Hopkins Medicine Magazine - go home
Current Issue Past Issues Talk to Us About the Magazine Search
an online version of the magazine Fall 2008
Circling the Dome
Nelson Tang displays his "go bags."
blank
ABC's Richard Chisolm on the scene in the ED with Ann Czarnik.
   ARTICLES IN THIS SECTION:

 
    ALPHA DOCS:  
 
 
 

Made for Prime Time

A popular TV series brought Hopkins to millions.

 

ER physician Ann Czarnik arrived at a bustling intersection in her life over the summer: Within a matter of weeks, she completed her Hopkins residency, started a new job—and became an overnight TV sensation, thanks to her role in Hopkins, ABC’s popular six-part documentary that drew nearly six million viewers per episode.

For several months in 2007, a television crew had tailed Czarnik and others at work and after hours. Among the most popular characters: Brian Bethea, the cardiothoracic resident whose marriage was on the rocks; urologist Karen Boyle, who was refreshingly frank about male infertility while celebrating her own fruitful marriage; and buoyant neurologist Alfredo Quinones-Hinojosa, whose journey from illegal migrant worker to world-renowned brain surgeon served up the perfect American success story.

For Czarnik and colleagues, the major concern was that the television crew did not affect the care of patients. “At first, it was hard,” she admits. “But as you adjust to their presence, there’s less of an impact on how we interact with patients.” During the months of daily shooting, Czarnik says she grew accustomed to speaking her mind. “If I was too busy, or the crew got in my way, I would just say, ‘You need to back off right now.’” Working with the same trio of ABC crew members boosted her comfort level. “They become your friends,” she says. “They worked their way into your life and you got used to them.”

Building rapport was central to the success of Hopkins, according to Richard Chisolm, key shooter for the series and a veteran of ABC’s Hopkins 24/7, which aired in 2000. “It is not about catching a moment secretly. It’s about the relationships you establish and finding a place where they don’t mind you being there,” he explains.

By the time the Thursday night series, produced by Terry Wrong, began airing in June, Czarnik had left for Baltimore’s Union Memorial Hospital. Her telegenic Hopkins appearance led to a flurry of guest turns on ABC News Now and several affiliate stations. Cardiac surgeon Bethea appeared on programs that included Entertainment Tonight. Boyle was tapped for The View. Quinones-Hinojosa shared his American dream story on Good Morning, America.

Czarnik regards her stints in the spotlight as good practice for future work with international relief missions. “Part of that,” she says, “is being comfortable with the media.”  Stephanie Shapiro




McKusick
> Dome with a view: McKusick's annual climb to the top was a high point for students.

Loss of a Legend

Hopkins mourns the passing of the founding father of medical genetics.

 

Skeptical colleagues of Victor A. McKusick ’46 thought he was foolish to abandon a promising career in cardiology in the mid-1950s to pursue the study of genetics. His doubting peers “thought I was committing professional suicide because I had a reputation in cardiology and was shifting over to focus for the most part on rare, unimportant conditions,” McKusick told The Sun earlier this year. “But it didn’t bother me. I felt certain it was going somewhere.”

Where genetics led, thanks to McKusick’s relentless inquiries, meticulous record-keeping, and indefatigable cataloguing, was to a whole new discipline that many scientists and clinicians believe is destined to be the driving force behind medical breakthroughs in the 21st century.  McKusick, acknowledged now as the founding father of medical genetics and a towering international figure in genetics research, diagnosis, and treatment, died on July 22 at his Baltimore home of complications from cancer. He was 86.

“We have lost a legend,” says Edward Miller, dean and CEO of Johns Hopkins Medicine. “His influence and legacy reach around the world.”

By launching what now is the most comprehensive catalogue of genetic data; being the first to advocate the sequencing of the human genome; and co-founding one of the most influential post-graduate courses in genetics, McKusick created a “legacy to medicine … so pervasive, even fundamental, that it will be difficult to pinpoint but impossible to avoid,” says Harry C. “Hal” Dietz III, the Victor A. McKusick Professor of Genetics and Medicine and director of the William S. Smilow Center for Marfan Syndrome Research. 

Victor Almon McKusick was born 20 minutes after his identical twin, Vincent, on October 21, 1921, in Parkman, Maine (estimated population, 550). His parents, both former teachers, made education a priority for the five children they raised on a dairy farm. McKusick went to a one-room schoolhouse, studying under the same teacher for seven of the eight years of grammar school, then attended a high school that had no courses in science.

He originally thought he might become a minister, but a major illness changed his mind. In 1937, at the age of 16, he contracted a severe streptococcus infection under his left arm from haying. He was hospitalized for 11 weeks before finally being cured with the antibiotic sulfanilamide, which had been introduced just the year before. The experience prompted him to switch his interest to medicine. “I liked what doctors did; I decided I wanted to join them,” he recalled.

McKusick enrolled at Tufts University in 1940 because it had a medical school. He had read about Hopkins, however, in a 1939 TIME magazine, and when the Hopkins medical school, facing a wartime shortage of students, offered admission to undergraduates in 1943, he left Tufts and came to Hopkins. He never left, establishing a record for the longest, uninterrupted service of any faculty member since the medical school’s founding in 1893.

Although he earned a medical degree from Hopkins and 22 honorary doctorates, McKusick joked that he did so as a college drop-out, having never officially earned a bachelor’s degree. His last honorary degree came in 2007 from the University of Bologna, the oldest university in the world. 

Initially concentrating his research on heart problems, McKusick found that cardiology led him to genetics. He became the first to describe the cluster of characteristics of Marfan syndrome, an inherited connective tissue disease characterized by heart defects, unusually tall height, and several other abnormalities. Studying Marfan patients and those afflicted with other familial diseases triggered his interest in learning about single genes that result in multiple deformities.

As part of his studies, he began compiling extensive medical histories of members of the Old Order Amish of Pennsylvania to identify genes responsible for their inherited disorders, of which dwarfism is unusually common. His resulting studies led to a detailed analysis of one of the two disorders that carry his name: McKusick Type Metaphyseal Chondrodysplasia, a form of dwarfism found among the Amish. His name also is attached to McKusick-Kaufman syndrome, a developmental disorder marked by congenital heart disease, buildup of fluid in the female reproductive tract, and extra fingers and toes.

Acknowledging his work on achondroplasia and other forms of dwarfism, the Little People of America made the 6'2" McKusick an honorary member. He was also an honorary fellow of the American Academy of Orthopedic Surgeons, prompting him to note wryly that he was the only member of those two organizations who was more than six feet tall and didn’t operate. 

In 1957, he founded Hopkins’ Division of Medical Genetics, forerunner of the more than 100 clinical genetics units that now exist in North America, training thousands of students.

He became a professor of medicine in 1960; a professor of epidemiology in what now is the Bloomberg School of Public Health in 1969; and was named William Osler Professor of Medicine, director of the Department of Medicine and physician in chief of The Johns Hopkins Hospital in 1973. He held those positions until he was named University Professor of Medical Genetics in 1985.

After years of meticulously compiling data on the patterns of inheritance and the clinical descriptions of numerous syndromes, McKusick published the first edition of his now-classic book, Mendelian Inheritance in Man, in 1966, listing the characteristics of 1,500 genes. The 12th and last printed version of the book—by then expanded to three volumes—appeared in 1998 and contained about 12,000 genes. Thereafter it has been published only online, with its database updated daily—by McKusick himself until shortly before his death. It now contains some 20,000 genes and is considered an essential tool of the medical geneticist.

At a birth defects meeting in 1969 in The Hague, McKusick proposed mapping the human genome, saying it would be the key to unraveling the mysteries of many congenital abnormalities and genetic diseases. Years later, McKusick said that his call for mapping the human genome “took a little nerve” because the main tools for accomplishing such a task expeditiously did not exist then. Many scientists dismissed it as wildly impractical, expensive, and of little value.

Not a laboratory scientist himself, McKusick relied on other researchers for the actual gene-mapping, which originally took years. With the aid of today’s automated sequencers, a gene can be mapped in a matter of weeks. The human genome sequence, containing more than three billion units of DNA, was published in February 2001.

“Wresting order from chaos is not an overstatement for what he did for science,” says Hal Dietz, also a professor in the McKusick-Nathans Institute of Genetic Medicine, named for McKusick and Daniel Nathans.

McKusick’s impact on the advance of genetics went far beyond the initial call to map the human genome and Mendelian Inheritance. His annual, two-week Short Course in Medical and Experimental Mammalian Genetics at Bar Harbor, Maine, first given in 1960 and founded in collaboration with Jackson Laboratory, widely is credited with training generations of genetic medicine practitioners and scholars—more than 4,000 in number. McKusick attended this year’s course via computer screening—even on the last day of his life.

Lean and laconic, McKusick leavened his New England reserve with a sly sense of humor. Never without his small notepad and pocket camera, he constantly scribbled observations and snapped pictures of events, places, and people. Perhaps his most memorable extracurricular exploit was a tour of the original Hopkins Hospital, conducted for medical students and residents, which concluded with a physically challenging (for others) climb up the narrow, winding stairs that led to the top of the building’s iconic dome.

In his later years, McKusick said he spent three-fourths of his time updating Mendelian Inheritance, but he also consulted on new patients with hereditary diseases and edited two journals: Medicine, founded the year he was born; and Genomics, which he co-founded with Frank Ruddle in 1987.

His honors were abundant. Among the most notable were the 1997 Albert Lasker Award for Special Achievement in Medical Science, often called the “American Nobel”; the 2001 National Medal of Science; and the 2008 Japan Prize in Medical Genomics and Genetics. He went to Tokyo last April to receive that medal—and a 50 million yen award at a formal presentation attended by the Japanese Emperor and Empress.

In 2004, more than 450 colleagues and friends, including many former protégés and several Nobel laureates, contributed the $2.07 million needed to create the Victor A. McKusick Professorship in Genetics and Medicine.

In 1949, McKusick married fellow Hopkins physician Anne Bishop, who remains a part-time assistant professor in the Division of Rheumatology. In addition to his wife and their children, Carol Anne McKusick., Kenneth Andrew McKusick, and the Reverend Victor Wayne McKusick, McKusick is survived by his twin brother, Vincent, retired chief justice of the Maine Supreme Judicial Court. Neil A. Grauer


In the Limelight

For Ben Carson, life of late has been a White House whirl.

 

1 1 1
cardin & bush
> Cardin with Bush.

Ben Carson has had quite a year. The director of pediatric neurosurgery was awarded the Presidential Medal of Freedom, the highest award a civilian can receive; met the Academy Award-winning actor who will portray him in an upcoming television movie; and had an endowed professorship named in his honor.

Carson, 56, says the accolade that meant the most to him was the endowed professorship. It was made possible by the generosity and concerted fundraising efforts of medical equipment businessman Ernie Bates, an alumnus of Hopkins’ Krieger School of Arts and Sciences. Bates, the second African-American in the U.S. to become a neurosurgeon, is a long-time vice-chair of the university’s board of trustees. Drawn into the project by neurosurgery director Henry Brem, Bates capped the $2.5 million fundraising drive by persuading retired Oppenheimer Funds executive Don Spiro and his wife, Evelyn, to donate $1 million toward the endowed chair, which also bears Evelyn Spiro’s name.

A few weeks later, at the White House ceremony in which President George W. Bush bestowed the Medal of Freedom, the Chief Executive praised Carson’s “groundbreaking contributions to medicine and his inspiring efforts to help America’s youth fulfill their potential.”

Carson achieved worldwide fame in 1987 for successfully completing the first separation of conjoined twins attached at the back of the head. He is the author of three books, including a memoir about growing up in a poor, single-parent family. In 1994, he and his wife, Candy, founded the Carson Scholars Fund to promote academic achievement among high-schoolers. To date it has awarded 3,400 scholarships in 26 states.

In attendance at the White House event was actor Cuba Gooding, Jr., star of Jerry Maguire and Men of Honor, among other movies. He will portray Carson in an upcoming TV movie. The two men had met for the first time only two days earlier. “I like this guy,” Carson told The Washington Post. “He’s got a spirit. I’ve met a lot of people from Hollywood, but there are not a lot I like.”  NAG

 


The Streak Continues

Even with new ranking system, Hopkins stays No. 1

1 1 1
cardin & bush
 

Truth be told, we were almost afraid to look this year. Could Johns Hopkins really still be the top hospital in the U.S. for 18 years in a row?

We'd heard rumblings about changes coming in the methodology used by the magazine folks at U.S. News & World Report. More hard data just to qualify. A premium placed on the latest technologies, like robotic surgery. The need for certain patient volumes and nurse-to-patient ratios.

We've long understood that well-informed patients can "shop" for the best healthcare—and that smarter health consumers increasingly look for proof of actual hospital quality—but we wondered if those at U.S. News could account for qualities like degree of difficulty, a Johns Hopkins strength.

Bracing for unpleasant surprises, we boldly opened our eyes and began scanning the list. First, the perennial strong suits: Ear, Nose and Throat? First rank! Rheumatology? We still rule! Urology? Tops! And we remained strong in the No. 2 spot, with Geriatrics, Gynecology and Obstetrics, Neurology and Neurosurgery, Ophthalmology and Psychiatry earning honors there. No. 3 stars included Cancer, Digestive Diseases, Endocrinology, Heart Disease and Heart Surgery, and Respiratory Medicine.

Taken together, an overall No. 1 showing for Johns Hopkins … again.

Does this mean we can now rest on our laurels? Not so fast, say Dean/CEO Ed Miller and Hospital President Ron Peterson. Though the two praise the excellence of Hopkins people at every level who help keep the institution strong, they say we need to keep improving our game: The rivals are getting better all the time.

And get used to the data-driven measurements, the wave of the future. "We applaud sincere efforts to assess the safety, outcomes, and service of institutions like ours,” say Peterson and Miller in a joint statement. “And we trust that as they improve over time they will be of even more use in informing the medical community, patients, and insurers."

For a detailed list of all the rankings, go to: www.hopkinsmedicine.org


The Great Save

A generation of researchers must assure their data don’t retire with them.

 

1 1 1
cardin & bush
> Nancy McCall, Barbara Hakins and Poebe Evans Letocha, Collections Management Archivist

When ophthalmology professor Barbara Hawkins retired in June, she faced a crucial decision: What to do with the reams of clinical trial data she had acquired over the last 30 years.

“Until recently in my group, we just kept data as a trial ended,” says Hawkins. “But now that I’m retiring, it’s time to transfer it. We need to save data so that other researchers can answer questions our database makes feasible.”

The issue Hawkins faced is relatively new—the world’s first randomized clinical trial didn’t take place until 1948, when English epidemiologist Bradford Hill tested streptomycin in treating tuberculosis. By the 1960s, clinical trials were in full swing. Today, as a generation of researchers moves into retirement, many scientists find themselves, like Hawkins, wondering: Now what?

The ophthalmologist turned to the Alan Mason Chesney Medical Archives. Her query to head archivist Nancy McCall, as it turns out, couldn’t have been better timed. The Archives had just received a grant to develop a prototype for electronic records management. The goal: to conduct a feasibility study for long-term preservation, access, retrieval, and use of critical data and information in digital formats, at JHMI.

Under this broad umbrella, preservation of clinical trial data would be a perfect fit—particularly given that,  since 2003, the NIH has required researchers receiving grants of $500,000 or more to have a plan for sharing their data after their trial is complete. Hawkins’ data will be the first clinical trial data at Chesney.

Archiving electronic data has inherent problems because digital files often must be accessed in the same software they were stored in—such as Access or Excel—and software becomes extinct. That’s why Chesney is looking to use an opensource platform, which is not software-dependent. 

McCall and her colleagues are exploring a centralized model as well as one in which divisions would keep their own repositories but follow standardized guidelines for compliance with the Common Rule and HIPAA and for maintaining and accessing data. “We aren’t trying to take over and manage all the data,” says McCall. “We’re trying to set up models so that institutions can preserve data long-term.”  

On June 30, Hawkins handed over databases on two CDs for two major studies she led (the Macular Photocoagulation Study, 1979-1995; and the Collaborative Ocular Melanoma Study, 1985-2005), as well as paper copies of data collection forms and other documentation. She also had to create detailed documentation for the databases to explain how each was created and organized. To access most data from the studies, researchers will have to apply and be approved by the medical archives’ privacy committee, an IRB, and the appropriate committee for the study involved.

While Hawkins had few qualms about making the hand-off, some researchers do. They worry about their data being taken out of context or being used to criticize the original work. “In the age of meta-analysis, it seems like the data have to be there, and you have to give up control and say someone may do something with my data, but there is that tension there,” concedes Janet Holbrook, PhD, an epidemiologist and director at the Hopkins Center for Clinical Trials.

For her part, Hawkins would be delighted to see her wealth of hard-won data generate future interest. “We hope that other researchers who have research questions that can be answered using one of these datasets or other archives materials will become aware of them and use them,” she says.

 

Kristi Birch

 


They’ve Got Mail

What’s the best course when it comes to patients’ growing e-mail inquiries?

 

1 1 1
cardin & bush

Shortly after 8:30 a.m. on June 2, John Flynn sees that one of his rheumatology patients is waiting for a quick consult—right atop the incoming mail in Flynn’s e-mail in-box. The doctor leans forward and double-clicks the e-mail’s subject line, engaging yet another pathway into the uncharted territory of modern medicine. “Dear Dr. Flynn,” it begins. “This morning I noticed a rash in a band around the right side of my back ….”

Flynn, a rheumatologist here who also directs clinical affairs for general internal medicine, welcomes this sort of contact, unlike many of his colleagues. When patient e-mails are done well, he says, they can be “clear, efficient and effective.” This one even comes with high-quality photos of the rash in question, along with relevant medical history:

“I had chicken pox when I was in elementary school, and I am currently not on any steroids. I am concerned that I have shingles, and I was hoping you could prescribe me an antiviral.” Flynn studies the photos. Sure looks like zoster to me, he thinks. He talks to the patient by phone and calls in a prescription.

On the surface, at least, this looks like a patient problem solved quickly and easily. But physicians here and across the U.S. are quietly taking sides about whether to broadly accommodate this manner of medicine, which many call “e-visits.” Does the speed of an e-visit outweigh the risks of diagnosing from a distance? How should such office traffic be managed? What happens to urgent cases when the in-box gets overloaded? Are the e-mails all subject to subpoena if cases go bad? And, of special importance to physicians in smaller practices, how should e-visits be compensated?

Hopkins has not yet attempted to govern e-mail exchanges with patients—beyond the usual HIPAA concerns regarding the protection of patient privacy—and national policymakers remain shy of adding guidelines to an already over-regulated field. But the topic has become increasingly nettlesome, especially as patient pressure grows: Some recent surveys suggest that up to 40 percent of patients would switch to e-mail-enabled physicians if they could.

The e-visit question took on greater national visibility in July, when both The New York Times and the Wall Street Journal gave space to physicians who described their own e-patient experiments. After citing his experiences, Weill Cornell psychiatrist Richard A. Friedman offered his Times readers this mixed review: “If you need to reschedule an appointment or need a routine medication refill,” he wrote, “please push ‘send’; if you have something on your mind you want to talk about, please call me—the old-fashioned way. I’m almost wistful for the sound of a ringing phone.”

Friedman emphatically encouraged patients in crisis to call him at home, even at 3 a.m., if necessary; he considers that an occupational hazard. But his request highlights a popular complaint: E-visits can “erode the boundaries,” he says, between doctors and their patients in the absence of any contractual guidelines. “You’re doing medicine from afar,” he says. This may work to an extent with psychiatry, he allows, but the landscape quickly gets dicey for clinicians. “You can’t see details like joint swelling, heart rate, shortness of breath.”

Some Hopkins physicians will admit they don’t answer e-mails from patients, especially from patients they’ve never examined who are looking for advice unseen. Even the many who do engage with e-patients confide mixed feelings about it. But the issue is ticklish, which keeps Hopkins doctors from articulating any reluctance on the record.

“At this point we don’t have a policy,” says thoracic surgery chief William Baumgartner, who is also president of Hopkins’ clinical practice association. In his capacity as a senior practitioner, Baumgartner says professional judgment has worked for him. For his own surgical patients, he provides his business cards, with his direct phone line and e-mail address. He says he feels patients have never abused the access.

He reports about two to three e-mail queries per month about new cases, which he finds manageable. “They’ll typically be concerned relatives looking for recommendations,” says Baumgartner. He says such queries can never be adequately handled via e-mails and phone calls. “No film, no angio, no nothing,” he says. “I’ll usually tell them we need more info, but I’m also happy to refer them to surgeons closer to where they live.” 

When it comes to managing regular patient relationships, John Flynn can’t see the point in undue discrimination. For the non-urgent cases, he already reserves two blocs of time per week for routine patient phone-in time. Why not handle some patients’ e-visits during the same periods? Of course, Flynn must document all changes in each patient’s medical management. And, of no small importance, he must write nearly all of the time off as ineligible for compensation.

“We can’t bill for them,” quips Hopkins billing administrator John Crockett. “The insurance companies won’t recognize these as billable time.”

There are exceptions in other parts of the country. Illinois physician Benjamin Brewer, for instance, runs part of his primary care office via patient e-visits on a secure web site. He says that, where his practice might typically bill $70 for an office visit, many insurers in the Midwest will pay half that for an e-visit. Brewer, who wrote the Wall Street Journal’s July column about his experiment in e-medicine, wishes the national policymakers would weigh in. “In some ways it seems like we early adopters have been left out here in the fog.”
The fog may be lifting. This spring, Congress applied pressure for physicians to broadly comply with new rules for dispensing prescriptions online—a move that dovetails with the push to codify the rules compensating for e-visits. Many say the private insurers are waiting on policymakers at the Centers for Medicare and Medicaid Services, whose rate-setters have lately leaned toward broader recognition that e-visits can reduce health costs.
For now, Hopkins seems most concerned with the legal unknowns. Barbara Cook, president of Johns Hopkins Community Physicians, says case law offers little guidance to help distinguish e-mail exchanges from telephone exchanges when it comes to dispensing advice and treatment. “One of the things we’ll need to know,” she says, “is whether we’re more at risk if we open up the e-mail and answer it than if we don’t open it in the first place.”
Flynn, for one, thinks leaving the e-mails unopened may not be the best course. In this age of the electronic patient record and other high-speed communications, denying e-mail access could mean denying “a tremendous opportunity to enhance the relationship between doctors and patients.” 

 

Ramsey Flynn


White Coat Values

A tailor-made professional oath.

 

For first-year medical student Sophia Strike, last spring’s White Coat Ceremony carried more than the normal rite-of-passage jitters. She had to don her physician’s coat for the first time and declare her greatest professional aspirations for the road that lay before her—in front of hundreds of gathered loved ones and faculty members.

“I was so nervous I hardly remember it happening,” she says.

At least Strike had the company of her classmates in the Class of 2011, but this “Profession of Values” detail was a first for any Hopkins class, and is intended to signal a new tradition. Coordinating the 306-word statement was a leadership test for Strike, who had to corral everyone to participate. “It doesn’t mean anything without the whole class,” she says.

Modeled after an idea in place at Case Western Reserve, the purpose of a class statement is to build upon the foundation of the Hippocratic Oath that has stood the test of time—for more than 2,300 years.

Strike says she started with a group of 15 participants and some prompting questions. What is our role as students? As caregivers? How do we know what professionalism is?

Strike and her teammates tested a draft, eventually adding one element they consider uniquely part of the modern view of a physician’s responsibility to the community that surrounds them.
Strike says that notion is embodied in their statement’s fourth paragraph, most particularly with these words: “As members of the community,” the statement reads, “we will not exploit or neglect those around us but rather will embrace our social responsibility to advocate for positive change.”

To see the Class of 2011’s complete Declaration of Values, visit www.hopkinsmedicinemagazine.orgRF

 


ALPHA DOCS


Fruitful Flies

A big find garners big money from the Howard Hughes Medical Institute.

 

Duojia Pan
>Could “hippo” hold a clue to cancer?

By studying a growth gene he discovered in the eyes of fruit flies, Duojia Pan has uncovered a possible key to how cancer develops—and caught the eye of the Howard Hughes Medical Institute. It has awarded him a grant of $500,000 a year for the next five years to continue his research.

Pan, an associate professor of molecular biology and genetics, is among 56 scientists who will share $600 million in new Hughes funds, the first grants the institute has given since it last bestowed awards to 15 researchers in 2005.

“I’m really excited about this,” Pan (known as DJ) told The Sun. “It’s not only the money—it’s an honor.” More than 1,000 researchers nationwide applied for this year’s Hughes grants. It is one of the country’s largest philanthropies and a major supporter of the country’s most creative and promising scientists.  

Pan and his research colleagues named the growth gene they discovered “hippo” because if it is removed from an organ in a fruit fly—or a mouse, as they’ve done in other experiments—“you get a big animal,” or at least a much larger organ, he explains.

The question of how organs grow to their correct size “has never been solved,” Pan says. Hippo may provide an important clue. For example, Pan’s studies have shown that if the gene is mutated in the eyes of fruit flies, they will develop abnormally large eyes; when it is mutated in the livers of mice, that organ grows five times its normal size and often becomes cancerous.

Pan thinks that the impact of mutating the hippo gene, which evidently controls when an organ stops growing, could be a key to cancer, “because cancer is literally uncontrolled growth.”

A native of China who immigrated to the U.S. when he was 19, Pan will use the Hughes money to expand his study of how hippo works in mice and explore its impact on other organs, such as the pancreas and prostate. Carol Greider, head of the department of molecular biology and genetics, calls Pan’s findings “really spectacular” and indicative of the importance of basic biological research.

 

Neil A. Grauer

 

 


A Man of Considerable Influence

TIME honors Pronovost for saving countless patient lives.

 

Pronovost
> Pronovost: Checklist to safety

Peter Pronovost, professor of anesthesiology, critical care medicine, and surgery, found himself in heady company last spring. TIME magazine named him one of the 100 most influential people in the world—along with the Dalai Lama, Vladimir Putin, Barack Obama, John McCain, Hillary Clinton, Michael Bloomberg, and Oprah Winfrey.

Pronovost, medical director of the Quality & Safety Research Group and the Center for Innovations in Quality Patient Care at Hopkins, was honored for what The New Yorker magazine once dubbed—with admiration—“a stupid little checklist.”

Pronovost’s checklist—five simple steps intensive care unit physicians should take to avoid potentially deadly intravenous line infections—was found to have saved more than 1,500 lives and $175 million in hospital costs during an 18-month study at Michigan hospitals. With line infections in the U.S. afflicting 80,000 patients a year and killing a quarter of them, Pronovost and his checklist already “may have saved more lives than any laboratory scientist in the past decade,” noted TIME.

A boyish-looking 43, Pronovost (Class of 1991) began his crusade against hospital-acquired infections at Hopkins in 2001. Focusing on line infections, he developed his five-point checklist for physicians: (1) wash your hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) cover the entire patient with sterile drapes, (4) wear a sterile mask, hat, gown and gloves, and (5) put a sterile dressing over the catheter site once the line is inserted. Nurses are authorized to stop the physicians if they see them miss a checklist step.

The initial results were staggering: The 10-day line-infection rate dropped from 11 percent to zero. Equally dramatic findings from the subsequent Michigan study led to a landmark 2006 paper in The New England Journal of Medicine—and some controversy, once The New Yorker article on Pronovost appeared in 2007.

The federal Office for Human Research Protections sought to restrict continued studies of the checklist’s effectiveness, contending that such inquiries didn’t have the written, informed consent of the patients and providers involved. Objections to that ruling were vocal and widespread. It was subsequently reversed last February. The studies now can continue—and locations as far apart as California and Spain plan to implement the checklist’s use soon. 

NAG

 

 


More Alpha Docs

Alicia Arbaje, assistant professor of medicine in the Division of Geriatrics, has received the Merck/AGS 2008 New Investigator Award and also been named a Harold Amos Faculty Development Scholar by the Robert Wood Johnson Foundation.

 

Theodore Bayless, professor of medicine and gastroenterology, has received the Maryland Society for Gastrointestinal Endoscopy’s Lifetime Achievement Award.

 

Joseph Brady, professor of behavioral biology and neuroscience and director of the Behavioral Biology Research Center, has been named the recipient of the 2008 Mentorship Award from the College on Problems of Drug Dependence.

 

Thomas Brushart, professor of orthopaedic surgery, received the Hanno Millesi Award from the World Federation of Neurological Societies at its March meeting in Vienna, Austria.

 

Joe Carrese, associate professor of medicine in the Division of General Internal Medicine, received the National Award for Scholarship in Medical Education at the annual meeting of the Society of General Internal Medicine.

 

Nancy Davidson, professor of oncology and head of breast cancer research, was cited for her contributions to the field at the annual American Association of Cancer Research (AACR) meeting in April. In January, Davidson also was given the National Cancer Institute’s Rosalind E. Franklin Award for Women in Cancer Research.
 
Hal Dietz, professor of genetics and medicine, received the Hero with a Heart Award at the National Marfan Foundation’s annual benefit, Heartworks: The Marfan Gala, in April.

 

Todd Dorman, associate dean and director of continuing medical education, has been elected vice president of the Society for Academic Continuing Medical Education. Dorman is professor in the departments of anesthesiology/ critical care medicine, medicine, surgery and nursing and vice chair for critical care.

 

John Gearhart, professor of pediatrics and director of pediatric urology, has been named an honorary member in the Fellowship of the Royal College of Surgeons of Edinburg, Scotland.

 

Frank Giardiello, professor of medicine, oncology and pathology and director of Hopkins’ Colon Cancer Risk Assessment Clinic, has received the 2008 Distinguished Educator Award from the American Gastroenterological Association.

 

Ulrike Hamper, professor of radiology, urology and pathology and director of the division of ultrasound, has been inducted as a fellow in the American College of Radiology.

 

Edbert Hsu, associate professor of emergency medicine, has received a 2008 Leadership Award from the American Medical Association Foundation.

Thomas Lloyd, resident in neurology, has received the American Academy of Neurology’s 2008 S. Weir Mitchell Award for his research in amyotrophic lateral sclerosis (ALS).

 

Gregg Semenza, professor of pediatrics and one of the top researchers on the molecular mechanisms of oxygen regulation, has been elected to the National Academy of Sciences.

 

Six Hopkins physicians are on Black Enterprise magazine’s list of America’s 140 leading African American doctors. They are: Arthur Burnett, II, professor of urology and director of the department’s basic science laboratory and male consultation clinic; Benjamin Carson, professor and director of pediatric neurosurgery; David Nichols, vice dean for education and professor of anesthesiology; Wanda Nicholson, assistant professor of obstetrics and gynecology; Neil Powe, professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research; and Michael Trice, assistant professor of orthopedic surgery.

 

Johns Hopkins researchers have received 45 of the 62 grants awarded by the Maryland Technology Development Corporation for studies into stem cells’ potential as a source of therapies for such illnesses as cancer and ALS. The 62 grants, awarded upon the recommendation of the Maryland Stem Cell Research Commission, total $23 million.

 

 

 
 
 
 
Features
 Get a Life!?
 Washing Out My Distressed Genes
 Guardians of the Heart
 Sleep Interrupted
 
Departments
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
 
Class Notes
 After the Prize
 
Opinions
 Learning Curve
 Post-Op
 
Johns Hopkins Medicine

© The Johns Hopkins University 2008