Spring/Summer 2002
 

 
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Writing the Common Lingo Can Be Tough If You're an M.D.

Frank Mondimore, the happy author.
Frank Mondimore, the happy author.

Academic physicians turn out scholarly articles one after the other, but penning a book for the general public can be a stretch. Jackie Wehmuller, therefore, takes pains when she approaches a School of Medicine faculty member who's interested in authoring a popular volume. "It's a lot different from working with a historian, she says.

Wehmuller, who's executive editor of the Johns Hopkins University Press, admits that she harbors a special feeling for her physician-clients, "It's harder for them," she says, "They're carving out the time to do something they feel strongly about. I've had two or three authors actually write books during vacation."

Hopkins Press, the nation's oldest university press, began publishing what became a series of consumer-health books in 1982 after the appearance of "The 36-Hour Day," a guide for families of Alzheimer's patients, That book is now in its third edition. Since then, the Press has gone on to explore subjects as diverse as cholesterol and bladder control, diabetes and HIV infection, epilepsy and severe burns. It releases about four titles a year, two-thirds by Hopkins authors.

Frank Mondimore, a psychiatrist and one of the Press's more prolific authors, came gradually to the idea that he might write an easy-to-understand book. Weary of repeating the same speech each time he handed over a prescription for antidepressants, he considered a brochure but soon realized he had a book's worth to say about depression. Mondimore published "Depression, the Mood Disease" in 1993, and followed it in 1996 with the more complex "A Natural History of Homosexuality," which has been translated into five languages (and is his personal favorite). Then, in 1999, the year he returned to Hopkins after a decade at the University of North Carolina, he produced the best-selling "Bipolar Disorder: A Guide for Patients and Families."

For Mondimore, the toughest part of the writing has been figuring out who he was writing for. With that sorted out, he says, "it's incredibly rewarding to start with a blank piece of paper and mold it into a published work." "It gives you a way to be creative that scholarly writing just doesn't offer."

When gastroenterologist Larry Cheskin, an expert on weight loss, decided to author a popular book, he knew right away that he wanted the credibility of a university press "as opposed to the lose-10-pounds-in-10-days type thing." Cheskin, director of the Johns Hopkins Weight Management Center, spent weekends for the better part of a year planning "Losing Weight for Good: Developing Your Personal Plan of Action." Released in 1997, the book's paperback edition came out last fall.

Mondimore finds being an author thrilling. His books, especially the one on bipolar disorder, which has sold 50,000 copies, bring him mail and phone calls from all over, "All of a sudden, you have a book out there," he says, "You walk into libraries and bookstores, and there it is on the shelf."

Mary Ellen Miller

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Doctoring the Birds

A new contract makes the Department of Orthopedic Surgery the primary medical care provider for the Baltimore Orioles. Under terms of the deal, which covers the 2002 season, department clinicians—mainly those in sports medicine—provide annual physicals to team regulars and prospective players. They'll also treat injuries, do surgeries, handle emergencies, make referrals and cover the training room. One physician will be on-site during all home games. If a player's injured when the team's on the road, X-rays will be transferred via digital e-mail. To kick off the arrangement, four sports-medicine docs attended spring training, where they assessed every player—from catcher to shortstop.

ABS

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Mission Improbable

Orthopedic surgeon Brian Krabak, one of the red-jacked medical volunteers who treated Olympic athletes.
Brian Krabak, a Physician Medicine and Rehabilitation Physician with a focus on Sports Medicine, was one of the red-jacked medical volunteers who treated Olympic athletes.

Maybe it was top-secret. But the fact that for the last three years about a dozen physicians from the Department of Emergency Medicine have been providing medical support to none other than the Secret Service seems to have escaped most people's attention. The ED specialists have made more than 20 missions to Africa, South America and Southeast Asia, protecting agents against health hazards in places where medical resources are inadequate.

Last February, the team had one of its biggest assignments yet—right here in the original 48. The mission? Overseeing some 2,000 Secret Service personnel who were stationed at the Winter Olympics.

Several agents were posted on remote mountaintops where feeling sick would have been a distinct inconvenience. To keep them in shape, two ED faculty and three residents teamed with Secret Service paramedics and scoured a 900-square-mile territory of northern Utah. There they treated upper-respiratory infections, altitude-induced sinus problems, orthopedic injuries and dental complaints for nearly 400 federal watchdogs.

Hopkins' collaboration with the Secret Service routinely involves updating nearly 100 EMS personnel on how to deal with medical mishaps. But with the Olympics, says ED Director of Emergency Medical Services Nelson Tang, who leads the Secret Service collaboration, "We were bringing medicine to the front lines, treating on the go."

MEM

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Music on the Cutting Edge. . .During Surgery

Keith Lilemoe

As Keith Lillemoe scrubbed in on a recent Wednesday for a five-hour operation in which he'd remove a dangerous tumor from a man's bile duct, in the OR, nurse Beth Putonen went down Lillemoe's preference sheet: she made sure the patient was lying in the correct position, that all surgical tools and meds were assembled and finally, that the beat-up boombox was working.

Lillemoe, a native of South Dakota, favors the music of achy heartbreak while he operates. And so, as he calls for suction, Garth Brooks sings quietly of ropin' the wind, never obscuring the beeps of the anesthesiologist's monitors or Lillemoe's own voice issuing instructions to the residents and nurses.

Lillemoe isn't alone in liking an audio background while he cuts. An informal survey shows that most of his fellow surgeons also operate to everything from jazz to classical, rap to alternative rock. It helps put them in the right frame of mind, they say, relaxes the team and creates just the right ambiance for focusing.

But, Lillemoe says that when a case gets tough, he doesn't hear a note.

Research suggests that whether it's the Rolling Stones or Rachmaninoff, music in the operating room should be of a genre the surgeon enjoys. A study published in the Journal of the American Medical Association found that surgeons had lower blood pressure and pulse rates and were more mentally agile when they listened to music of their choice. No benefit was found when surgeons listened to music chosen by others.

But Lillemoe is a flexible guy. "I liken the operating room to the family car," he says. "If dad's driving, he usually controls the radio. But like any happy family, there's room for discussion."

Seth Hurwitz

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A Web of Societies

Groups like the American Heart Association, the American Academy of Pediatrics and the European Association for Cardio-Thoracic Surgery typically have all gone their own way when it came to the Internet. And because they used different computer systems and programming language, that meant they couldn't necessarily talk to each other. Now, a consortium named MedBiquitous, founded by Hopkins Medicine, has taken the lead in changing all that by creating online health care communities. Those who join MedBiquitous will be able to share such information as continuing medical education courses and other data through standard coding and software.

Peter S. Greene, M.D., associate dean for emerging technologies, is the founding executive director of the innovative enterprise. Carey J. Kriz, special assistant to Dean/CEO Edward Miller and a longtime veteran of the computer industry, is the consortium's managing director of commerce and industry initiatives.

Mary Ann Ayd

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Zerhouni Gets the Nod from the President

Elias Zerhouni with President Bush

When Elias Zerhouni heard rumblings of unhappiness within the Hopkins scientific community a couple of years ago, he called a meeting. By the end, Zerhouni, then interim vice dean for research, had digested the discontent: The scientists felt the institution wasn't purchasing new technologies they needed to do their research. Zerhouni's response was instantaneous. Identify the equipment that's missing, assign each a priority and issue a report.

Hematologist Chi Dang, who succeeded Zerhouni as head of research, says that kind of logical action exemplifies Zerhouni. It also may be one reason why President Bush, after months of leaving vacant the post of director of the National Institutes of Health, in February nominated Zerhouni for the job. If confirmed by the Senate, Zerhouni will need to negotiate his way through yet another morass—the debate about how stem cells should be used in scientific research. But if anyone can do that, it's Zerhouni, many of his colleagues believe. "He asks two or three questions," notes Jeremy Berg, director of biophysics and biophysical chemistry, and determines whether a complex idea is feasible, "after most of us have been struggling with it for months."

Zerhouni's rise through the ranks in U.S. medicine wasn't predictable. He was born in 1951 in a small mountain village on the western border of Algeria, where his father taught math and physics. The family had eight children and moved in 1953 to Algiers. Zerhouni became a star student, earned an M.D. at the University of Algiers School of Medicine, whipped through the US medical equivalency examinations and in 1975 at age 24 came to Johns Hopkins speaking barely a word of English. He'd decided to specialize in the rapidly changing field of radiology. Three years later he was elected that department's chief resident and then a member of the faculty.

Quickly becoming a national expert in computed tomography (CT), Zerhouni is credited with developing imaging methods that have become standard tools for diagnosing cancer and cardiovascular disease. In 1997, he was named radiology's chairman.

By the late '90s, Zerhouni also had become Dean/CEO Edward Miller's man for solving tough issues, and Miller named him executive vice dean of the School of Medicine. When Miller began focusing on shoring up scientific research here, he called on Zerhouni to shape the vision. Convinced that the ability to program cell types to form new tissues in humans could be tantalizingly close, Zerhouni became the prime mover (fueled by an anonymous $58.5 million gift he helped raise) behind an Institute for Cell Engineering (ICE), dedicated to unlocking the mysteries of how cells reinvent themselves. "If there's one example of his vision," says ALS researcher Jeffrey Rothstein, "ICE is it."

Accepting the nomination to head the NIH at the White House on the last Tuesday in March, Zerhouni told the president, "Twenty-seven years ago, my wife Nadia and I left our home country to come to America, where we had no family, no friends and no money. . . I could never have dreamed of being offered the privilege to serve America in this capacity."

Patrick Gilbert

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Turmoil in the World of Medical School Admissions

There were signs of trouble right away. And yet, the Association of American Medical Colleges Application System (AMCAS) went ahead and rolled out its new online program. What followed threw the 2002 medical school application cycle into chaos.

Jim Weiss with hundreds of applications.
Jim Weiss with hundreds of applications.

The AMCAS system has been around for 30 years. It allows anyone applying to med school to fill out a single form for any school that belongs to the service. AMCAS then verifies each applicant's transcript, MCAT scores, etc. and delivers the whole package to the schools the applicant chooses. Hopkins, one of the last schools to join the program, came on board in 1998. "AMCAS gave us the information we required in a timely fashion," says James Weiss, associate dean for admissions at the School of Medicine, "and most of all, it was reliable."

That is, until last year. By that time, AMCAS's computer hardware was old and its vendor no longer willing to offer technical support, according to Pamela Cranston, an AAMC associate vice president for student services. A replacement system was installed, but beta testing indicated right away that it might not be able to process the expected flood of applications. And in fact, when the system opened in May 2001, the association found to its horror that none of the three components worked right—not the application program, not the utility that sent applications over the Internet to medical schools and not the software program that let schools download the information.

"We were getting garbage," Weiss says. "There were incorrectly tabulated GPAs, there were missing MCAT scores. In many instances, the names of the universities the student applicants were attending were missing. Most unbelievably, we got a thousand applications with no student names on them. It was chaos, total chaos."

The problem, according to Cranston, was that there weren't enough servers to handle all the information. The software programs also had some hitches. By last July, with complaints beating a tattoo on its door, AMCAS added additional servers,"but getting rid of the bugs took a long time," Cranston concedes. In September, AMCAS instituted a backup system that printed and mailed each candidate's primary application form to medical schools. But it was too late.

By then, the schools had taken matters into their own hands, some spending as much as $100,000 to throw together their own systems. Hopkins hastily created a Web site that explained the AMCAS hangups and instructed applicants to send all their information to the School of Medicine admissions office on their own. "Fortunately, we did this in time," Weiss says. The School of Medicine received more than 6,500 primary applications for the 2001 class. But Weiss says it cost the admissions office thousands of dollars and countless extra staff hours to sort through the muddle. It also threw off the timing for sending out secondary applications and scheduling interviews.

AAMC pulled out all stops to get a dependable product ready for the 2003 admissions cycle. "We had to reestablish confidence," says Cranston.

PG

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A Perfect 10

Every year, the National Institutes of Health tallies up the research dollars it shells out to medical schools, and this year—the 10th in a row—the School of Medicine topped the rankings.

NIH distributed $334 million in competitive grants to Hopkins in fiscal year 2001 (Oct. 1, 2000 to Sept. 30, 2001), a $33 million increase over the $301 million it sent this way in FY00. The University of Pennsylvania ranked second with $327 million. Rounding out the top 10 were UCSF, Washington University, University of Washington, Yale, Baylor, University of Michigan, UCLA and Duke.

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He Led a Charmed Life, but at 100, the Devil Is in the Details

While at Oxford in the '20s, Baker asked someone to photograph him in the broad jump as King George V looked on. Unfortunately, the shot caught the King (right) perusing his program instead.
While at Oxford in the '20s, Baker asked someone to photograph him in the broad jump as King George V looked on. Unfortunately, the shot caught the King (right) perusing his program instead.

He may have eschewed academic medicine for private practice, but from the '30s through the '60s, Ben Baker was so much a part of the Hopkins scene (as well as doctor to the rich and famous) that today he is revered as one of the Department of Medicine's all-time finest. A master diagnostician, he taught physical diagnosis and volunteered six mornings a week in the outpatient clinic. As a researcher, he was among the first to study the effects of cholesterol. Later his interests turned to colon cancer, and he funneled contributions into basic science studies of the disease. Considered one of the last great Renaissance physicians, this part-timer attained the rank of full professor.

Born in Norfolk in 1901, Baker was the son of a "horse and buggy" doctor. He enrolled at the University of Virginia, then won a Rhodes Scholarship. At Oxford's Balliol College he became acquainted with the widow of Hopkins' revered first chairman of Medicine, Sir William Osler.

It was a simple toss of a shilling that brought Ben Baker to Hopkins.
It was a simple toss of a shilling that brought Ben Baker to Hopkins.

Baker completed his Hopkins medical degree (with honors) in 1927 and did a medical residency under Warfield Longcope. In 1939, he married Julia Scott Clayton, the daughter of a prominent businessman who became undersecretary of state after the war. During the war, Baker was chief of the medical service with the US Army's 18th General Hospital in the Pacific Islands. He was a superb athlete—captain of the track team at Virginia and a star runner at Oxford, where he broke a world record in the 440.

Today, Baker's memory is fading, his athletic prowess gone, but he remains the consummate Virginia gentleman. Recently, we paid him a call. Here, then, is Ben Baker at 100.

You had a big birthday last November. How are you doing these days?

I'm a perfect wreck!

Well in your heyday, you had quite a career in medicine. During the '40s, you were the physician of choice for the likes of Clark Gable and Carole Lombard and F. Scott Fitzgerald.

Oh sure, I remember Scott Fitzgerald. He was a charming man. But he was a little bit of an alcoholic.

But how was it that with all your scholarly interests you decided to go into private practice and not stay on the full-time faculty at Hopkins?

I don't know. I was a nut. If I wanted to be a more prominent physician, I should have stayed on the full-time staff.

How did you wind up at Hopkins in the first place?

I had been accepted to medical school at both Hopkins and Harvard, along with Eldridge Campbell [SOM '27]. We had gone to U.Va. together, then he applied for the Rhodes scholarship in West Virginia, and I applied in Virginia. We both went to Balliol College, but we couldn't decide which of the two medical schools to go to. So I tossed a shilling. Heads, we go to Hopkins; tails we go to Harvard. I got heads. We both went to Hopkins.

Did you ever think you'd return to Oxford?

I had been asked to. I told them, just let me go to Baltimore, then I'll come back and stay the rest of my life. I wonder if I was a dummy not to? Of course, I wouldn't have had my wife and my four children, but there would have been other nice things.

Do you think you might have become a researcher if you had taken that tack?

I don't think I was any fancy researcher. My research was with patients. What little talent I had was with them. I loved the practice of medicine. Loved taking care of patients.

You knew several of the Hopkins greats—men like William Welch and Alfred Blalock.

Welch got mad at me! He wanted me to go with Mr. Rockefeller to Egypt. I didn't want to go with Mr. Rockefeller; I wanted to be a resident physician. I played golf with Dr. Blalock. We were friends, but he had lots of friends, and I was not very high on the list. He drank a little too much whiskey.

You were a bachelor for quite some time, very popular, handsome—a real prize.

Go away! Go away!

You were also quite an athlete. At Oxford you ran against two runners of "Chariots of Fire" fame, Harold Abrahams and Eric Liddell.

I ran against Eric Liddell, the Scot, in the Oxford-Cambridge—it was the sprint, the 22. And you're going to say this can't possibly be, but I give you my word of honor, I honestly and truly can't remember whether I beat him or he beat me! You wait until you get to be 100 years old. You can't remember a damn thing!

It sounds though like you've lived a wonderful life.

I've been lucky, very lucky. And, oh Lord, Hopkins has been wonderful to me in every possible way. Just think of the people I've gotten to know, the length of time I've been there. But ...what are you going to do with all this? Don't write about me! I didn't do anything.

ABS

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Farewell to the A B Cs

To soften its image, the School of Medicine overhauls its grading system.

Dave Nichols, who spearheaded the grading change.
Dave Nichols, who spearheaded the grading change.

The School of Medicine is throwing away its famous letter-grading system and introducing a more streamlined method for evaluating students. Ed Garcia thinks this is a good move. Garcia can't forget seeing a classmate distraught after receiving a C on an exam. "I kept trying to tell him," says the chair of the Medical Students Society and member of the class of 2002, "that in the grand scheme of things, the grade wasn't all that important."

Perhaps not, but within the Hopkins culture the C sent a message and that student knew it. Hopkins' complex letter-grading system for years has been viewed as a way to stimulate excellence—and to pinpoint mediocrity. It gave the medical school a reputation for being highly competitive. That image over time has put off some talented applicants.

Last year, concerned that too many med school applicants who originally had listed Hopkins as their top choice were choosing other schools, David Nichols, vice dean for education, was determined to find out why. The medical school surveyed 129 medical students who hadn't chosen Hopkins. Of the 62 who responded, most gave two major reasons why they'd gone elsewhere: They would receive less financial aid here, and they were put off by the grading system.

The School of Medicine had been hearing rumblings about its grading system for awhile, Nichols says. As other medical schools in a 13-member consortium—including Duke, Penn, Yale, Stanford and Washington University—had converted to some form of a pass/fail system, Hopkins had held out for letter grades. But it was the rigidity of its system, with its 13 possible letter grades, that made the School truly come across as a 19th-century martinet in comparison with other institutions.

Nichols brought the problem before the medical school's education policy committee, a body made up of course and clerkship directors plus four students. The general feeling, he says, was that the Hopkins system "fostered an obsession with grades and excessive competitiveness."

Once the committee agreed the system should be altered, debate centered on what to substitute. Some members favored an honors/pass/fail system, but most argued that the system shouldn't be so tightly compressed. The School of Medicine's detailed grading had always given its students a leg up when they applied for residencies. Hospitals could compare how candidates had done, and as a result, Hopkins graduates usually landed their first choices. Any new grading system also needed to reflect several levels of comparison, the committee felt.

The system the group finally recommended will make it possible for students to receive one of four grades—honors, high pass, pass or fail. Last month, the Advisory Board of the Medical Faculty adopted that recommendation.

Nichols is pleased with the change, but stresses one point: "We've changed the grading system, but we haven't diluted our standards."

PG

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