Refuge for an Aging Body

No more basketball or running for this sports doctor. Biking is a kinder, gentler pastime.

If there’s one guy around who knows the price a super jock may pay for his habit, it’s Ed McFarland. The 50-year-old ex-all-American football player—a professor of orthopedics and shoulder surgery here—has built his career patching the battered bodies of overzealous athletes.

But McFarland’s a sports nut himself—so he’s got his own tales to tell. He’s herniated a disc mountain biking; he blew his ankle out playing football in college; he suffers from chronic tennis elbow; tendinitis nags his shoulder.

And just like the men and women whose knees and shoulders he so craftily reconstructs, McFarland has lately been receiving direct messages from his own aging body. “It’s gotten to the point where if I go running, my knees hurt for days,” he grieves.

Your best bet as you get older, McFarland tells action-addicted patients, is to cut way back on sports that put a lot of pressure on your joints. “There’s a reason you don’t see many people in their 80s jogging.”

Following his own advice, Mc-Farland has returned to a passion from his boyhood when he rode a paper route around his hometown of Paducah, Kentucky. “Biking,” he says, “is an activity that’s easy on the joints and ligaments—the perfect sport for an aging body.”

Of course, McFarland would love to get back on a basketball court. But given that his feet go numb when he runs—a leftover from his old back injury—he’ll stick to biking. “It’s easier on the body,” he says. “You remember how your mother used to tell you your injuries would come back to haunt you? Well she was right. If you’re active, you’re going to rack up injuries. And those injuries can cause problems as you get older.”

Studies show, in fact, that the first signs of tendinitis appear around age 30 and become more common and severe the older we get. “And if you have arthritis or damage to your ligaments or cartilage, it’s that much worse,” McFarland laments. 

The sports doctor now bikes to work. He bikes his neighborhood. He bikes county roads. He bikes rails to trails. And when it’s raining or snowing, he bikes on his front porch—on a stationary number (which doesn’t quite do it for him). Biking, he exudes, gives him the same high he used to experience running long distance. “It generates those same endorphins. It’s like a drug.”

Still, cycling the six miles of city streets between his home and his East Baltimore office can prove hairy. To avoid rush-hour pitfalls, McFarland leaves home at the crack of dawn. At the end of the day, he navigates the side streets for his return trip. Even so, “there’s one street where I have to ride alongside a stretch of parked cars,” he sighs, “and if someone opens a car door, I’m toast.”

Nevertheless, McFarland has vowed to keep cycling until he can’t move. His 80-year-old father, he says, still bicycles around his Florida neighborhood. “You see a lot of old people down there cruising around on three-wheelers. It helps keep them healthy.”

Eric Vohr

Once More, With Feeling

ABC returns for "24/7."

The producers at ABC News have decided it’s time for the Hospital’s  residents and interns to take center stage.

Six years after airing the award-winning ABC docudrama Hopkins 24/7, a team of 16 producers and videographers has again descended on the medical campus. This time, says series producer Terry Wrong, he’s angling to show how some of the world’s best physicians are trained.

The Hospital has arranged wide access for the crew, which typically gathers up to 30 hours of video material daily. Their work is expected to arrive as a six-part series in the summer of 2008.

And since they’ll be dovetailing patient cases into their story-telling, “we don’t know what will happen,” Wrong says. “Some of these cases will have poor outcomes, and you can’t have something that is unremittingly bleak. It’s terribly risky and nerve-racking.”

In the end, Wrong says, the series will show both the Hospital’s glories and pitfalls, adding to the documentary’s verité qualities.

Anne Bennett Swingle

We Try Harder

SOM keeps lofty rank.

If we’ve got to be stuck somewhere, it’s nice to be up high. So it is with the School of Medicine’s ranking in U.S. News & World Report. Once again this year, we’re No. 2 among American medical schools—right behind Harvard. Since Hopkins has held this perch for most of the last two decades, the news lies in how our specialties are faring.

Hopkins stayed tops in internal medicine and biomedical engineering and climbed to the top slot in geriatrics. We rose two notches—to third place—in neuroscience/neurobiology.
 
Watch for that last category to move up: An infusion of funding just got behind the new Brain Science Institute, which dean/CEO Ed Miller says will bring “rapid progress” to that field here. 

Ramsey Flynn

Soapbox Tactics

Med students learn to champion health care causes.

About halfway into the two-hour presentation, the room takes on the feeling of a pre-game pep rally: As Glenn Schneider saunters back to the podium, he chides the 20 gathered medical students. “I don’t feel enough energy in here!”

The admonishment may be in jest, but there’s no denying the bigger picture: Schneider, executive director of the Maryland Citizens’ Health Initiative, is an advocate for government-supported health care. It’s a topic he believes in—passionately. That made him one of two public officials to be invited to address first-year students in a course called “The Patient, Physician and Society.” Sharing the platform with him was Peter Beilenson, Baltimore’s former health commissioner,

“We’re clearly tilting this class in one direction,” acknowledges Eric Bass, the internal medicine and public health specialist who leads the course. “Like many physicians, I think this is an issue we have some responsibility to take a stance on.”

Schneider and Beilenson tell these budding M.D.’s how they can become leaders in pushing for legislation to expand health care coverage to everyone. Whether students follow their suggestion, of course, will be up to them. But, as Schneider notes, “hopefully, today you’re going to have a tool you can use should you want to change the world.”

In Maryland, Beilenson states, 810,000 citizens have no health insurance at all; another 800,000 have “lousy” health coverage, the sort that covers only catastrophic cases. “This cause could use the support of bright physicians.”

“We’re one of the few countries in the world without universal health coverage,” Beilenson points out. “And yet, we’re the wealthiest nation in the world.” The fight has suffered defeats, he declares, because “opponents call it socialized medicine,” invoking a term loaded with the baggage of inefficiency and failure.

So, what if a med student disagrees with the idea of health care for everyone? Not a problem, says Bass. He hopes any student with a dissenting position “would plunge right in” with an argument.        

The 120 members of the Class of 2011, he makes clear, were free to choose from among seven topics for this advocacy portion of the course. “But there’s a better chance of improving health care coverage if physicians understand crucial issues like this one.” 

Ramsey Flynn

The Bumpy Road Up

A helping hand arrives for young faculty who hope to make it at the School of Medicine.

Ask Diana Scorpio how she felt about being appointed to the faculty here a few years ago and she’ll tell you. Scared. The School of Medicine has high expectations of its scientists, and Scorpio knew it. They need to publish; they need to earn grants, present papers at national meetings and work with medical students. To make it all the way up to full professor, they’re even expected to hold international reputations.

But Scorpio—who learns about human diseases by studying laboratory animals in the Department of Molecular and Comparative Microbiology—had no idea how to get the ball rolling. What’s more, she was in the dark about where to look for guidance.

Today, thanks to Janice Clements, vice dean for the faculty, young doctors and scientists find the path upward less murky. Deciding it was high time they had some help mapping out their careers, Clements opened the Office of Faculty Development last year and drafted Lisa Heiser, a skilled career advisor, to head it.

“Lisa hit the ground running,” Clements says of Heiser, who’s since peppered her office with resources. Programs now teach faculty how to build dossiers. Seminars for department directors show them how to coach faculty at each stage. And formal mentoring arrangements link assistant professors with experienced colleagues.

“These designated mentors,” Heiser says, “felt equally lost when they were beginning, so they resonate to their new role. It’s like we’re teaching the orphans to be parents.”

Last year, two senior colleagues in Scorpio’s department, Christine Zink and Christian Newcomer, signed on as her mentors. Among other things, Zink—who says she didn’t even know who her department head was when she began—helped Scorpio understand the benefits of collaborating with scientists from other institutions. She even coached her in how to introduce her studies of tickborne diseases to colleagues she met at conferences. Clear at last about what she needed to do, Scorpio arrived back from a professional meeting a few months ago with three leads for research collaborations. 

Ramsey Flynn

Meanwhile on the Coast of Ecuador...

Plastic surgeon Jaime Flores took a break amid a marathon series of procedures with indigent patients at a naval station outside Guayaquil in February. After he drifted off, colleagues strategically placed stuffed toys (intended for the pediatric patients) under his arm. In Ecuador as part of a 10-day humanitarian mission, the Hopkins team performed under intense tropical heat with sparse equipment and translators bedeviled by complex local dialects. Still, Flores says, the group logged 85 operations, including cleft palates and lips, burns and general surgeries. Among Flores’s most satisfying results? After he released the contracted knee joint on a 9-year-old boy, the patient gazed up and smiled: “Now I can walk to school.”

 Ramsey Flynn

STRAIGHT TALK

Pushing Every Day: Ron Peterson

The head of The Johns Hopkins Hospital and Health System talks about the struggles, how he remains content 10 years into the job, and watching his daughter become a doctor.

> The head of The Johns Hopkins Hospital and Health System talks about the struggles, how he remains content 10 years into the job, and watching his daughter become a doctor.

After this tumultuous decade in health care, is there one thing you’re most proud of as head of the Hospital?
Well, the fact that we’re finally moving forward with the redevelopment of our clinical buildings will probably constitute the capstone of my career. In some parts of the Hospital, we’ve been doing world-class medicine in third-world facilities.

You and the dean/CEO, Ed Miller, seem to have been focusing on this rebuilding project for a while.
To the skeptics who say we’re giving too much attention to physical structures, I would only repeat that we’ve had to remain focused because we’d gotten so far behind. Everything we do depends on our buildings. They provide the environment where we care for our patients; they’re the workshops for our faculty, staff and nurses; and they determine which physicians and scientists Hopkins is able to attract and retain. But now that the buildings are under way, we’re turning our attention to issues of diversity among employees and support for young faculty who are trying to move forward in their academic careers here.

What do you think of the current trend to give report cards to hospitals and doctors?
I think it’s inevitable that people are becoming more savvy about health care and want to make more informed choices about where they are treated. Like it or not, we are heading toward more transparency, so we need to embrace that idea. It’s probably healthy.

Are these the kinds of issues you talk about with other national hospital leaders? 
I was down in Washington yesterday. The American Hospital Association invites me to a little think-tank group once a year to do some brainstorming with senior leaders from around the country. We talk about things like the president’s budget, which proposes a reduction of $101 billion from Medicare and Medicaid over the next five years, much of which will be coming out of the hides of hospitals. We talk about an anticipated 10 percent reduction in Medicare’s reimbursement rates for physicians, and the move toward pay for performance for doctors. Patient safety is always on the agenda. And of course we worry about hospitals being able to amass enough funds to replace their aging physical facilities.

It sounds like nothing but problems. Does anything make you smile on the job?
Every once in a while, I’ll stop in to visit a patient. Spending time with someone who’s had successful treatment here and feels grateful for the care is one of the best things I do. Another thing is watching entry-level workers—often people who grew up right here in East Baltimore—gaining new abilities through the Hospital’s programs and then moving into jobs a couple of pay grades higher. I see them feeling so good about what they’ve accomplished—and also about the organization that employs them. Those things make me smile.

You thought of becoming a physician once. Now your daughter is a medical student here. Do you ever live her life vicariously?
Oh sure, I think about that. My daughter, Susie, is in between years two and three, and it’s a great thrill. I don’t bother her every day, but I pay attention to what she’s doing and I enjoy seeing her progress. She’s doing a year of research in HIV immunology right now and thoroughly loves it. She would love to continue here at Hopkins for training after med school, if she can. My son’s also in town. He’s a lawyer, and he and his wife are expecting their first child. It’s nice for us to have our young adult children in the vicinity.

A lot of people would have trouble spending 10 years in an organization’s number two spot. What’s your recipe?
I don’t think of it as the number two position. I think of it as a partnership. That’s the way Ed has always dealt with me. Even though he understands health care operations, he hasn’t dabbled in micro-management. And you know, I’ve come to appreciate that at a research-focused medical institution like this, the dean should be at the top of the pecking order. He’s the head of the medical faculty.

Leaders like you are always getting job offers from competitors and head hunters. Are you ever tempted?
Occasionally I get a call or an e-mail. In fact, I have one sitting on my desk right now. I generally just give a courteous no. I think Hopkins is the best. I enjoy being associated with this institution. I also have significant ties to this region. My family is here. I have a mother who, unfortunately, has Alzheimer’s and is in a long-term-care facility in the area. I’m not interested in looking anywhere else.

So how much longer? 
Well, Dr. Miller and I are both believers in succession planning. He’d like to stay on until the completion of the medical buildings. At 58, I’m a little younger, and I think it would be in the institution’s best interest to have a bit of overlap when he leaves. But his successor will be the one who decides if someone new should be in my position.

Everything is in order, then?

Oh, I’m not complacent or too comfortable. I’m respectful of the challenges ahead.  I’m not resting on my laurels. I’m pushing every day, believe me.

Edith Nichols

ALPHA DOCS

African American Pantheon

Five surgeons become museum icons.

>Carson, Thomas, Cornwell, Brock and Watkins (seated)

The School of Medicine has always suffered an embarrassment of riches when it comes to its surgeons. But now, five of them are being honored in a whole new light. Baltimore’s Reginald F. Lewis Museum of Maryland African American History and Culture has included Malcolm Brock, Ben Carson, Edward Cornwell, Claudia Thomas and Levi Watkins in a series of 7-foot-high panels celebrating 17 African American academic surgeons. These five make up the largest group from a single medical school.

The display touts Brock as a thoracic oncology surgeon who uses cancer’s molecular code to reveal signatures of the disease. The world-famous Carson, director of pediatric neurosurgery, is acclaimed for separating conjoined twins. Cornwell, chief of adult trauma surgery, is known for his expertise in treating critically injured patients. Thomas became the nation’s first African American female orthopedic surgeon. And Watkins, a professor of cardiac surgery, performed the world’s first human implantation of an automatic defibrillator.

Exhibition curator Jill Newmark says the selections were easy for the museum because the Hopkins surgeons had strong track records for mentoring younger minority physicians. “They pass on the torch,” she says.

That’s especially true of Watkins, who joined the School of Medicine admissions committee and within four years increased minority representation by 400 percent. This exhibit, he says, “documents the power and beauty of diversity. America is better off when we include the excluded.”

Thomas, meanwhile, welcomes the exhibit’s greater mission. “It was my childhood exposure to an African American female pediatrician,” she says, “that encouraged me to believe that I could achieve the same.”

Carson, true to form, says he hails any event that honors African American success “in areas other than sports and entertainment.” America’s future, he says, “will only be maintained by intellectual accomplishments.”

Neil A. Grauer

Opening the Book of Life

The genetic institute’s new head puts out the welcome mat.

On first pass, David Valle’s vision for the Institute of Genetic Medicine sounds as startling as JFK’s 1962 proposal to land a man on the moon: Valle wants to “enable genetic research by all members of the faculty.”

Does this mean the IGM’s new director wants every one of these people to participate in genetic research? Not quite, but he’d certainly like colleagues to feel welcome to everything his institute has to offer. “This reflects our realization that genes play a role in virtually all aspects of health and disease,” he says, proposing to extend the IGM’s genetic tools throughout the School of Medicine.

That toolbox, he explains, includes high -throughput genotyping, the use of their “zebrafish technology,” and a host of exotic genetic research tools gathered in an internally managed database known as the “Genetic Core.” And, just in case it’s not self-evident, Valle says, the institute will offer the whole faculty its “knowledge and resources in clinical genetics and genetic counseling.”

All told, it’s a formidable offer. The 8-year-old McKusick-Nathans Institute stems from powerful DNA. It’s named for Victor McKusick, one of the founders of the whole field of medical genetics (and now a University Professor here), and the late Daniel Nathans, a 1978 Nobel Prize winner who helped kick off today’s genetic biotechnology revolution. The institute is now endowed with some 30 faculty members. Under Valle’s predecessor, Aravinda Chakravarti—who is becoming head of the IGM’s new Center for Complex Disease Genomics—the institute moved into new facilities and built bridges between the basic sciences and clinical research.

Valle, meanwhile, possesses his own sterling credentials. A long-time Howard Hughes investigator, he established himself as a wunderkind with his 1978 work on an inherited form of blindness called gyrate atrophy, and he ran the pediatric genetics clinic during his early years on the faculty, focusing on understanding the basis for rare, inherited disorders.

Citing a host of dramatic advances in genetic medicine, Valle envisions a glowing future for the IGM. “I see this as a crucial time,” he says.

Neil A. Grauer

More Alpha Docs

Charles Balch, professor of surgery and oncology, has received the Society of Surgical Oncology Heritage Award. He was president of the society from 1991 to 1992 and helped launch its Annals of Surgical Oncology, of which he was editor in chief for 12 years.

Todd Dorman, associate professor of anesthesiology, surgery and medicine and associate dean and director of continuing medical education, has been appointed chair of the Critical Care Work Group, which works with Medicare on payment and regulatory issues.

Linda Fried, director of the Division of Geriatric Medicine and Gerontology and the Center on Aging and Health, has received the 2007 Mary Betty Stevens Award from the American College of Physicians for her research on conditions common to older adults.

William Greenough III, professor of medicine, has been named to the inaugural, 27-member class of ambassadors in the Paul G. Rogers Society for Global Health Research.

James Harris, professor of psychiatry, is the 2007 recipient of the American Psychiatric Association’s Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry.

Christoph Lehmann, director of clinical information technology, has been elected to the board of directors of the American Medical Informatics Association.

Constantine LyketSos, chief of the Department of Psychiatry at Hopkins Bayview, received the 2006 William Proxmire Award for leadership in the fight against Alzheimer’s disease.

Lee McCabe, associate professor of psychiatry and behavioral sciences and director of the Office of Behavioral Health Care, has been elected president of the Academic Behavioral Health Consortium.

Richard North, professor of neurosurgery, anesthesiology and critical care medicine, has received the Founders Award from the American Academy of Pain Medicine for his groundbreaking studies of spinal cord stimulation for pain.

Karen Swartz, Psychiatry’s associate director for residency education, has received the 2007 Irma Bland Award for Excellence in Teaching Residents from the American Psychiatric Association. She also received the Eli Lilly 2007 Welcome Back Award in Psychiatry for her work with depressed adolescents.

Peter van ZijiL, professor of radiology, radiological science-nuclear magnetic resonance, and biophysics and biophysical chemistry, is the winner of the International Society for Magnetic Resonance’s 2007 Gold Medal, the group’s highest honor.

Patrick Walsh, Distinguished Service Professor of Urology, has been awarded the King Faisal International Prize for Medicine for developing nerve-sparing radical surgery for prostate cancer, as well as his research into genetic aspects of prostate cancer. He also received the Physician of the Year Award for Clinical Excellence from Castle Connolly Medical Ltd., a company known for publishing America’s Top Doctors.