Egos in BU center take a backseat to sharing, progress, and promise In...
By Lisa Brown
Researchers Find Changes to Protein SirT1 Can Prevent Excess Metabolic Stress Associated with Obesity, Diabetes, Aging
Studies have suggested that the protein SirT1 may be protective in metabolic diseases and the effects of aging, and diminished SirT1 activity has been reported in various disease models including diabetes and metabolic syndrome. Maintaining a normal level of this protein may be effective in preventing obesity- and age-related diseases.
Metabolic stress caused by obesity, diabetes and aging increases a small molecule, glutathione that reacts with SirT1, inhibiting its activity. In a recent paper published in the Journal of Biological Chemistry, BUSM researchers have demonstrated that by changing three of the amino acids on SirT1 they could produce a “super-sirt” which functioned normally despite the metabolic stress.
“In the process of preventing the effects of the stress occasioned by metabolic excess typical of obesity, diabetes and aging, the enzyme function of SirT1 can be destroyed by the very metabolic stress it is trying to overcome,” says Richard Cohen, MD, professor of medicine and director of the section of vascular biology at BUSM. “This study establishes that stresses associated with excess metabolism can be circumvented by changing the protein, or by preventing the glutathione reaction with the protein.”
Dr. Louis Sullivan, BUSM ’58, will be discussing his newly published autobiography, Breaking Ground: My Life in Medicine, on Monday, Feb. 10, at 4 p.m. in the 670 Albany Street Auditorium, First Floor.
A 1958 graduate of BUSM and former faculty member who currently is a member of the Dean’s Advisory Board, Dr. Sullivan is the founding dean and first president of Morehouse School of Medicine (now president emeritus). He served as Secretary of Health and Human Services during the George H. W. Bush administration. He is chair of the board of the National Health Museum in Atlanta and the Washington, D.C.–based Sullivan Alliance to Transform America’s Health Professionals. He also is author of The Morehouse Mystique: Becoming a Doctor at the Nation’s Newest African American Medical School (with Marybeth Gasman).
Dr. Sullivan has many annecdotes to share about his experiences in Washington, D.C., dealing with the burgeoning AIDS crisis, PETA activists, and antismoking efforts, along with his efforts to push through comprehensive health care reform decades before the Affordable Care Act. His interactions with political figures, including Thurgood Marshall, Jack Kemp, Clarence Thomas, Jesse Helms and the Bushes, capture a time in recent history.
A reception and book signing will follow in the auditorium foyer.
- Breaking Ground: My Life in Medicine, Lecture and book signing
- Dr. Louis Sullivan, BUSM ’58
- Monday, Feb. 10
- 4 p.m.
- 670 Albany Street Auditorium, First Floor
Type 1 diabetes is a genetically-driven autoimmune disease of pancreatic beta-cells, whose origins remain unknown. Researchers at Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) discovered that skin cells from patients with type 1 diabetes display abnormal activity triggered by immune response mechanisms to environmental stimuli like a viral infection. These findings currently appear online in PLoS One.
They found that these cells acquire elevated levels of calcium when exposed to either cytokines or fat. In humans, cytokines or cell signalling molecules essential to the body’s immune response, increase with the onset of infection as does an excess of fatty acids when people are sick and stop eating, a common occurrence in children when they get viruses.
“This is significant as it is known that a viral illness usually precedes the development of type 1 diabetes in children but no one knows why it should be related,” says Barbara Corkey, PhD, Zoltan Kohn Professor of Medicine at BUSM and vice chair for Research in the Obesity Research Center at BMC. “Our findings that diabetic cells have a different sensitivity as indicated by higher levels of calcium to an environmental event such as a virus, may help to explain why the onset of type 1 diabetes might be triggered by an environmental stimulus as well as a genetic predisposition.”
In fact, their data showed that skin cells from relatives of people with type 1 diabetes who are not afflicted with type 1 diabetes themselves display an intermediate calcium response to circulating signaling molecules. These data suggest that a unique environmental stimulus may interact with a genetic trait to initiate diabetes.
“Determination of this trait before development of diabetes could help to identify susceptible individuals prior to disease onset,” adds Corkey.
Students will complete both degrees in six years
BU’s new MD/JD program will appeal to students interested in health care administration, health care legislation, medical licensing, and intellectual property issues focused on medical research.
Boston University will offer a joint Doctor of Medicine (MD) and Juris Doctor of Law (JD) degree program starting next fall, becoming only the second New England university, along with Yale, to offer the dual degree. Simultaneous admission to both the School of Medicine and the School of Law will be required, and applicants must take the LSAT and MCAT exams to be considered. The new program will be highly selective, initially accepting two students a year.
Citing the increasing interaction between the fields of health and law and recent changes to government regulations and health policy, MED and LAW administrators believe that the program will appeal to students interested in health care administration, health care legislation, medical licensing, and intellectual property issues focused on medical research.
“This degree, which combines medical and legal expertise, is excellent preparation for students considering hospital or health care system leadership opportunities or careers in medical policy and academic administration,” says Karen Antman, provost of the Medical Campus and dean of MED.
Megan Sandel, a MED associate professor of clinical pediatrics and program director of the joint degree program for the School of Medicine, says students will spend the first three years in a medical curriculum, focusing on the basic sciences during the first two years and the eight core clerkships, among them surgery, pediatrics, and internal medicine, the third year. They will spend their fourth and fifth years completing the first two years of law school, with some medical clinical experiences built in to maintain skills. The final year of the program will include a mix of elective courses from both MED and LAW that will complement an area of concentration of their choice.
Boston University becomes the 19th university in the country to offer a joint MD/JD program. In addition to Yale, other schools include Duke, the University of Miami, the University of Chicago, Vanderbilt, and Texas Tech. Almost all of the programs, like BU’s, allow students to complete the two degrees in six years, rather than the seven it would take if they were to pursue the degrees separately. Each school structures the program slightly differently. At Duke, for example, students spend the first two years in the MD program and the next two years enrolled in the law school, and then they return to the medical school for elective clinical work tailored to their interests.
“The MD/JD degree program advances the University’s ‘One BU’ philosophy and the law school’s strategic plan to establish dual degree programs,” says LAW Dean Maureen O’Rourke. “We are launching this new degree with the School of Medicine at a time when the growing fields of technology, health care management, and health law need professionals who possess both medical and legal expertise.”
This BU Today story was written by John O’Rourke. He can be reached at email@example.com
Douglas V. Faller, MD, PhD, Grunebaum Professor for Cancer Research and professor of medicine, pediatrics, biochemistry, microbiology, pathology and laboratory medicine; vice-chairman, Division of Medicine; and director of the Cancer Center at Boston University School of Medicine (BUSM), recently was awarded the Marta Marx Award from the Scleroderma Foundation for receiving the top score of all proposals reviewed by the scientific peer-review committee. The award includes a two-year $150,000 grant for his project “PKCs Inhibitors as Targeted Therapeutics for Systemic Sclerosis.”
Scleroderma, or systemic sclerosis (SSc), is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. Scleroderma is a disease that involves the buildup of scar-like tissue in the skin. It also damages the cells the line the walls of the small arteries. The cause of scleroderma is unknown.
The hallmark features of SSc include vascular damage, immune dysfunction and extensive skin and organ fibrosis. According to Faller, significant strides have been made in understanding the development of SSc and identifying potential therapeutic targets, including a central role for transforming growth factor (TGFb) signaling. “The novel Protein Kinase C isozyme (PKCd) plays a key role in the occurrence of fibrosis and vasculopathy in SSc. My colleague, professor Maria Trojanowska, director of the Arthritis Center has shown that in SSc fibroblasts, PKCd is activated, and fibrosis induced by TGFb is dependent upon PKCd. The TGFb/PKCd pathway is also involved in the fibrotic pathology of multiple other fibrotic diseases. Thus, blocking the TGFb/PKCd pathway could be an attractive therapeutic approach for both the vasculopathy and the fibrosis of SSc,” explained Faller, who also is vice chairman of the Cancer Research Center at Boston Medical Center. “We have now developed novel small molecule drugs to block this pathway,” he added.
Faller believes that a specific small-molecule inhibitor of PKCd would ameliorate the fibrosis and vascular pathology induced by TGFb and other inflammatory mediators in models of scleroderma, and represents a new therapeutic approach to this disease. “Since therapeutic options for SSc are limited, the development of such novel and targeted treatments is of paramount importance,” said Faller.
One of two universities in New England to offer distinctive program
Boston University will begin offering a six-year Doctor of Medicine (MD) and Doctor of Law (JD) degree through a joint program between two of its most prestigious professional schools—the Schools of Law and Medicine. With the implementation of this new dual degree in fall 2014, BU joins Yale as the only two universities in New England to offer this distinctive program.
The complex interactions of medicine and law combined with changes to health policy and government regulation and mandates have created a need for individuals trained in the nuances of each of the areas. Today those trained as both physicians and lawyers may find themselves at the juncture of these forces. Career paths for those holding both degrees may include working in health care administration, on a wide array of health law issues including legislation and programs to end health disparities, on intellectual property issues related to medical research and technologies, or in areas such as medical licensing.
“From the implementation of the Affordable Care Act to patenting innovations in biotechnology to managing the growing complexities of health care organizations, the legal and medical fields have become increasingly intertwined,” says BU School of Law Dean Maureen A. O’Rourke. “We want to prepare future leaders who can manage the rapid changes that are happening in these interdisciplinary fields.”
Students earn both degrees one year sooner than they would if they pursued them independently. They complete the first three years of the medical school curriculum, then spend their fourth and fifth years fully integrated into the J.D. program at the School of Law. They fulfill their remaining medical and law course requirements in the sixth year of the program.
“This degree, which combines medical and legal expertise, is excellent preparation for students considering hospital or health care system leadership opportunities or careers in medical policy and academic administration. By collaborating across the University with our outstanding law school colleagues, we believe that we have designed what will become one of the highest quality, most comprehensive and sought-after MD/JD programs in the U.S.,” says BU School of Medicine Dean and Medical Campus Provost Karen Antman, MD.
The program is conducted under the auspices of both Schools with simultaneous admission to both required for acceptance into the program. Matriculating students will be advised by faculty members from both Schools. Consistent with other MD/JD programs, over the six years students will complete the required coursework in both schools. This will begin with the first three years of medical school, including the eight core clerkships, to gain a foundation of clinical medicine. It then will proceed with the required 58 credits of courses in law over the next two years, and in the final year combine medicine and law electives consistent with the area of concentration of the student’s choice. Applications to the program will be accepted in spring 2014.
For more information, visit www.bu.edu/law/central/jd/programs/dual/medicine/index.html.
A week on food stamps shows MED students the program’s limits
At 6 feet and 200 pounds, Fabian Chang must fuel an ample frame for the grind of medical studies. Yet for one week in December, he ate only what he could buy for $30. That’s the average weekly benefit paid nationally under the federal food stamps program, says the School of Medicine student, whose week was an odyssey in belt-tightening.
Chang (MED’16) conceived this “SNAP challenge” (SNAP—Supplemental Nutrition Assistance Program—is the food stamps program’s formal name) for himself and others on the Medical Campus, and during last month’s weeklong regimen, he didn’t go hungry. But he discovered, as have families on food stamps, that fending off an empty stomach means making do with a malnourishing menu. His fresh food ran out by day five, leaving him to end the week subsisting on eggs, bread, rice, and pasta.
“I was able to get enough food,” he says, “but it was definitely difficult to maintain a healthy diet.” And with the expiration of the portion of the Obama stimulus devoted to SNAP, things like coffee were an unaffordable luxury.
In advance of continued congressional debate over whether to cut SNAP, about 15 MED students and deans took the SNAP challenge, sponsored by the school’s Student Nutrition Awareness & Action Council. The goal was to raise future doctors’ awareness of the nutritional challenges faced by poor patients.
Boy, was it raised.
“My body feels BAD,” one participant wrote on a blog set up for the experiment, after just two days on her regimen. “I’m not sure if the food has gone bad or was low-quality to begin with, but after my lunch of beans and meat yesterday around 3 p.m., I felt physically ill at school and had to come home to take a break and drink lots of water. I also notice that because my meals aren’t nutritious, no matter how much I eat, I don’t ever feel satisfied.” Another blogger reported that the experience prompted her to volunteer at a food bank.
Indeed, while few Americans starve—there’s an obesity epidemic, notes SNAP challenge taker Dan McGrail (MED’16)—shopping becomes stressful on a tight budget. “It is really difficult to walk through the store and pass up on items like bread because you think it will put you over budget,” McGrail says. “It is a challenge to obtain a healthy meal.” (A Harvard study corroborates the unhealthy aspects of eating under the constraints of SNAP, while also noting that it is possible to go hungry on the program: recipients may run out of food at month’s end, since benefits are paid at the start of each month.)
Before embarking on the challenge, Iris Trutzer (MED’21) confessed to feeling terror at a mere $30 budget, mitigated only by the fact that she knew she’d be able to eat normally again after seven days. “We all have to keep in mind that we’re not living like a person who lives on SNAP benefits,” she said. “We’ll be off this in a week, and we’re also living with a full kitchen in a house that has heating and no utilities insecurity, no housing insecurity. So we’re doing this very much in a vacuum.”
While student participants interviewed hoped to increase awareness of how paltry the SNAP food allotment is, their main goal was to show their aspiring-doctor peers that the condition of malnourished patients is not necessarily the patients’ fault. “Increasing the empathy of future health care providers—understanding where patients are coming from, the challenges they face—will hopefully help us be better providers of care,” McGrail says.
“For some of our kids in our clinic, SNAP can be a lifeline,” says Megan Sandel, a MED associate professor and a pediatrician at Boston Medical Center. Some of her patients have had problems ranging from inactivity to disruptive school behavior after their families’ food stamp benefits were cut, she adds.
Chang borrowed the one-week-on-SNAP idea from U.S. Senator Cory Booker (D-N.J.), who had done it while serving as mayor of Newark, N.J. It has been an education unlike that of medical school, teaching Chang the fine art of food budgeting: “The cheapest meat pieces are these chicken leg quarters that are like a dollar a pound.…If you budget those chicken quarters, you can get two meals out of them.” Frozen and in-season vegetables are also good buys, he discovered, but “fruits are a luxury.”
Canned beans, a good protein source, are more expensive than dried ones, but don’t need cooking, he notes. But he’s also learned that splurging to save a night’s cooking is a privilege denied those on SNAP.
“If you’re on that tight budget of $30, you have to cook every meal,” he says. “It gave me a level of understanding about people who may be at the poverty line who are struggling to make ends meet, and they might have two jobs—where do they find the time to cook all the food and plan?”
This BU Today story was written by Rich Barlow. He can be reached at firstname.lastname@example.org.
Pediatrician remembered as strong advocate of primary care
Joel Alpert loved the Yale Bulldogs, believed men should wear ties, hated smoking, and relished a good debate. But among his many passions, he most ardently supported the provision of quality primary care to the children and families he served as the one-time chief of pediatrics at Boston Medical Center (BMC).
Arriving at BMC (then Boston City Hospital) in 1972, Alpert, a School of Medicine professor and chair emeritus of pediatrics, “came into a challenging situation and basically, at a time when everyone was moving to subspecialty care, put the limelight on primary care pediatrics,” says Robert Vinci, MED’s Joel and Barbara Alpert Professor of Pediatrics and department chair and chief of pediatrics at BMC. “He turned around this institution. He led with strength, with vision, and he became one of the national figures in academic pediatrics.”
Alpert, who was also a MED assistant dean for student affairs and a member of the Dean’s Advisory Board, died of leukemia on December 31, 2013, while in hospice care near his home in Palm Beach Gardens, Fla. He was 83.
During his four decades at MED and BMC, Alpert pioneered pediatric primary care training and the development of a curriculum that emphasized child development, advocacy, and community care. He held several leadership positions in major pediatric associations and earned numerous awards throughout his career. His writings, including The Education of Physicians for Primary Care in 1974, still define the practice today.
“Joel Alpert was a recognized leader in pediatric care and medical policy,” says Karen Antman, Medical Campus provost and MED dean. “He was an enormous influence on generations of medical students for whom he served as a role model and mentor and held himself, his department faculty, and students to the highest academic standards.”
Alpert was a vociferous advocate of universal health care long before it was politically in vogue. His position was likely rooted, colleagues say, in his Judaism, his focus on equity, and his experience serving as a doctor in London in 1958 and as an Army physician in Kansas in the early 1960s. He completed his residency at Boston Children’s Hospital and joined the Harvard faculty in 1961. A decade later, he arrived at BMC, MED’s primary teaching hospital, where patients largely come from the city’s underserved populations. In an American Academy of Pediatrics interview, he credited his mentor, Charles Alderson Janeway, then the physician in chief at Boston Children’s Hospital, for the advice that pushed him in that direction: “At Harvard, you will teach the people who teach,” Janeway told him. “At Boston University, you will teach the people who do.”
Alpert drilled the value of primary care and community-based pediatrics into the generations of doctors he trained. One of those doctors, Barry Zuckerman, the first Joel and Barbara Alpert Professor of Pediatrics, remembers how his mentor insisted that physicians show up at their clinics, continue to care for patients beyond their first appointments, and ensure that all patients’ needs were met—regardless of whether those needs were medical. “Back in 1972, that just wasn’t done,” says Zuckerman.
But he also recognized and nurtured the individual passions of his younger colleagues. As an intern in 1980, Vinci remembers Alpert encouraging his desire to start a branch of pediatric emergency medicine at BMC. Zuckerman says that Alpert supported him in setting up a division of developmental behavior pediatrics—one of the first in the country—despite Zuckerman’s being only one year out of his fellowship.
“He valued those things that I believed in,” Zuckerman says. Although they might not have been mainstream, “he cared about them and valued both me and my ideas.”
Alpert campaigned tirelessly around issues of lead poisoning and gun control—even proudly pointing to his position on the National Rifle Association’s enemies list, according to the Boston Globe. And he despised smoking. Zuckerman remembers a conference Alpert hosted at his home in the early 1970s at which he insisted that anyone who wanted to smoke—including the woman who had helped endow the event—step outside the house, despite the rain. “You can’t fully appreciate how obnoxious he was” about smoking, Zuckerman says.
“When Joel believed in something, he went after it, and there was nothing that was going to stop him,” Vinci says. “I learned from Joel that no matter how challenging the situation, you just didn’t back down. If this was the right thing to do, you went after it.
“He really believed that pediatricians should be advocates, that our voices should be heard,” Vinci adds. “And in doing so, that we should be and become the voices of the children and families we served.”
Alpert’s “numerous contributions in the field of pediatrics improved the lives of countless children and their families and will continue to do so for many years to come,” says Kate Walsh, BMC president and CEO.
Born and raised in New Haven, Conn., Alpert graduated from Yale University in 1952. He earned a degree from Harvard Medical School four years later, but remained loyal to his undergraduate alma mater. He attended more than 50 Harvard vs. Yale football games over the years and always rooted for the Bulldogs, Vinci says.
While at BU, Alpert served as president of the American Academy of Pediatrics and of the Academic Pediatric Association, formerly Ambulatory Pediatrics. He was also elected a member of the Institute of Medicine and named an honorary fellow of the Royal College of Paediatrics and Child Health in London.
In 2000, Alpert and his wife, Barbara, established the Joel and Barbara Alpert Professorship in Pediatrics, which is held by the department chair. That same year, the couple established the Children of the City Fund at BMC to support early career pediatric researchers who study issues affecting inner-city children served by the hospital.
Despite his many career accomplishments, Alpert was first and foremost a family man. He is survived by his wife, three children, eight grandchildren, and his sister. Zuckerman recalls that whenever his boss got a call from his wife or children in the middle of a meeting, he would always take it.
“It was a clearly consistent message that family is what comes first for him,” he says.
Services for Joel Alpert were held on Monday, January 6, at Temple Isaiah and followed by a burial at Westview Cemetery, both in Lexington, Mass. In lieu of flowers, the family asks that contributions be made to the Joel and Barbara Alpert Children of the City Fund at Boston University School of Medicine, 850 Harrison Ave., fifth floor, Boston, MA 02118.
The School of Medicine plans to hold a memorial service in Alpert’s honor later this year.
This BU Today story was written by Leslie Friday.
Boston magazine’s annual list includes 68 faculty
Among the 650 physicians named to Boston magazine’s recently released “Top Docs 2013” list are 68 from Boston Medical Center (BMC) and the BU School of Medicine. The list, which provides consumers with information on the Hub’s top doctors across 50 specialties, commended BMC physicians from 30 different disciplines, such as cardiovascular disease, surgery, and pathology, and profiled another—Jeffrey Kalish, a MED assistant professor of surgery and of radiology and BMC director of endovascular surgery—for heroic work during the April 15 Boston Marathon bombings. The list appears in the magazine’s December issue.
“We are delighted that these outstanding faculty are being recognized by their colleagues for providing the highest quality of compassionate care,” says Karen Antman, MED dean and provost of the Medical Campus.
Alik Farber, a MED associate professor of surgery and of radiology and chief of the BMC division of vascular and endovascular surgery, has been included on the list in the vascular surgery category each year since 2010.
“To be nominated in a city that is the center for medicine for the United States and possibly the world is a humbling experience,” Farber says. Having 67 of his colleagues on the list, he adds, is “an important accolade for Boston Medical Center.”
Francis A. Farraye, a MED professor of medicine and codirector of BMC’s Center for Digestive Disorders, has held a spot as a top gastroenterologist on the list each year since 2010. Farraye is especially proud of the gastroenterology department’s recognition, in light of the fact that it is smaller than those at many of the other teaching facilities in Boston. Four gastroenterologists were named to the list this year, which he says is “a testament to the breadth of the clinical faculty.”
The profile of Kalish, titled “Six Heroic Saves,” focused on his work treating Adrianne Haslet-Davis, a professional ballroom dancer whose foot Kalish amputated. The two became close during her stay at BMC. Nearly eight months later, Haslet-Davis is dancing—albeit differently—and her doctor promises to watch her perform again someday.
Kalish says that “when members of the health care system get together across disciplines, we provide more effective and better care for all of our patients.” In the aftermath of the bombings, he recalls, professionals from all specialties and ranks worked in sync to determine the best course of action for the patients. “Forming bonds with these patients through this tragedy reinvigorated for many of us why we actually went into health care,” he says. “It reminds us why we do this.
“I’m just one person that was part of an enormity of people that did amazing work, he says. “While I have this unique bond with Adrianne, there are plenty of others who have done the same.”
Kalish says the medical community learned “amazing lessons” this year. Boston’s December issue should reinforce Bostonians’ confidence in their medical community as it proves “the variety and strength of physicians and the ability of the city’s medical community to address any problem that might arise,” he says.
To be included in Boston magazine’s Top Doc list, physicians undergo a rigorous screening process by national medical research firm Castle Connolly. The firm gathers nominations online from other licensed physicians, conducts phone interviews with medical professionals to corroborate nominations, and checks the professional qualifications of all nominees, among them education, experience, and disciplinary history. The nominees complete a professional biography form, and the information is cross-referenced and confirmed.
“We have an incredible medical community here in Boston, and that was on full display in the wake of the Marathon bombings,” says Boston magazine senior editor Janelle Nanos. Nanos says she relished the opportunity this year “to celebrate the work that they did and acknowledge how lucky we are as citizens of Boston to be surrounded by such amazing medical professionals.”
A full list of 2013’s “Top Docs” and those from Boston Medical Center is here.
This BU Today story was written by Emily Truax.
As a result of the limited transgender medical training offered at medical schools, very few physicians possess the knowledge needed to treat transgendered patients. This circumstance is the topic of a paper in this month’s issue Current Opinion in Endocrinology, Diabetes and Obesity.
Joshua Safer, MD, FACP, associate professor of medicine at Boston University School of Medicine (BUSM) and Director of the Endocrinology Fellowship Training Program at Boston Medical Center, is the senior author of the piece which includes guidelines for transgender treatment and also references the impact of recently piloted teaching on the topic at BUSM.
There are approximately 900,000 transgender persons living in the U.S. These individuals have a unique set of medical needs because their gender identities do not correlate with their biological sex. Medical interventions such as hormone therapy are required to appropriately and safely address the health of transgender patients.
According to Safer while many of the treatment regimens for transgender patients are fairly straightforward, very few physicians have the knowledge needed to treat these individuals. In fact, many physicians share the misconception that transgender treatment is a psychological issue and that gender identity can be reversed—an assumption that has been discredited.
“Because medically appropriate high-quality care for transgender individuals is not taught in most medical curricula, too few physicians have the requisite knowledge and comfort level for treatment of transgender individuals,” explained Safer.
Safer has recently piloted a transgender medicine component to the pathophysiology curriculum for medical school students at BUSM. According to pre- and post-course surveys published this summer in the journal Endocrine Practice, there was a 67 percent improvement among students enrolled in his course regarding their confidence with transgender medicine.
Safer is working to develop comprehensive transgender medicine training curricula for medical students, physician trainees, teaching physicians and other health care professionals. to address the specific biological distinctions of the patient group and evidence-based treatment paradigms derived from that biology. This training program would increase access to safe care for transgender patients.