Winter 2002
 

 
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150 Million to Johns Hopkins — Its Biggest Gift Ever

Contribution from fashion magnate Sidney Kimmel will go for cancer research and cancer patients.

He's not a Baltimorean, he's never been a patient at Hopkins, and he's not a University alum, but Sidney Kimmel, a New York clothing industry billionaire, has donated $150 million to Johns Hopkins for cancer research and patient care.

Inspired by the death from cancer of his best friend's daughter, Kimmel has become one of the country's leading individual donors to cancer research, giving millions to the cause. He's already endowed oncology programs in his native Philadelphia, in San Diego and in New York; served as national chairman of "The March," a 1998 program in Washington, D.C., that increased federal funding for cancer by $400 million; and established the Kimmel Scholars Program, which each year supports 15 young cancer scientists with grants of $200,000.

In these endeavors Kimmel, 73, is known for his hands-on approach. A layman without a science or medical background, he's gone to great lengths to educate himself about cancer. He may have no long history with Hopkins, but he quickly became familiar with the Institution's oncologists and their research. Impressed by the way the School of Medicine and Hospital have coordinated the use of federal, state and private funds, and recognizing the potential for state-sponsored programs made possible by the Cigarette Restitution Fund, Kimmel selected Johns Hopkins as the academic medical center that would receive his $150 million.

It is Kimmel's largest gift and one of the two biggest donations in the United States for cancer research. It is also the largest philanthropic contribution ever to Johns Hopkins. (The University has re-ceived two $100 million gifts: one from an anonymous donor for research on malaria, the other from New York mayor-elect Michael Bloomberg, a 1964 University graduate and former chairman of its board of trustees.)

Besides supporting research, the Kimmel gift will fund a residence for out-of-town patients and their families who must remain at Hopkins for lengthy cancer treatments. "As important as research is," Kimmel noted, "I want to assure that some of those most acutely devastated by cancer, whose conventional and experimental therapies require a protracted presence in Baltimore, have the advantage of a family residence."

The son of a cab driver, Kimmel grew up poor in West Philadelphia. In 1960, he went to work for a clothing manufacturer, then worked his way up in the fashion industry to found Jones Apparel Group in 1970 and build it into a multibillion dollar empire with labels like Jones New York, Lauren and Evan Picone. Kimmel also is a part-owner of Cipriani International, a restaurant and catering business, the Miami Heat basketball franchise, and of the new Regent Wall Street Hotel in New York, not to mention his film production company ("Blame It On Rio," "9 1/2 Weeks").

Kimmel has no children, was married for the first time only a few years ago, and has said he intends to give away his entire fortune—much of it made in 1991 when he took Jones Apparel public—to help find a cure for cancer.

The Cancer Center now will become the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. But, buildings within the center—the Harry and Jeanette Weinberg Building for patient care and the Bunting-Blaustein Research Building—will retain their names. In announcing the gift at a November press conference, Hopkins leaders expressed their appreciation in their own styles.

"We seek nothing less than the eradication of cancer in our lifetime, and this gift brings us closer to that goal," said Dean/CEO Edward D. Miller.

Noted Martin Abeloff, director of the Cancer Center: "We have a challenging road ahead of us, but the infusion of these new resources to our cancer research program promises to make a dramatic difference in our progress against this deadly disease." Abeloff added that now he would be able to recruit more of the best talent.

Finally, Curt Civin, professor of pediatric oncology, who came to know the philanthropist by working on the Kimmel Scholars advisory board, took the podium. "Sidney Kimmel, you are a 'mensche,'" Civin said, "a biblically good man. It's a tremendous honor to now work under your banner, your inspiration and your driving force. And Sidney, after a small celebration, we'll get right to work!"

Anne Bennett Swingle

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Rescuing the Trapped:
The Pentagon, Sept. 11

Ed Bessman, the tunnel rat.
Ed Bessman, the tunnel rat.

With his first glimpse of the inferno at the Pentagon on Sept. 11, Edward Bessman understood what people staring at televised news accounts couldn't grasp. "Based on my experience at Oklahoma City," says the chairman of emergency medicine at Johns Hopkins Bayview Medical Center, "I knew we weren't going to find anyone alive."

Though hundreds did escape in the immediate aftermath, Bessman's in-person view into the gash where a hijacked American Airlines jet had slammed into U.S. military headquarters showed no pockets, like those that can occur after earthquakes, where survivors could hold on. "The area was pancaked," he says, "filled with smoke, carbon monoxide, jet fuel vapors. If people weren't killed by the impact, they died of smoke inhalation."

A member of one of the 28 Urban Search and Rescue teams nationwide that the Federal Emergency Management Agency turns to when disasters strike, Bessman is trained to find, support and extricate people trapped in tight spaces. He was at work in the Bayview ED when word came in about the first plane that hit the World Trade Center in New York. As he was helping gear up the hospital's disaster plan to receive burn patients, he was notified that his FEMA task force had been put on alert. An hour later, the unit was activated for duty in Washington.

Before he left, Bessman grabbed a few moments with his two eldest children, 15 and 17, but had to settle for talking to his youngest two, 13 and 11, by phone. "They were taking it pretty hard," he says. "They were afraid for my personal safety."

The job is dangerous. All 62 people who staff the 31 positions on each FEMA team are emergency medical technicians with additional expertise in managing the search, rescue, medical and technical aspects of the site. The primary mission of the two physician members is to keep everyone, including the search dogs, healthy and in good spirits. They have to know how to maneuver themselves through hazardous debris to bring care to the trapped—a specialty called confined space medicine. "I'm a provider, a tunnel rat, a grunt," says Bessman. "I go in."

Luckily, at the Pentagon, Bessman didn't need his knowledge of "crush syndrome," a phenomenon that requires treating people while they're still in the rubble to keep them from dying of a heart attack or renal failure minutes after they're pulled free. Instead, as the mission status changed from search and rescue to recovery, he was caring for the pounding headaches induced by prolonged exposure to jet fuel fumes and the blisters that developed on feet encased in boots waterlogged by efforts to extinguish the flames.

"The unspoken assumption," says Bessman, "was that FEMA teams would be dealing with natural disasters. But our biggest use has been at Oklahoma City and now, New York and Washington. Task force members look at all this destruction, and it's man-made. In the emergency department, I'm used to the knife-and-gun club. This is far worse. What you hear and what you smell are even more penetrating. Heavy machinery thundering. Smoke. Jet fuel. And after a couple of days, bodies."

The team relies on tunnel vision, the physical demands of 12-hour shifts and a unique camaraderie to get them through. "We talk to each other a lot," says Bessman. "If we see folks who aren't talking, we go up to them and get them talking."

Then he adds: "In my line of work, I'm very glad to get older. I see plenty of folks every day who don't."

Mary Ann Ayd

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The Next Threat

Hospitals will be major players in the event of a bioterrorist attack. Hopkins is preparing.

Trish Perl holds a bottle of anthrax antidote. Bacillus anthracis is shown enlarged in the background.
Trish Perl holds a bottle of anthrax antidote. Bacillus anthracis is shown enlarged in the background.

Until Sept. 11, Trish Perl was more often than not dismissed by her colleagues for her preoccupation with bioterrorism, chided for reading too many Tom Clancy novels. Then came the terrorist attacks on the World Trade Center and the Pentagon. Her fixation now seems anything but far-fetched.

"There's this unsettled-ness that we never had before," says Perl, epidemiologist for Hopkins Hospital. "You wouldn't not have a plan for a tornado if you were a hospital in the Midwest."

Thanks to Perl's leadership, Hopkins Hospital does have a strategy if ever Baltimore is exposed to the release of anthrax or smallpox or some other biological agent. "We've developed an unbelievably sound approach," says Perl of Operation Orange. "A lot of smart people put a lot of thought into this."

Perl started thinking about bioterrorism in 1999 after attending a noon lecture by DA Henderson, former dean of Hopkins' School of Public Health who established the Center for Civilian Biodefense Studies in 1998. Since then, she's worked closely with the center, whose staff has lectured across the country on the threat of bioterrorism, given testimony before Congress and written consensus papers on the five major biological agents (anthrax, smallpox, plague, tularemia and botulinum toxin). But nothing did as much to put bioterrorism on the map as the events of Sept. 11.

Not only do biological weapons have the power to cause mass casualties. But the things used to make them are "ubiquitous in the world," according to internist Thomas Inglesby, who was trained in infectious diseases at Hopkins and is now one of the biodefense center's seven faculty members. "It's the same technology we use to make live virus vaccines, to grow things up in large quantities, to disseminate pesticides," says Inglesby. "We're not talking about tightly controlled fission materials for nuclear weapons. We need to make sure part of our profession isn't working to create weapons of mass destruction."

Last fall, Perl and her Hopkins associates called an all-day meeting to discuss creating a bioterrorism preparedness plan with nearby health care enterprises. Representatives from 25 Maryland hospitals attended. "All of us are worried and nervous," she admits. "But we're better prepared than yesterday. We're better prepared than almost any other institution in the country."

Mary Ellen Miller

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Here's the Plan

Because several chaotic things could be happening simultaneously-an epidemic, mass casualties and civil disobedience-a hospital's run-of-the-mill disaster plan will not suffice in the event of a bioterrorist attack.

Trish Perl says developing Hopkins Hospital's bioterrorism preparedness plan, which she did hand in hand with emergency medicine physician Christina Catlett, was "the most complicated process I've gone through."

First, a list of essential employees to triage and treat infected patients needs to be on hand. Rapid notification is key. Those employees would be given protective antibiotics. But the "worried well" would inevitably also be clamoring for treatment.

Initially, patients would be triaged in the Emergency Department, because that's where staff has the most experience in dealing with large numbers of patients at once. But in case those 33 beds don't suffice, Perl's task force has identified a secure building on campus that meets all their specifications.

"Education is critical," Perl says. "You have to understand the issue and know how to be prepared. Just putting a mask on is a huge first step."

Drills also are important. Nurses and physicians need to practice evacuating patients, materials management staff needs to know how to activate their supply plan, and waste management needs to know how to dispose of hazardous biological waste.

While Perl's plan covers Hopkins Hospital, she says all departments need to have their own plan, as well (the emergency department was the first to have its done). In addition, a plan is being drafted for every part of Johns Hopkins Medicine.

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One More Job for DA

His was a lonely voice when he was director of the Hopkins Center for Civilian Biodefense Studies. But now, life for Donald "DA" Henderson, newly appointed chief of the nation's Office of Public Health Preparedness, has become a whirlwind of round-the-clock work, media requests and speaking engagements. Indeed, in November, as news of anthrax attacks swept the country, Henderson could barely pick up the phone without receiving an invitation to appear on a Sunday morning TV talk show.

Henderson, 73, served as dean of the Johns Hopkins School of Public Health from 1977 to 1990. Before that, he ran the World Health Organization's successful global smallpox eradication program from 1966 to 1977. The world's last case occurred in 1978, and two years later, the blight that once ravaged whole continents was declared wiped from the face of the earth. Henderson campaigned for destroying the last remaining vials of the virus, but ironically, it was his new boss, the Bush administration, that recently decided to retain the virus so scientists could develop new vaccines and treatments.

Now, bursting again upon the health scene as head of the new federal agency, Henderson is tackling one more formidable assignment—to construct a cohesive, coordinated approach to bioterrorism—with mixed emotions. In trying to combat diseases for which man is responsible, he says he is entering "an unhappy interlude in my life. But the problem is so important that I just can't walk away from it."

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New Gadget for M.D.s Offers the Latest in Antibiotic Use

Community physicians who need to figure out fast which of a multitude of complex antibiotics makes sense for a particular patient usually whip out a pocket-size drug guide or else head for the desk-top reference in the office down the hall. But, with new antibiotics coming onto the market almost daily now, a pocket manual can be out of date the day it's published and fetching the weighty desktop text takes time away from the patient.

To do away with such hindrances, last year Hopkins' Infectious Diseases staff put their collective heads together and came up with the Guide to Antibiotics and Infectious Diseases. The reference offers easily retrievable, precise information in a useful, bullet format through a handheld PC or a desktop computer.

Sharon McAvinue and Walter Atha with their high-teh antibiotic guide.
Sharon McAvinue and Walter Atha with their high-tech antibiotic guide.

To compile the guide, a group of medical teachers, scientists and clinicians distilled therapeutic information from more than 140 diagnoses, 190 drug therapies and 1,500 clinical guidelines and presented the facts about these illnesses from all three perspectives. They then organized a list of the latest and best antibiotics for a range of such common conditions as acute sinusitis and community-acquired pneumonia and compiled information about key topics like the role of infection in coronary artery disease. They even included reports on FDA drug-safety alerts.

Walter Atha, M.D., who helped design the tool, says, "It's all based on the best scientific evidence, not on anecdotal accounts or convenience."

How successful is the digital guide? Traffic is doubling weekly, according to Sharon McAvinue, director of program development for Infectious Diseases. For more information, log on to http://hopkins-abxguide.org.

Gary Logan

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Rocky Times for the International Office

"Our patients were very afraid of blind reaction, of blind anger," says Sharaf Saleh, Middle East patient services manager.
"Our patients were very afraid of blind reaction, of blind anger," says Sharaf Saleh, Middle East patient services manager.

News of the Sept. 11 attacks sent shivers throughout the entire medical campus, but few offices had more at stake than Johns Hopkins International, where during the last fiscal year more than half the patients came from the Middle East. Hopkins' business from that corner of the globe suddenly plummeted. "Still,"says Harris Benny, JHI director of operations, "the total number of international patients hasn't dropped as much as you might think."

After the attacks, Benny bent over backward to get in touch with people from the Gulf region and reassure them that it was safe to keep their medical appointments here. Each prospective patient received copies of messages University and Hospital leaders had sent to employees, calling for compassion toward Muslim patients and tolerance for all ethnic groups. Finally, Benny wrote in Arabic to each patient acknowledging the unusual climate of the times but affirming the institution's mission to provide superb patient care always.

"Surprisingly," Benny says, "patients were afraid their care would be compromised. We reminded them that from the time they arrived at the airport, everything—hotel, transportation to the Hospital, round-the-clock interpreting—would be taken care of and that they would never be alone."

Still, it was an earlier decision that may have saved the day for International's bottom line."We already had started to diversify," says CEO Steven Thompson. Even before Sept. 11, the focus for marketing Hopkins Medicine overseas had turned to Eastern Europe, Latin America and, believe it or not, Bermuda, where referrals are soaring.

The altered strategy paid off after Sept. 11. In October 2001, even as daily outpatient encounters with patients from the Middle East fell by 60 percent compared with a year earlier, business from Bermuda grew by 20 percent, and Europe showed a slight increase. Revenues for JHI as a whole, says Thompson, were down by only 4 H percent.

Hopkins' international program is the biggest player (ahead of Mayo Clinic and the Cleveland Clinic) in a competitive US market. Last fiscal year, it racked up 20,000 outpatient visits and 1,100 discharges and brought in $39 million in revenues. The program's distinctive feature is project work overseas. JHI sends physicians and administrators abroad to assist several nations in building health care infrastructure and training doctors. "Right now," says Thompson, "we're struggling with a reluctance by our people to travel to service projects, particularly in the Persian Gulf. But we see this as a short-term challenge."

For the long term, says Benny, it's still too early to tell just how deeply international business has been affected by the current unrest. "Things are always slow during Ramadan and the winter months, so it may not be until early spring that the true effects of Sept. 11 can be assessed."

ABS

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Roche Settlement

The University has reached an out-of-court financial settlement with the family of Ellen Roche, the Hopkins lab technician who died June 2 after inhaling an experimental chemical in an Asthma and Allergy Center study. As part of the agreement, neither the University nor the family is allowed to disclose the amount of the settlement. The agreement eliminates the possibility of a lawsuit against the University or the asthma researcher who conducted the experiment. The attorney for the Roche family said that the family is confident that what happened to Ellen won't ever be repeated and understands the need for medical experiments on human subjects to advance science.

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The Class of 2005 At A Glance

Last fall, when Reed Hall began humming again with students hauling themselves and their stuff into the storied dorm to settle in for the first year of medical school, we took a look at the class profile.

Among the ranks of this year's matriculating students: a banker, a sculptor, three former Peace Corps members, two legacies, 71 men and 47 women. The oldest student is 33, the youngest, just 18.

Nationally, medical school applications for the class of 2005 were down by 6 percent. At Hopkins, applications received through the American Medical College Applications Service, or AMCAS, numbered 6,534 compared with 7,058 in the previous year. There were 4,663 secondary (final) applications versus 5,057 last year. Hopkins accepted 268 students, and 118 of them accepted Hopkins—a yield of 44 percent, compared with 48 percent last year.

Applications shot up by 135 percent from 1999 to 2000, the first year Hopkins was part of AMCAS. Based on other schools' experiences after they joined AMCAS, Paul T. White, assistant dean for admissions, says, "We expected our decline to be far steeper than it actually was."

ABS

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Out of the Operating Room, into the Kitchen

Late this spring, one more group of Johns Hopkins residents will complete specialty training and fan out to faculty appointments and private practices all over the country. Heading for Manhattan will be Sandra Saw, a newly minted anesthesiologist. Saw's not planning on spending time in an operating room any time soon, though. She's enrolling as a full-time student at the French Culinary Institute (FCI).

Make no mistake: Sandra Saw has no intention of abandoning medicine. The time simply is right to take her longtime avocation to a higher level. And so for six intense months, Saw will be working under luminary chefs like Alain Sailhac (Le Cirque), Andre Soltner (Lutece) and television personality Jacques Pepin, earning what's known as a "grand diploma" from one of America's most prestigious cooking schools. Says Saw: "I'm unattached, my residency will be finished, and now is the time."

FCI admissions representatives were dumfounded when Saw arrived for her interview. True, some of the school's well-known alums had forsaken pre-law or banking careers, but a Hopkins-trained M.D.?

The youngest of four daughters of a cardiothoracic surgeon and a whiz-bang Chinese cook, Saw grew up in a two-kitchen home on the West Coast where cooking was the linchpin of family life. But even though she's a cooking veteran, to get up to FCI standards, Saw is following the school's suggestion and working at a local restaurant. Once-a-week on post-call evenings this year, she can be found cooking on the line at Roy's Baltimore, part of a 28-restaurant chain based in Hawaii and specializing in Pacific Rim cuisine, her favorite.

Saw also turns out dinners for her fellow residents in the small, well-stocked kitchen in her Baltimore apartment. Cooking, she says, is an outlet, never a chore. "Few things in life are better than sitting down with loved ones and seeing them enjoy a wonderful meal." - ABS Caption In front of the stove at Roy's Baltimore: Sandra Saw indulges her passion.

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The Rush for the Ph.D.

Are graduate students being hustled through their education and into laboratories prematurely?

Bill Agnew as mentor.
Bill Agnew as mentor.

Going for a Ph.D. in the basic sciences isn't what it used to be. At least that's what physiology chair Bill Agnew has observed. One significant change is the pace of the education. In the recent past, grad students could expect their training years to include a range of elective courses, stretches for in-depth reading and opportunities to test a few risky research tacks before homing in on a thesis project. "Having time to fiddle in the lab, even unproductively, can be incredibly important in developing as a scientific thinker," Agnew contends.

But freedom to explore appears to be disappearing. Around the country, many basic science departments gently are encouraging Ph.D. students to complete their degrees more quickly. They are being prompted to choose an adviser within the first two years of training, even by the end of their first year of course work, and to wrap up their research and thesis in the following three to four years.

Last year, the National Institutes of Health underscored this trend by recommending a cap on training grants used for graduate stipends: "[To] encourage the earliest possible completion of…education and training… the NIH proposes to limit the use of federal dollars from any source for the support of graduate training that exceeds six years."

"There's a consensus that research training has been taking too long," explains Walter Schaffer, a biochemist who heads up the NIH Office of Extramural Research, which fielded responses. "If it's seven years for a Ph.D. and then four to six years as a postdoc, that's a long time to wait before being able to look for a job with a benefits package."

Many Hopkins faculty members agree that a time limit is healthy. For one, points out Eric Young, director of graduate students in biomedical engineering, having a succinct program enables a department to take on more students. In addition, having an end in sight encourages students who might have trouble focusing on a thesis project to buckle down and get work done.

"Five years seems like it should be sufficient time to learn from one mentor," adds Tom Kelly, director of molecular biology and genetics.

What's more, a pithy Ph.D. process tends to look good to prospective students, says molecular biologist Carol Greider who has traveled to universities across the country to recruit for Hopkins.

But if there's movement here to shorten the training years it may be coming as much from eager-to-finish students, points out Peter Maloney, assistant dean of graduate student affairs. Individual stipends for graduate students in the sciences ring in at about 60 percent of the salary of a bachelor's-qualified lab technician and about a third of the salary of a comparable position in industry.

And while NIH training grants cover stipends and tuition costs during the first years of Ph.D. class work, in the later years, student funding traditionally comes out of each adviser's research grants. This means that in many cases graduate students will be restricted to projects addressed by the research grant. Students also may be under more heat to produce results.

To Bill Agnew, that kind of pressure means less time to spend thinking or reading up on relevant scientific literature. "If you were a student at Oxford University, you'd be expected to master the scholarship of your field before you did one experiment," he says. Agnew hopes that the recent establishment of Hopkins' Institute for Basic Biomedical Science and its concerted fund raising for graduate training may help shift the culture. "Students are being prematurely swept into the laboratory and onto specific projects," he says. "It isn't a serious issue here, but it's one that needs to be addressed."

Kate Ledger

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