By Lisa Brown
On January 15, 2015, Boston University Henry M. Goldman School of Dental Medicine (GSDM) students Christopher Chan and Raman Samra (both DMD 15) traveled to Penonomé, Panama, to provide dental care. The trip was sponsored by North East Volunteer Optometric Services for Humanity (NEVOSH), a Rhode Island based organization dedicated to providing health care to those in need around the world. In addition to the dental and optometry volunteers, many other medical professionals and students comprised the NEVOSH group.
Along with Chan and Samra, three GSDM alumni (Christina Thompson DMD 06, Jose Alamo DMD 06, and Frank Casarella DMD 88), a Georgetown School of Dentistry alumnus, a hygienist, and several dental assistants comprised the dental team. With the help of a local rotary club, the clinic was set up at an elementary school—two computer labs provided a functional workspace with ample power sources to run the generator for the makeshift dental operatories. One room featured 12 oral surgery chairs and the other room consisted of two operative chairs and a hygiene chair. “We saw a lot of serious issues. It was like nothing Raman or I had ever seen before,” said Chan. ”It was pretty obvious that it had been a long time, or maybe never, since many of the patients had visited the dentist.”
The dental team was able to see 868 patients ranging from 2- to 80-years-old. “One of the great things about this experience was that we got to see a diverse group of people from the village and city of Penonomé,” said Samra, who felt that the language barrier posed the biggest challenge of the trip. “Thankfully we had a great group of students from a local college that dedicated their free time to help us with translation.”
When not at the clinic, Chan and Samra visited the Panama Canal, the historic quarter of Casco Viejo in Panama City, and a tourist village up in the mountains. “The people of Panama were extremely welcoming,” said Samra. “We were met with open arms everywhere we went.”
After leaving Panama on January, 26, 2015, both students looked back at the externship as an eye-opening and rewarding experience. “Seeing so many patients and learning from a great group of dentists—the experience was something I will remember for the rest of my dental career,” said Samra. They both agree they’d like to take part in a similar, future mission trip.
“I’m very proud of Christopher and Raman for their hard work at the clinic in Penonomé,” said Dean Jeffrey W. Hutter. “I’m also very pleased to see our alumni continuing to make time to take part in mission trips after graduation. It is gratifying to know that service to our global community is a commitment that our graduates learn here and take out into the world with them as they enter the profession.”
Submitted by GSDM Commmunications.
Boston University’s (BU) Biomedical Laboratory and Clinical Sciences (BLCS) Program and the Center for Regenerative Medicine (CReM) were awarded grants from the Massachusetts Life Sciences Center as part of a $17M package targeted for capital projects, equipment and supplies.
“We are delighted that both the Center for Regenerative Medicine (CReM) at Boston Medical Center (BMC) and Boston University School of Medicine as well as the Biomedical Laboratory and Clinical Sciences (BLCS) Program have received this honor from the Massachusetts Life Science Center,” said Karen Antman, MD, dean of Boston University School of Medicine and provost of Boston University Medical Campus. “Their investments in these programs will help patients with pulmonary hypertension, cystic fibrosis, and acute lung injury as well as provide students with the necessary equipment as they train for careers in the biotechnology field,” she added.
CReM was awarded $1.7 M to launch an expansive Lung Regeneration Initiative (LRI) as part of their Center for Regenerative Medicine. The goal of the LRI is the clinical application of recent BU-led discoveries in stem cell research, such as the treatment of lung diseases with personalized therapeutics, as well as the ultimate reconstitution of diseased lung epithelia in patients with emphysema. The LRI also aims to define and launch treatments for pulmonary fibrosis, pulmonary hypertension, cystic fibrosis and acute lung injury from inhaled pathogens.
The BLCS Program, which is offered by BU’s Metropolitan College in collaboration with the School of Medicine, received $180,000 in funding to enhance the quality of the training and add to the competencies of the students. The funding from MLSC will enable the BLCS program to obtain essential equipment: a small bioreactor, an HPLC protein chromatography unit and a small bench top fluorescence activated cell analyzer, as well as to implement an electronic laboratory information and management system to train students for the changing environment for record keeping in the biotech industry.
Bioethicist Arthur Caplan to deliver this year’s SPH Shine Lecture
In March 2014, seven-year-old Josh Hardy lay critically ill in St. Jude Children’s Research Hospital in Memphis, Tenn., with a life-threatening adenovirus infection. His weakened immune system was unable to control the infection, a complication from a bone marrow stem cell transplant that the young cancer patient had received.
After efforts to treat the infection failed, his parents took to social media to lobby a small biopharmaceutical company to supply Josh with an unapproved virus-fighting drug still in clinical development, under what is known as a “compassionate use” exception. The company resisted, but eventually caved under pressure from a Twitter “#SaveJosh” campaign that gained national media attention. The boy received the drug and was discharged home.
Yes, for Josh—but not so much for the rest of the world, according to bioethics expert Arthur Caplan, who will deliver the annual School of Public Health Cathy Shine Lecture tomorrow on the Medical Campus. The lecture, sponsored by the SPH health law, bioethics, and human rights department, is endowed by the family of the late Cathy Shine in recognition of the work of George Annas, a William Fairfield Warren Distinguished Professor and health law, bioethics, and human rights department chair. Shine, a strong advocate for human rights, died in 1992 from a severe asthma attack. Annas wrote about Shine’s experience and the importance of respecting patients’ rights in a much-cited article in the New England Journal of Medicine.
Caplan, the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics at the New York University School of Medicine and founding director of the Division of Medical Ethics at the NYU Langone Medical Center Department of Population Health, will present a talk titled The Right to Try: Compassionate Use of Experimental Medicine.
“Social media is a wild card in compassionate use,” Caplan says, speaking of the Josh Hardy case and others like it. “When you have an adorable, photogenic seven-year-old boy, it can be very effective. If you’re appealing on behalf of a 70-year-old alcoholic, things are not going to turn out as well.
“If we’re going to talk about fairness in providing experimental drugs, we can’t have a system that favors those who are savvy with social media or who have resources.”
Caplan, a Boston native who attended Brandeis University before earning a PhD from Columbia University, is a leading voice in the national discussion about when and if patients facing death or irreversible disease should be granted access to unapproved and unproven interventions.
He notes that such “compassionate use” access to treatment is now unregulated by federal authorities, is subject to disparate corporate decision-making, and could potentially derail an effective research and clinical drug trial system.
BU Today spoke with Caplan about his views on the so-called “right to try” experimental drugs:
BU Today: Is “compassionate use” an appropriate response in cases when dying patients have no hope with approved treatments?
Caplan: Yes, I think it is. I think morally, we owe it to desperately ill and dying people to try interventions that might help them, certainly when there are experimental drugs and vaccines that we have enough information about to know they might help. Some, we know, have been used and are relatively safe. We may also know that scientifically, the logic of how a certain drug works makes sense. There may be other drugs that have been effective against certain kinds of cancer in adults, so it makes sense to try them with a child. There is a likelihood, at least, that they will have some impact on the disease. We saw this during the AIDS epidemic.
The problem you run into is that sometimes there are kooks or quacks who will peddle unproven drugs only to make money. We saw this with drugs like Laetrile. It’s a crapshoot, whether the drug being sought has any science behind it. Who’s making those determinations, and how they’re made, is where some of the concerns lie.
Who is making those decisions?
Right now, there is no clear process or guidelines. Biotechnology companies have no legal or regulatory obligation to provide access to unapproved treatments on the grounds of compassionate use. Some companies allow access under the guidance of well-thought-out policies; other companies decline to allow access. This lack of uniform policy is confusing to those seeking unapproved treatments.
The US Food and Drug Administration (FDA) has a pathway for compassionate use, but it does have some problems. Still, the agency isn’t an obstacle to those seeking compassionate use and usually defers to the company developing the treatment.
But a system that relies on the discretion of a corporate entity to make humanitarian decisions—with conflicting pressures of costs, investors pushing their agendas, and potential impacts on the formal drug-approval process—is not a system that is fair, thoughtful, or efficient. For some companies, there’s the fear that, ‘If you die on my drug, I’ll be held liable.’ Or if there’s an adverse event with the drug, that the FDA could hold that against you in the approval process.
The larger issue is one of balance. The need to provide access and a chance at rescue for individual patients in desperate straits must be thoughtfully balanced against the reality that society is best served when drugs and vaccines are carefully tested.
Absent a clear process, is there any public movement to expand compassionate use?
Some states would simply like to get the FDA out of the way and turn this over to the public. Eight states—including Arizona, Colorado, Louisiana, Michigan, and Missouri—have passed “right to try” laws that say that patients who have exhausted all other treatment options can gain access to experimental drugs as long as they have a physician’s recommendation.
One of the major problems is that none of these laws obligates anyone to actually do anything. They don’t require drug companies to agree to provide the drug or get anyone to pay for the treatment. They create a feel-good impression that you can get treatment. It appears they’ve been catching on lately because the emphasis on personalized medicine and genetically engineered drugs has given people more things to ask for. In truth, they create more false hope than reality. I refer to them as “right to beg” laws, not “right to try.”
The other problem is that they open the door to irresponsible physicians who might not have pure motives. There’s a risk of that, when you take the FDA out of the picture. Unfortunately, some experimental drugs may not only do nothing—they may make you die quicker.
Isn’t there always going to be a subjective component in who gets experimental drugs? Look at Ebola, for example.
Ebola is a good example, yes. Western health care workers got more compassionate use of experimental drugs like ZMapp here than in Africa. Who gets a possible therapy shouldn’t be decided on the fly, just because some group knows how to strike a deal with a pharmaceutical company.
An ethical case can surely be made that an organization that puts health care workers in harm’s way should be able to acquire access to experimental drugs and bring staff home to get the best possible care. But that is neither a fair nor a just policy for deciding what to do when an emergency arises and rationing is the only option.
I think one of the values we have to look at when rationing access to an experimental drug is whether we can learn from the people we’re giving it to. That favors people who are not on the verge of certain death, who can be followed, who have access to hospital facilities. When selecting people under terrible circumstances, part of the drive is to try to help them—but part of the drive is to learn whether something is useful.
Other questions we have to think about are: who will pay for the unapproved drugs, who can give consent for using them, and how will companies be protected from liabilities should the drugs have harmful side effects.
It is long past time to have a transparent public policy about what to do when not everyone gets a chance to live. Much more work needs to be done to create a sound infrastructure for compassionate use in humanitarian emergencies.
Arthur Caplan, the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics at the New York University School of Medicine, will give the 2015 Cathy Shine Lecture, The Right to Try: Compassionate Use of Experimental Medicine, tomorrow, Thursday, March 19, at noon in the School of Medicine Instructional Building Bakst Auditorium, 72 East Concord St. The lecture is free and open to the public and will be followed by a reception.
This BU Today story was written by Lisa Chedekel. She can be reached at email@example.com
Submissions due March 27
Exhibit Monday-Tuesday, March 30-31
BUSM Instructional Building, 14th floor Hiebert Lounge
All students, faculty and staff at the Boston University Medical Campus are encouraged to submit artwork of any medium to the 25th annual “Art Days”, founded by former BUSM Dean Aram Chobanian to foster the support and growth of the creative arts at BUMC. The exhibition is mounted by the Creative Arts Society.
This is the fourth year of a university-wide arts initiative with an annual Keyword to be used as a thematic organizer for various courses and events. The Keyword for this year is INTERSECT. There may be a special section at Art Days for display of works addressing Intersect. However, it is also fine to submit work not related to the Keyword.
Submissions are due March 27. Paintings, photos, poetry, sculpture, needlework, etc. will be accepted. Pieces should be framed if possible. Security will be provided. Works will be returned April 1. Specific instructions will be sent at a later date to those who respond to this announcement.
To be placed on the submit list or if you have any questions please contact Keith Tornheim, PhD, 638-8296 or firstname.lastname@example.org.
It’s Cultural Diversity Week! Members of the BUMC community are invited to celebrate our campus’s diversity of cultures through a variety of food, entertainment, education, and activities. Activities include:
- Musical performances in the Newton Pavilion Cafeteria each day, Noon-1 p.m.
- “Communicating with Persons Living with Hearing Loss,” featuring Jonathan O’Dell, a member of the Massachusetts Commission for the Deaf and Hard of Hearing. One CME credit will be available for staff attending this cultural forum.
Tuesday, March 17, Noon–1 p.m., Keefer Auditorium
- Celebrating Diversity Fair! Come see a variety of musical and dance performances, including drumming, belly dancing, and a gospel performance.
Thursday, March 19, 11 a.m.–2 p.m., Shapiro Center lobby
View the full schedule of events by downloading the program.
The Grasberger Research Symposium Lecture and Visiting Professorship is an annual research event that provides an opportunity for the surgical residents, faculty and staff to present original basic and clinical research. Now in its 24th year, the event will be held on Friday, March 13. This year’s visiting professor will be K. Craig Kent, MD, A.R. Curreri Professor of Surgery and Chairman, Department of Surgery, University of Wisconsin.
K. Craig Kent, MD
Dr. Kent for the past five years has served as the A.R. Curreri Professor and Chairman of the Department of Surgery at University of Wisconsin. Prior to his arrival to UW, Dr. Kent was Chief of the Division of Vascular Surgery at New York Presbyterian Hospital. In 2001, following the merger of New York and Presbyterian Hospitals, Dr. Kent was asked to assume the role of Chief of the combined Columbia and Cornell Division of Vascular Surgery as well as Director of the Vascular Service Line for New York Presbyterian Hospital.
Dr. Kent received a BS from the University of Nevada and his medical degree from the University of California, San Francisco. He completed a General Surgery Residency at the University of California, San Francisco and a Fellowship at Brigham and Women’s Hospital where he was the John Homan’s Vascular Surgery Fellow. In 1988 Dr. Kent joined the faculty at Harvard as an Instructor in Surgery. After being promoted to Associate Professor, Dr. Kent was recruited in 1997 to New York Hospital/Cornell.
Faculty, students, and staff of the Schools of Public Health and Medicine are invited to join a webcast on Wednesday, Feb. 25, from 3:30-6 p.m. on the newly released recommendations of the 2015 Dietary Guidelines Advisory Committee.
Committee members will discuss the new set of recommendations, which reflect the latest in food and nutrition research and will help the US Departments of Health and Human Services (HHS) and Agriculture (USDA) to update the nation’s dietary guidelines. Among the committee’s more controversial recommendations is a call to lift the longstanding cap on dietary cholesterol, which the panel said has no appreciable relationship to blood cholesterol levels.
The outside experts who make up the 2015 Dietary Guidelines Advisory Committee are nationally recognized in the fields of nutrition, medicine, and public health. The panel is led by Barbara Millen, a retired faculty member who was a professor of family medicine at the School of Medicine and associate dean for research and faculty development at SPH.
Wednesday’s symposium is hosted by the Harvard T.H. Chan School of Public Health and will be moderated by Howard Koh, an alumnus of BU’s School of Public Health who is professor of the practice of public health leadership at Harvard and former assistant secretary for health for the US Department of Health and Human Services. The public is invited to attend the event in Snyder Auditorium (G-1), 667 Huntington Ave., Boston. The webcast will be also be broadcast live. Sign in to register in advance.
Questions may be submitted to presenters at https://harvard.az1.qualtrics.com/jfe1/form/SV_7WL0pzPIwAnLIl7.
10th Annual John McCahan Medical Campus Education Day
SAVE THE DATE
Wednesday, May 20
8:30 a.m.-3:15 p.m., Hiebert Lounge
*Abstract and workshop submissions open Feb. 23*
Attend Education Day to:
- Network with other creative educators in the BUMC community
- Showcase your innovations and ideas in classroom, clinical and lab teaching
- Cultivate your teaching skills
- BUMC faculty, fellows, residents, students and staff who are interested in educational innovations and scholarship are encouraged to participate.
For more information go to http://www.bumc.bu.edu/jmedday/
Sponsored by the BU Schools of Medicine, Public Health, Goldman School Dental Medicine and Division of Graduate Medical Sciences
BU faculty, fellows, residents, students and staff interested in traumatic brain injury, dementia, and brain aging are invited to this workshop. Join with other BU investigators to explore opportunities to maximize utilization of the Boston University Alzheimer’s Disease and Traumatic Encephalopathy Center resources across the University.
Brief presentations by BU ADC investigators (40 minutes)
Small group discussions (1 hour) may include:
- clinical trials, biomarkers and cognitive neuroscience
- cellular and molecular mechanisms
- genetics and epidemiology
Wrap up and readout from discussions (20 minutes
BUMC Provost Workshop
“Accelerating Research on the Chronic Effects of Traumatic Brain Injury and Brain Aging”
Tuesday March 10
3-5 p.m., Hiebert Lounge
Vaccines are safe and effective
The large ongoing measles outbreak linked to Disneyland in California is a topic of discussion in nearly every newspaper, news blog, and other journalistic outlet across the country, as well as on personal blogs and websites that either support or negate the value of vaccination. At last count, there were 121 cases of measles in 17 states and the District of Columbia, and 80 percent occurred among unvaccinated individuals. Although it’s difficult to keep up with the constant flow of new material, the main story is about vaccination—are you for it, or against it? This type of coverage may have the unintended effect of confusing vaccine-hesitant parents by exaggerating the true size of the antivaccination movement and by giving potentially confused parents reason to believe that choosing whether or not to vaccinate their child is an important controversy worthy of debate. It’s not. Nothing about vaccination is controversial.
Here are the facts:
Vaccine-preventable diseases are dangerous. Prior to widespread childhood vaccination, measles infected three to four million people in the United States every year; this is approximately 100 times the population of the Boston University student body. Among those infected, 500 died, 48,000 were hospitalized, and 1,000 had permanent brain damage from measles encephalitis annually. Worldwide, 146,000 people still die from the disease each year.
Vaccination is safe. US federal laws require extensive clinical testing before a vaccine is licensed, and vaccines cannot be licensed unless their potential benefits clearly outweigh their risks. Once in use, the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and independent researchers continually monitor vaccinated individuals to ascertain previously unseen rare reactions or increases in known reactions and to identify individual vaccine lots with unusual events. If a problem is detected, the CDC and the FDA initiate decisive action such as immediate withdrawal of a vaccine recommendation, as was done in 1998 following the identification of a small, but larger than expected, number of cases of a rare side effect known as intussusception less than a year after the introduction of a new rotavirus vaccine.
Vaccination is effective. Measles, mumps, and rubella (MMR) vaccination is 97 percent effective against development of measles. Since the introduction of measles vaccine in the United States in 1963, there has been a 99 percent decline in the incidence of measles and a 100 percent decline in measles deaths due to the combined effects of individual vaccination and the herd immunity that has been afforded to those who are too young or too ill to be vaccinated. Until recently, there were only 50 to 100 measles cases per year in the United States, and all of these cases were attributed to importation of measles from other countries.
The American public is overwhelmingly in favor of vaccination. For the past 15 years, the United States has consistently achieved or exceeded the public health target of 90 percent vaccination for each of the recommended childhood vaccines. At the start of the 2013–14 school year, 95 percent of kindergartners were appropriately vaccinated against measles, and only 1.7 percent of children had evidence of a nonmedical vaccine exemption. In a study based on a nationally representative sample of parents of two-to-three-year-old toddlers, even parents who chose to follow a delayed vaccine schedule showed strong support for vaccination: 95 percent of parents who delayed at least one of their child’s vaccines believed that “vaccines are necessary to protect the health of children.”
What is controversial is knowing the best approach to address the concerns of vaccine-hesitant parents. Vaccine-hesitant parents represent a heterogeneous group of parents, who because they love their children very much may purposely delay or avoid certain vaccines because they have concerns about vaccine safety. There are three notable things about vaccine-hesitant parents. First, there are more vaccine hesitators than vaccine refusers. Second, vaccine-hesitant parents typically have moderate concerns and do not reject vaccination completely. Third, these parents often seek out vaccine information and are influenced by what they find.
Meaningful research that specifically addresses the needs of vaccine-hesitant parents is just beginning, and in a few years we will know more. In the meantime, there are reports suggesting that constant attention on vaccine refusers may lead vaccine-hesitant parents to wrongly infer that the antivaccination movement is mainstream. But it’s not. In order for this message to be heard, we need to refrain from participating in relentless debates that often include trading insults with semianonymous online commentators and to instead engage in respectful conversations with our family, our friends, and the occasional random acquaintance who exists in our social network. As we engage in conversation, we should remember that vaccination is not controversial, but how we perceive what we are told about vaccination can be.
“POV” is an opinion page featured on BU Today that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international.
Kimberly Shea is a School of Public Health assistant professor of epidemiology. Her research interests include the epidemiology of infectious diseases, especially the epidemiology of vaccine-preventable diseases and the post-licensure effectiveness of vaccination. She can be reached at email@example.com