Academic Medicine offered an assess-ment of how well schools were educating stu-dents in the complexities of the health-caresystem. The researchers studied data from morethan 58,000 new MDs who had completed the

Policy maven: Professor Madelon Finkel, PhD, has taught the required clerkship since its inception.

4 2 W E I L L C O R N E L L M E D I C I N E

AAMC’s annual graduation questionnaire from2003 to 2007, and also compared the responsesof more than 1,000 graduates of two otherwisesimilar (and unnamed) schools: one with inten-sive offerings in health-care systems, the otherwithout.

The authors found that a large majority ofgraduating students were satisfied with theirclinical training. However, they wrote, “In starkcontrast, fewer than half the students felt thatappropriate instructional time was devoted tothe practice of medicine, especially the compo-nent of medical economics.” Unsurprisingly,graduates of the school with extensive offeringsin health-care systems reported being muchmore satisfied with their grounding in the sub-ject—and furthermore, the researchers found,such instruction did not seem to come at theexpense of other topics.

At Weill Cornell, exposure to health-care pol-icy issues takes a variety of forms. While Finkel’sclerkship is required for fourth-year medical stu-dents, a similar course is mandatory for third-

year residents in internal medicine (see sidebar).That one-week block rotation is the brainchild ofthe Medical College’s associate dean for affilia-tions, Oliver Fein, MD, who also coordinates theDavid Rogers Health Policy Colloquium—aweekly program that draws a diverse, interdisci-plinary group of faculty and is especially popularamong first- and second-year medical students.(Topics have ranged from the consumerizationof genetic testing to a speech by a West Pointgeneral condemning torture; the series alsoincludes regular “My Life in Medicine” talks byleaders in a variety of health-care fields.) “Myhope is that participants in both the RogersColloquium and the block rotation learn tobecome more creative and positive actors inchanging the health-care system,” Fein says.“And that they will play a role—not just in howthey organize their practices, but also in the pro-fessional societies they join and the communi-ties where they live—in shaping how medicalcare is delivered.”

Both the student clerkship and the resident

Lively debate: Fourth-year student Faye Robertson (farleft) makes a point during adiscussion of the merits andpitfalls of electronic medicalrecords. To her right are classmates Erica Greenberg,Marie Bartholdi, David Dayan-Rosenman, and Linda Fan.

S P R I N G 2 0 1 0 4 3

rotation offer a mixture of classroom instructionand field trips. Finkel’s students visit medicalpractices, pharmaceutical companies, govern-ment agencies, private and public insurers, andmore. “She’s so knowledgeable about health-carepolicy, and she has so many contacts to get peo-ple in various areas to speak to us,” ChristinPrice, MD ’09, says of Finkel. “Not only was shea great teacher, but she exposed us to a lot of toppeople in the field.” In general, students do sitevisits in the morning and have seminars in theafternoons; toward the end of the two weeks,they give oral presentations and turn in a paper.But the course content is always in flux. “I givethis clerkship six times a year, and every time it’sdifferent, because the issues change,” saysFinkel. “We focus on current political, econom-ic, and social issues pertaining to health-caredelivery, and it has to reflect what’s going on inthe world.”

The February session of the coursewas held in the thick of the contro-versy over the Obama Admini-stration’s health-care reform bill;tempers were running high as the

opposing sides hurled invective, and critics of thebill fueled fears of “death panels.” As Finkel saysto the students: “I think more people are follow-ing the health-care debate than the Olympics.”

The day after Ancker’s talk, the studentsbegin their oral presentations. This time around,Finkel has assigned teams to discuss health-caredisparities from perspectives such as race, gen-der, geography, and sexual orientation. “Whatwe want to focus on today is, what effect does ithave on health status?” she tells them. “Howdetrimental is it, or isn’t it?” Conversation turnsto a New York Times piece from earlier in themonth in which Finkel was quoted; the author,an MD, told a story about a former patientwhose abdominal incision hadn’t healed proper-ly because he couldn’t afford the gauze tochange the dressing. Such tales are common inthe current recession, Finkel tells the students.

In addition to issues of access—the fact that80 percent of African American patients are seen

by 20 percent of doctors, for example, or thatwomen are more likely than men to havedependent insurance coverage and are thereforemore vulnerable to losing it—the students dis-cuss questions of cultural and educational com-petency. In what languages should patientinformation be offered? To what grade levelshould it be geared? After citing a survey thatfound that only one American in ten has theskills to manage his or her own health care—defined by basic tasks like filling out forms andreading prescription bottles—Finkel offers ananecdote about her husband’s ninety-six-year-old Aunt Ruthie. “She takes twenty-two pills aday,” Finkel says. “Before she went into assistedliving, she was following instructions about tak-ing her medications at breakfast and lunch, butbreakfast was at eight-thirty and lunch at eleven-thirty—so she was overdosing.”

According to Finkel, student feedback aboutthe course has been overwhelmingly positive;more than three-quarters of exit surveys call itexcellent or outstanding. She has also gottenstrong feedback from former students now inpostgraduate training—like Price, an internalmedicine intern at Brigham and Women’sHospital in Boston. “I definitely would havebeen more naïve starting residency if I hadn’ttaken that course,” Price says. “It has given me aleg up. As an intern, you’re constantly dealingwith the daily grind; you’re so busy that youdon’t always get the chance to look at the bigpicture. But having gone through that coursehas made me pause before I order dozens of testsand scans, to make sure that it’s cost effective. IfI hadn’t taken that class, I’m not sure that I’d dothat in the hustle and bustle of internship.”

Like the block rotation for residents, thefourth-year clerkship is full-time; students cangive it their complete attention, without the pullof patient obligations. “It’s a wonderful respitefrom the clinical curriculum,” says AnthonyRosen ’10, who plans to specialize in emergencymedicine. “As medical students, we’re focusingso closely on learning how to manage individualpatients. A lot of the time we’re quite shelteredfrom issues of insurance and ability to pay; weseldom get the opportunity to step back andthink about what health-care delivery means asa policy issue.” •

‘I definitely would have been more naïve starting residency if I hadn’t taken that course,’ saysChristin Price, MD ’09. ‘It has given me a leg up.’

Dear fellow alumni:As I move into the second year of my term as

president of your Alumni Association, I am con-tinuing my quest to personally meet as many ofyou as possible. In March, Spencer Kubo, MD’80, and I organized a dinner at the Omni Hotelin Atlanta for local alumni as well as many oth-ers who were in town for the 2010 meeting ofthe American College of Cardiology. We werefortunate that Dean Antonio Gotto was a speak-er at the meeting and hosted our event, whichwas modeled after a similar regional gathering inBoston last fall.

We were thrilled to have thirty-five WeillCornell alumni at the dinner—includingRudolph Jones, MD ’45, and his daughter, ZoeJones, MD ’79, and Richard Schwartz ’60, MD’65, and his son, Michael Schwartz ’92, MD ’98. Itwas especially nice to have several younger alum-ni present, including Philip Peters ’95, MD ’00,Jodi Accaria-Chitwood, MD ’01, and Minal Patel,MD ’05. Ten visiting cardiologists joined us, com-ing from Arizona, Texas, and the Northeast. Itwas a great opportunity for local alumni to meet;three of them did not know that they all work at

4 4 W E I L L C O R N E L L M E D I C I N E

the Centers for Disease Control and Prevention!Dean Gotto updated us on recent events at theMedical College, with news from New York City,Qatar, Tanzania, and Haiti. The evening was a lotof fun, and we are currently taking suggestionsfor future regional events.

As you may know, the GHESKIO clinic inPort-au-Prince was near the epicenter of the Haitiearthquake and suffered significant damage. Theclinic was started by Jean William Pape, MD ’75,in 1982 to help fight HIV/AIDS, and has sinceexpanded to treat other infectious diseases. Sincethe earthquake, GHESKIO has become both arefugee site and a center for emergency medicalrelief. Currently it is providing food, clean water,and health care to 6,000 refugees camped on theGHESKIO compound. Dr. Pape has asked mem-bers of the Cornell community to keep theplight of Haiti in the public consciousness anddonate whatever they can. You can follow theevents at GHESKIO and make donations at theGlobal Health department’s website (http://weill.cornell.edu/globalhealth).

The Reunion Committee, under the leader-ship of Michael Alexiades, MD ’83, is developingan exciting program for the 2010 gathering. Atevery reunion, alumni have reminisced about theclass shows. A survey was recently sent to all ofyou asking about your involvement in the artssince medical school. Many responded that youhave continued to nurture your passion formusic, art, and writing, and some have incorpo-rated the arts into your medical practice. Wewould like you to share your artistic talent withus at Reunion 2010, the theme of which is“Medicine and the Arts: The Alumni Perspective.”There will be poetry reading, an art show, andmusic performances by alumni. The ReunionCommittee also has planned events for alumniwith young families, so there will be somethingfor everybody. I hope to see all of you there!

With warmest regards,Hazel Szeto, MD ’77, PhD ’77President, CUWMC Alumni Associationhhszeto@alumni.med.cornell.edu

NotebookNews of MedicalCollege and GraduateSchool Alumni

Hazel Szeto,MD ’77, PhD ’77

JANET CHARLES

the Winter 2009/10 issue of Weill CornellMedicine, Dr. Shaver’s name was misprintedas “Beverly Dean” and her degrees weremistakenly omitted. We regret the errors.

G. B. Lerner ’55, MD ’59: “I’m retired,living in western Pennsylvania, and enjoy-ing my children and five grandchildren.”

1960sBart Schmitt, MD ’63, is professor of

pediatrics at the University of ColoradoSchool of Medicine. “I continue to enjoyseeing patients and teaching three days perweek at our Children’s Hospital. I write tele-phone triage and advice protocols for nursecall centers another three days a week. Irecently created Pediatric SymptomMD, aniPhone app for parents and grandparents. Ihope some of you will give it a test drive.”

Irvine G. McQuarrie, MD ’65, PhD ’77:“Turning 70 seems to have prompted sever-al of my classmates to write to this columnand give an accounting, so now I’ll try.After training in neurosurgery at New YorkHospital, I went into the Navy on the BerryPlan, then came back to finish a PhD inneurosciences under Professor BerniceGrafstein. I completed board certificationwhile attending at NYH, then went toCleveland for a postdoc in neurosciences.By 1982, I had my own lab at ClevelandVAMC, closing it in 2002 (having trainedone grad student and three postdocs alongthe way). That wasn’t a good year. I alsoclosed the Neurosurgery Service, retiredfrom the Naval Reserve, and divorced forthe second time. I’m close to my four chil-dren, but have a ways to go with my threegrandchildren. I’m still full-time at Cleve-land VAMC, now as a neurologist doingdisability evaluations for traumatic braininjury. The thing I miss most is my 22-yearpart-time career with the Marine Corps,training corpsmen and overseeing humani-tarian assistance missions to developingcountries (for which I was awarded theLegion of Merit). I also miss teaching neu-rosciences and head and neck gross anato-my to second-year medical students at CaseWestern Reserve University. It’s been real.”

Robert Pezzulich ’61, MD ’65: “I retiredfrom general surgery in August 2008 after35 years in practice. From 1982 until 2004I also served as chief of staff at South-western Vermont Health Care, steppingdown to become the principal investigatorof a $1.5M AHRQ grant awarded to studythe effect of computerized health records

S P R I N G 2 0 1 0 4 5

1940sRobert J. Haggerty ’46, MD ’49: “The

biggest news from the Haggerty family isthat Muriel and I celebrated our 60th wed-ding anniversary this past October. Not toomany now achieve this. At my age andfully retired I receive lifetime awards, notones for current activities. I suppose it’snice that I’m alive to receive them. Twothis past year were much appreciated. Onewas the 2009 Lifetime Award from theSociety for Research in Child Developmentfor distinguished contributions to the livesof children; the other two recipients wereT. Berry Brazelton and Hillary Clinton. Theother was the Distinguished Career Awardfrom the Academic Pediatric Associationfor the improvement of patient care, teach-ing, and research in general pediatrics.Hope to attend the 60th Reunion—actual-ly our 61st!”

1950sRussel H. Patterson, MD ’52: “Doing

well. Still going back and forth betweenManhattan and Vermont. Gave up the air-plane in July, which makes the Vermonttravel more complicated.”

Artemis Pazianos-Willis, MD ’55: “Iheard from several of our classmates atChristmas. Jan and Roland Richmond, MD’55, have continued to travel extensively.Last year they took trips to the IndianOcean and Persian Gulf as well as theFrench Riviera. They also had many visitswith family and friends within the U.S.They have been married for 56 years andhave four children and grandchildren, alldoing well. Son Ken has followed in hisfather’s footsteps and is a physician. SteveSchenker, MD ’55, writes that he has final-ly retired and is an emeritus professor, butstill sees a few difficult patients. His moth-er is still living at age 103. MickeyHollenberg, MD ’55, said he hopes to makeit to our 55th Reunion. Gunter Meng ’51,MD ’55, and Hilde have had a few medicalproblems, but they are now well and werevisited by their two children and grand-children over the holidays. Harned Isele,MD ’55, and Joan took trips to Lisbon andSeattle in 2009. I had a wonderful trip withcollege friends in October along theTurkish coast, into Syria to visit the ruinsof Palmyra, and ending in Alexandria,Egypt.”

Beverly Deane Shaver ’54, MD ’58. In

on patient safety. As part of that, I helpedform the Department of Patient Safetywithin our organization. Helen, my wife of46 years, and I are enjoying travel (havingreturned from a week and a half on theAmazon and planning an extensive trip toVietnam with stays in Thailand andCambodia) and time with our two grand-daughters, who live here in Vermont, andour two grandsons, who live just outside ofBoston, as well as their parents. Both thetravel and the grandchildren are providingme the utmost opportunities for photogra-phy, a love resurrected after retirement.Helen and I are looking forward to seeingas many classmates as possible at our 45thReunion this September.”

1970sJames S. Reilly, MD ’72, is president of

the Interamerican Association of PediatricOtolaryngology. The IAPO biannual meet-ing is being held in Panama City, Panama,in July 2010.

Robert A. Linden ’71, MD ’75: “I wroteThe Rise and Fall of the American MedicalEmpire: A Trench Doctor’s View of the Past,Present, and Future of the U.S. HealthcareSystem (Sunrise River Press). The first twoparts of the book examine the impendingdeath of primary care medicine and thenation’s health-care insurance distributionmodel, its faults, and the potential solu-tions. The last two sections analyze thepharmaceutical industry’s infiltration intothe science and practice of medicine andthe medical malpractice dilemma.”

Jean W. Pape, MD ’75, founder andCEO of GHESKIO Center, Haiti, receivedthe 2010 Carlos Slim Health Award for hiswork with HIV/AIDS patients and theintroduction of oral rehydration therapy toreduce the mortality rate of children withdiarrhea.

Melissa S. Pashcow, MD ’76: “My son,Justin Seidenfeld, graduated from Princetonin June 2009 with a major in civil engineer-ing and a minor in environmental studies.He is teaching high school math in a char-ter school in Memphis, Tennessee. Mydaughter, Laura Seidenfeld, is an adminis-trator at Sotheby’s and was recentlyengaged to David Teigman, an associate atSullivan and Cromwell. We are looking for-ward to a summer 2010 wedding.”

Mary K. Crow, MD ’78, was appointedphysician-in-chief and chair of theDivision of Rheumatology at Hospital for

4 6 W E I L L C O R N E L L M E D I C I N E

cology and Therapeutics at the Children’sHospital of Philadelphia Research Institute,has been named chair of the Children’sOncology Group. He will remain on thestaffs of the Children’s Hospital and theUniversity of Pennsylvania School ofMedicine, where he is a professor of pedi-atrics and pharmacology.

1990sChristine L. Frissora ’86, MD ’90,

opened the Roberts Center for IrritableBowel Syndrome and Related Disorders. Dr.Frissora, director of the IBS Center, willlead a team focused on the care and treat-ment of patients with IBS.

Gregory W. Lampe, MD ’94: “I’ve beenenjoying the practice of emergency medi-cine in Orange County, California, for thepast 11 years. Just board certified again inmy specialty. Actively involved in settingup my hospital and health system’s infor-mation technologies. Still shocked at howfar behind the medical field is in informa-tion technology.”

Sheila K. Partridge, MD ’97, is a sur-geon practicing at Newton–WellesleyHospital in Newton, Massachusetts, andmedical director for the NWH Center forGeneral and Weight Loss Surgery. She hasbeen married for ten years and has twochildren, ages 6 and 4.

2000sJason E. Portnof, MD ’06, and his wife,

Courtney, announce the birth of their son,Justin Miller Portnof, on January 21, 2010.The family resides in New York City, whereJason has joined the faculty of the oral andmaxillofacial surgery residency program atBeth Israel Medical Center/Jacobi MedicalCenter/Albert Einstein College of Medicine.

Special Surgery. She is a professor of medi-cine at Weill Cornell. Dr. Crow will continueas co-director of the Mary Kirkland Centerfor Lupus Research and director of theAutoimmunity and Inflammation Researchprogram at HSS. She also serves as presi-dent of the Henry Kunkel Society. In addi-tion to her studies of lupus, she investigatesthe immunologic mechanisms involved inrheumatoid arthritis and scleroderma.

Thomas O’Dowd, MD ’79: “We couldn’twait until our official reunion this year—four of our Class of 1979 decided to gettogether for our own mini-reunion late lastyear. We’ve all committed to attending thebig reunion this fall, and we look forwardto seeing our classmates and to seeing howmuch better we look compared to our ‘old’classmates.”

1980sBrad Radwaner, MD ’80: “I’m the father

of four boys: David, 20, Daniel, 18,Jonathan, 15, and Jake, 1-1/2. After 15 yearsas an invasive cardiologist, I’m now med-ical director of the New York Center for thePrevention of Heart Disease in Manhattan.I’m expecting publication of my first bookon the epidemic of obesity and cardiovas-cular disease. I remember most theDecember 1976 Christmas Show, includingthe famous rendition of the ‘First semesterblues, nothing to lose except your mind.’”

Robert C. Marchand, MD ’83, wrotewith news of his four children. “Eddie, 25:real world, medical sales. Bo, 23: realworld, Rhode Island State Police. Kevin, 18:fun world, Cornell undergrad football.Isabel, 5: kindergartner and living large.”

Peter C. Adamson, MD ’84, director ofclinical and translational research andchief of the Division of Clinical Pharma-

InMemoriam

We want to hear from you!Keep in touch with

your classmates.Send your news to Chris Furst:cf33@cornell.eduor by mail:Weill Cornell Medicine401 East State Street, Suite 301Ithaca, NY 14850

’35 MD—Elizabeth Chittenden Lowry(Mrs. Thomas Lowry, MD ’35) of Madison,CT, December 21, 2009; retired pediatri-cian; active in community and profession-al affairs.

’35 BA, MD ’38—John D. Hunter ofManhasset, NY, January 11, 2008; familyphysician; staff physician at ManhassetMedical Center, North Shore Hospital, St.Francis Hospital, and Nassau Hospital;medical examiner, Federal Aviation Ad-ministration; active in community, profes-sional, and religious affairs.

’42 MD—Richard B. Donaldson ofChattanooga, TN, December 27, 2009;orthopaedic surgeon; founder, Chatta-nooga Orthopaedic Clinic; staff surgeon,Erlanger Children’s Hospital, MemorialParkridge, Erlanger–North, East Ridge, andNorth Park Hospitals; medical director,Rehabilitation and Pain Management, EastRidge Hospital; courtesy staff, SouthPittsburgh Hospital and Emerald–HodgsonHospital (University of the South); con-ducted a crippled children’s clinic andamputee clinic at the Siskin Foundation;veteran; active in community, professional,and religious affairs.

’38 BA, MD ’42—John S. Hooley ofNaples, FL, January 10, 2010; general sur-geon; veteran; active in civic, community,and professional affairs.

’40 BA, MD ’43—Morrison Rutherfordof Medford, OR, formerly of Oxnard, CA,February 4, 2009; ob/gyn; veteran.

’41 BA, MD ’43—Kathleen SpellmanMcLaurin of Raleigh, NC, formerly ofCincinnati, OH, October 30, 2009; brieflypracticed medicine in New York City andHollywood; personal doctor of Louis B.Mayer; active in civic and community affairs.

’45 MD—Charles A. Bailey of Coro-nado, CA, formerly of Ridgewood, NJ,December 25, 2009; cardiologist; internist;researched the Rh factor and typhus whilein the Navy; president of the medical staff,Valley Hospital; veteran.

’45 MD—Howard M. Edwards Jr. ofRockford, IL, January 12, 2010; general

S P R I N G 2 0 1 0 4 7

practitioner; president of medical staff, KSBHospital; staff physician, Sterling Com-munity, Rockford Memorial, Amboy, andDixon State Hospitals; invented an X-rayspacer and a limiter for a portable X-raymachine; president, Edwards BuildingCorp. and Serend Inc.; veteran; pilot;author; active in community and profes-sional affairs.

’46 MD—Ellsworth C. Alvord Jr. ofSeattle, WA, January 19, 2010; neuro-pathologist; professor and head of theDepartment of Neuropathology, Universityof Washington School of Medicine; workedon mathematical models for brain cancer;also worked at Baylor University; veteran;philanthropist; active in civic, community,professional, and alumni affairs.

’48 MD—Hector M. Brown of Alex-andria, MN, formerly of Bemidji, MN,January 18, 2010; physician; coroner; vet-eran; active in civic, community, and reli-gious affairs.

’50 MD—Bernard Amster of WestHollywood, CA, December 4, 2009; familypractitioner; veteran.

’54 MD—Edwin M. Jacobs of SanFrancisco, CA, October 17, 2009; pioneer-ing oncologist; head of clinical research,UCSF Cancer Institute; clinical professor ofmedicine, UCSF; also worked for Nat’lInstitutes of Health; veteran; member,Pierre Monteux Society; active in commu-nity and professional affairs.

’58 MD—Ralph J. Lewis of BaskingRidge, NJ, February 15, 2010; chief of tho-racic surgery, Robert Wood JohnsonUniversity Hospital, St. Peter’s UniversityHospital, and Somerset Medical Center;clinical professor of thoracic surgery, RobertWood Johnson Medical School; pioneer invideo-assisted thoracic surgery; author;active in professional and alumni affairs.

’58 MD—Thomas J. O’Grady of Syl-vania, OH, February 28, 2010; thoracic andcardiovascular surgeon at the Toledo Clinic;chief of staff, St. Charles Hospital; on thestaff of Flower Hospital, the Toledo Hospital,St. Charles Hospital, Mercy Hospital, andthe Medical College of Ohio; former presi-dent, Academy of Medicine of Toledo andLucas County; board member, FlowerHospital; chairman, medical advisory board,American Red Cross, Western Lake Erieregion; captain, Air Force Medical Corps.

’64 MD—Arthur H. Hayes of Oxford,CT, February 11, 2010; former FDACommissioner under President Reagan;

directed the FDA’s response to the Tylenoltampering case; former associate dean foracademic programs and assistant professorof medicine, Weill Cornell Medical College;professor and director of clinical pharma-cology, Pennsylvania State UniversityMedical School; co-founded medical clinicon the Pacific island of Pohnpei for JesuitMissions; provost and dean, New YorkMedical College; president, E. M. Pharma-ceuticals; founder, MediScience Associates;veteran; author; active in professional, reli-gious, and alumni affairs.

’64 MD—Thomas R. Vaughan Jr. of SanFrancisco, CA, November 30, 2009; chief ofstaff, St. Francis Memorial Hospital; pulmo-nologist and critical-care specialist, KaiserPermanente Medical Center; fellow, UCSFCardiovascular Research Institute; staffphysician, San Francisco Veterans Hospital;active in professional affairs.

’65 MD—Nicholas Fortuin of OwingsMills, MD, April 11, 2010; cardiologist andprofessor of medicine, Johns HopkinsMedical Institute; first director, echocardio-graph laboratory, Johns Hopkins; workedfor the U.S. Public Health Service at theUniversity of North Carolina School ofMedicine; researched the effects of air pol-lution on the heart; active in professionaland religious affairs.

’70 MD—Clark N. Hopson of HiltonHead Island, SC, September 6, 2009; chair-man, Department of Orthopaedics, Uni-versity of Cincinnati; established a private

practice, Orthopaedic Reconstruction, inHilton Head Island.

’70 MD—Joseph S. Tulumello ofBuffalo, NY, November 6, 2009; practicedpulmonary and internal medicine.

’96 BA, MD ’00—Keisha M. DePass ofBaltimore, MD, January 19, 2010; pediatri-cian and orthopaedist, Maryland PediatricOrthopaedic Center; active in professionalaffairs.

FacultyJames F. Masterson of Rye, NY, April

12, 2010; clinical professor emeritus of psy-chiatry at Weill Cornell Medical College;expert on narcissism and other personalitydisorders; founder and director, MastersonInstitute for Psychoanalytic Psychotherapy;proponent of object relations theory; for-mer head of the Payne Whitney PsychiatricClinic’s adolescent program; author of sev-eral books, including The Search for the RealSelf and The Psychiatric Dilemma of Ado-lescence; veteran; active in professional affairs.

Elisabeth P. Pickett of Aurora, CO,February 14, 2010; former instructor inurological surgery at Weill Cornell; firstboard-certified female urologist in the U.S.;research fellow, Sloan-Kettering Instituteand adjunct attending at Memorial Sloan-Kettering Cancer Center; director, SpinalCord Injury Center, Castle Point VeteransHospital; trained Afghan physicians in the1970s; mountain climber; active in profes-sional affairs.

Mary Ann Payne, MD ’45, PhDThe Weill Cornell Medical College Alumni Association Board ofDirectors humbly recognizes the life and remarkable contribu-tions of Mary Ann Payne, who passed away on March 24,2010, at the age of 96. Dr. Payne had a long and distinguishedcareer in medicine. She received her MD from CornellUniversity Medical College and her MA and PhD (endocrinolo-gy) from the University of Wisconsin. She was a clinical profes-sor of medicine at the Medical College and an attendingphysician at the New York Hospital. Dr. Payne served in sever-al leadership positions at the Medical College, including presi-dent of the Alumni Association and member of the Board ofOverseers. She also was a member of the Dean’s Circle, recog-nizing outstanding alumni generosity, president of theVoluntary Staff of NewYork-Presbyterian Hospital, and the firstwoman president of the New York Academy of Medicine. In1994, the Alumni Association honored her with the Alumni Award of Distinction; otherawards include the Special Recognition Award from the American Society of InternalMedicine, the Award of Merit from the New York State Society of Internal Medicine, and theDistinguished Service Plaque from the New York Academy of Medicine.

goal of $2,013 from the class and more from outside sources. Thepayoff: he would have his hair cut at the annual class show onMarch 1. In the end, donations outstripped expectations; they gar-nered $2,427 from the class—ninety-six people gave, out of 103—and $6,100 total, including gifts from other students, relatives, andthe engineering firm where his father works. Individual donationsranged from $1 to $500. “I was tickled to death by how much theclass gave and how much they stepped up,” says Goodwin, whohopes subsequent first-years will be inspired to include a fundraiseras part of the annual class show. “It was powerful to see a bunch ofyoung, motivated people doing something like this.”

And what of his newly shorn locks? Measuring more than twen-ty inches, they’ll be donated to Wigs for Kids. “I wanted to get themost to donate, so we buzzed my head,” he says, a bit ruefully.“Which, I want to point out, was not the original deal. It was sup-posed to be a haircut.” Still, for a twenty-eight-year-old who’s wornlong hair most of his life, the close-cropped style has felt surprising-ly good, except for chilly ears in a New York winter. “It’s fantastic,”he says. “It’s so much easier. And I use a lot less shampoo.”

— Beth Saulnier

4 8 W E I L L C O R N E L L M E D I C I N E

First-year medical student MattGoodwin was in the anatomylab, dissecting his cadaver andtalking about the horrific earth-

quake that had struck Haiti, when aclassmate had the brainstorm thatwould cost him his Sampsonesque locks.In the six months preceding his firstsemester, Goodwin had worked at theWeill Cornell-affiliated GHESKIO clinicin Port-au-Prince, studying retentionrates of HIV vaccination trials and theincidence of HPV infection in HIV-positive women. Now he felt utterlyhelpless, to the point where he was con-sidering taking the semester off so hecould contribute his Creole languageskills to the recovery effort. “I rememberreading in the Wall Street Journal aboutthe street that I lived on—they were reportingthat one of the markets collapsed, and it wasthe market we went to every day,” Goodwinrecalls. “It was devastating and surreal.”

He and his classmates cast about for ways to help theDepartment of Global Health raise funds for GHESKIO, which hadbeen inundated with patients and refugees. It was Crystal Castañeda’13 who uttered the fateful words: “You should raise money by cut-ting off your hair.”

“I said something like, ‘I don’t think people would pay for that,’”Goodwin recalls with a laugh. “And another girl said, ‘Oh ...you’d besurprised.’”

Goodwin’s massive reddish-brown mane had not gone unre-marked by his fellow members of the Class of 2013. It was, as hedescribes it, “crazy and curly,” falling to chest length—a work inprogress since summer 2007, when he was applying to med school.“Of course, after I applied I stopped cutting it,” says Goodwin, aSouth Carolina native who holds a PhD in physiology fromAlabama’s Auburn University. “Then I deferred for a year and it gotlonger, and I showed up looking like a complete hippie.”

Fully prepared to sacrifice his crowning glory for the greatergood, he led his fellow first-years in a fundraising campaign, with a

Hair Raising

To help Haiti, a student puts his locks

on the chopping block

Post Doc

JOHN ABBOTT

Kindest cut: At the annual class show, Matt Goodwin ’13 sacri-fices his mane to raise funds for Haiti, with a classmate wieldingthe scissors. Inset: Post-coiffure, Goodwin sports a military look.

Please write to us at: Privacy Office, Weill Cornell Medical College, 1300 York Avenue, Box 303, New York, NY 10065 if you wish to have your name removed from lists to receive fund-raising requests supporting Weill Cornell Medical College in the future.

The notion of “giving ahead” is intrinsic to the life of Jack Richard, MD ’53. As a member of the Weill CornellMedical College faculty for more than fifty years, he is a sensitive and caring physician who views his medicaleducation and his physician practice as the best way for him to help improve the lives of others.

“My father always told me that his concept of immortality was doing things while you’re alive that will continueto benefit others after you’re gone,” Dr. Richard says.

As an alumnus, he continues to give in the most effective ways he can to help current medical students. He made planned gifts to the Medical College through pooled income funds and charitable gift annuities, and established the Jack Richard Clinical Fellowship in Endocrinology, among other gifts.

As Alumni Chairman of the Lewis Atterbury Stimson Society—which honors those who include the College intheir planned giving—he encourages retired Weill Cornell alumni and alumnae to include planned giving forstudent scholarships in their charitable contributions to the College.

“For retired physicians who want to contribute to Weill Cornell scholarship funds but are concerned aboutretaining assets in their retirement, planned gifts are the answer—you can give now to help those in medicalschool, yet continue to receive income from those funds during your life,” Dr. Richard says.

For information on planned giving options at Weill Cornell, please contact

Robert Wollenburg, Director of Planned Giving, Phone: 646-962-3415, Email: row2012@med.cornell.edu

Please visit our Website at www.weill.cornell.edu/campaign

Student Scholarships

‘Planned gifts are the answer.’

‘By supporting theeducation of physicians, you’rehelping to ensurethat people will getquality care whenthey need it. Andthat’s one of themost importantthings to me.’

Jack Richard, MD ‘53

Weill Cornell Medical College and Weill Cornell Graduate School of Medical Sciences1300 York Avenue, Box 144New York, NY 10065

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