NBC Meet the Press Ann McKee, MD, neurosurgery
Deborah A. Frank, MD, BUSM inaugural Professor in Child Health and Well-Being, Pediatrics, has been named to the National Commission on Hunger by the U.S.Congress. Frank is director of the Grow Clinic for Children at Boston Medical Center (BMC) and founder and principal investigator of Children’s HealthWatch, a network of pediatric and public health researchers working to improve child health. A highly respected national authority, she has testified before both the United States and Massachusetts legislatures on the growing national problem of hunger and its effects on children. Learn more at https://hungercommission.rti.org/.
Deeper understanding of telomeres may lead to targeted cancer treatments
By a quirk of biology, every time an adult cell divides, a bit of DNA gets lopped off the end of the double helix. This seems like a recipe for disaster—imagine a crazed librarian ripping the last chapter off a book every time it got checked out. Soon, the book would be useless. So would truncated DNA, if not for structures called telomeres, long sequences of repetitive base pairs—the same meaningless TTAGGG over and over—that cap each end of our DNA. Every time a cell divides, it’s a bit of telomere that gets chopped off, rather than vital genes.
But biologists have long understood telomeres to be a double-edged sword. When they get too short, cells stop dividing. We see this as aging: hair turns gray, skin sags. But some cells are able to keep their telomeres long, effectively becoming immortal and dividing forever. Sometimes, the immortal cells become a cancer.
Now, scientists led by Rachel L. Flynn, a Boston University School of Medicine (MED) assistant professor of pharmacology and experimental therapeutics and medicine, have found a new way to kill certain cancers by targeting mechanisms of telomere elongation. The research, funded by the National Institutes of Health, the Foster Foundation, and the Karin Grunebaum Cancer Research Foundation, and published in the January 15, 2015, issue of Science, may lead to new therapies for certain rare and deadly cancers that often appear in children.
Cells that are able to lengthen their telomeres, and thereby divide indefinitely, use two known methods to do so. The more common is to use an enzyme called telomerase, which is active in embryonic stem cells but repressed as cells become specialized. The less common method, and the one Flynn studies, is called ALT, for alternative lengthening of telomeres. The ALT pathway is most prevalent in certain cancers, including pediatric osteosarcoma, a bone cancer, and glioblastoma, a type of brain cancer.
“In terms of the possible clinical applications, this research could be a game changer,” says Karen Antman, MD, provost of BU Medical Campus and dean of Boston University School of Medicine. “This exciting finding could allow us to target any cancer that uses the ALT pathway to maintain telomeres. Such cancers are often resistant to common treatment options and have a poor prognosis.”
The ALT pathway, though discovered almost two decades ago, is still poorly understood, says Flynn. “We know that ALT is a mechanism that relies on recombination—one telomere basically hijacks another and uses it to replicate and elongate itself,” she says. “But we didn’t know how the pathway was maintained until now.”
Flynn’s paper suggests how cancer cells may be able to maintain the ALT pathway—by depending on an enzyme called ATR kinase. This enzyme is what’s known as a “master regulator,” says Flynn. In a normal cell, it recognizes DNA damage when a cell is preparing to divide, and leads to either DNA repair or cell death. ALT cancer cells are constantly undergoing DNA repair at the telomere and are more reliant on ATR kinase activity than other cancer cells. Therefore, ATR promotes immortality by helping telomere elongation. Attack this enzyme, says Flynn, and you stop the cancer cell in its tracks.
“When you take ATR kinase out of the picture, it shuts down a whole chain of events,” says Flynn. “The cancer cell tries to promote telomere elongation, but it can’t, and the cell dies.”
There are several drugs already on the market that act as ATR kinase inhibitors, but none are used individually to treat these types of cancers. “The cool thing about these drugs is that the cancer cells actually die incredibly fast as opposed to just slowing down cell growth,” Flynn says. She also notes that since the drugs only affect cancer cells using the ALT pathway, normal cells should be left unharmed.
Flynn’s next step is to get the existing drugs into clinical testing for targeted use. She is working with a group at Massachusetts General Hospital who will test it on mice with glioblastomas. Eventually, she hopes, her work will lead to a new treatment for these deadly diseases.
“The dream is that this research will eventually give kids with devastating cancers an option for individualized treatment, something that will hopefully improve outcomes,” says Flynn.
This BU Today article was written by Barbara Moran. She can be reached at firstname.lastname@example.org.
A version of this story was originally published in BU Research.
Emelia J. Benjamin, MD, ScM, professor of Medicine at BUSM, professor of Epidemiology at BU School of Public Health, co-Principal Investigator of the Framingham Heart Study and attending cardiologist at Boston Medical Center, has been selected as the recipient of the prestigious 2015 American Heart Association (AHA) Paul Dudley White Award.
The award, named in honor of one of Boston’s most revered cardiologists, Dr. Paul Dudley White, a founding father of the AHA, is given annually to a Massachusetts physician who has made a distinguished contribution to the Association’s mission of building healthier lives, free of cardiovascular disease and stroke. Benjamin will receive the award at the Boston AHA Heart Ball on May 2. Last year BUSM faculty member Dr. Gary Balady, received the award.
Benjamin is an associate editor for Circulation, and she also volunteers as vice chair of the Heart Disease and Stroke Statistics annual publication. She is a current member of the Council Operations and the Research committees, and past chair of the Functional Genomics and Translational Biology Council, and the Genomics & Translational Biology, Epidemiology and Observational/Epidemiology Research Study Section. In 2012 and 2013 she received the AHA’s Women in Cardiology and Functional Genomics and Translational Biology national mentoring awards, respectively.
Benjamin focuses on cardiovascular genetic epidemiology, and has made major contributions in the areas of atrial fibrillation, inflammation, vascular function and echocardiography.
Med schools would remain separate, safety-net hospital would stay in place
Boston Medical Center, Boston’s “safety-net hospital” and the primary teaching hospital for the BU School of Medicine, is discussing a strategic partnership, including a potential merger, with Tufts Medical Center, the primary teaching hospital for Tufts University Medical and Dental Schools.
Karen Antman, dean of the School of Medicine and provost of the Medical Campus, stressed that any partnership or merger would not include the medical schools, which are parts of their respective universities.
Robert A. Brown, president of Boston University, says it is imperative that any partnership or merger maintain Boston Medical Center (BMC) as a premier academic medical center and as a safety-net hospital, fulfilling the hospital’s mission to provide exceptional care to the city’s vulnerable populations, regardless of insurance status or ability to pay. “BMC is a superb academic medical center and the city’s most important safety-net hospital,” Brown says. “If a partnership or merger can ensure that BMC continues to play both these roles in a stronger, sustainable way in the future, it is worth pursuing.”
Kate Walsh, president and CEO of Boston Medical Center, echoed Brown’s commitment to continuing to provide first-rate medical care for all. Walsh says conversations to date suggest that a strategic partnership may strengthen the missions of both medical centers and that “an affiliation that secures a long, bright future of continuing to provide exceptional care without exception would be of great interest to us.”
She says a partnership with Tufts Medical Center could have great potential benefits, including new options to serve patients, greater financial resources, and a larger referral network to attract new patients and better payments from insurers.
“Tufts Medical Center is our neighbor,” says Walsh. “We know them, we respect them, we share a common geography and a commitment to providing high-quality care to all patients. We also share a mutual commitment to our academic missions of teaching and research.”
Over the last 20 years, changes in health care models have made hospital partnerships and mergers a virtual requirement for a sustainable health care business, particularly in the Boston area. In 1994, Massachusetts General and Brigham and Women’s teaching hospitals teamed up to form Partners Health Care, which has since brought in several community hospitals around Boston. In a rival venture, Steward Health Care has, in the past few years, taken over 10 community hospitals as well at St. Elizabeth’s and Carney hospitals. Earlier this year, Beth Israel Deaconess Medical Center took control of Jordan Hospital in Plymouth and formed a joint venture with New England Baptist Hospital. Antman says many observers of Boston’s crowded health care arena consider a merger involving Boston Medical Center to be long overdue.
Similarly, changes in health care payments combined with cuts in research funding have hit academic medical centers particularly hard. An alliance between Tufts and BMC could produce efficiencies of scale, Antman says.
Walsh cautioned that while the two medical centers have much in common, “there is more work we need to do before we will know whether a partnership is the best option for our employees, and most importantly, our patients.”
A combination of the two medical centers could result in significant change for clinical faculty at both schools of medicine. Boston Medical Center currently has 724 physicians, including the clinical faculty at the BU School of Medicine, and Tufts Medical Center employs 500. BMC officials say any partnership involving the two hospitals would take years to accomplish, and that the medical center would continue to offer a full range of services.
“We do not underestimate the anxiety that this will create among our clinical faculty,” Brown says. “We also understand that the hospitals, and not the universities, control the outcome of any discussion. We will do all we can to provide support and advocacy on behalf of our clinical faculty during what will be a period of uncertainty.”
If the two hospitals merge, the two medical schools would remain separate, each with its own faculty, curriculum, and rotations, called clerkships. The merger would have no impact on the number of students enrolled at the BU Medical School or on the size of the medical sciences faculty who teach at the school. However, the consolidation may result in fewer hospital beds, which might reduce the number of clerkships and residency slots available to BU and Tufts Medical students in the consolidated hospital. Currently, 45 percent of BU medical students do their clerkships at BMC while 35 percent of Tufts medical students do theirs at Tufts Medical Center.
Antman says she does not foresee a shortage of clerkship opportunities for BU medical students. “We are affiliated with 20 other hospitals in the area,” she says, “and we have a program in place to identify even more clerkship and residency opportunities in Boston, and around the country.”
With more than 870,000 patient visits last year and more than 4,500 full-time staff, Boston Medical Center is the largest safety-net hospital in New England. Approximately 70 percent of BMC patient visits come from come from people who rely on government payers such as Medicaid, the Health Safety Net, and Medicare for their coverage.
Boston Medical Center struggled with changes to the health care business for years and only recently, under the leadership of CEO Kate Walsh, has it approached financial stability. In 2012, the hospital reversed three years of losses and posted a small but meaningful financial gain. At the same time, Moody’s Investor Service and Standard & Poor’s bumped up their ratings of the hospital from negative to stable.
“Kate Walsh’s excellent track record as our hospital leader gives us added assurance that any change is likely to be in the best interests of the hospital, the underserved, and those medical students and clinical faculty associated with the facility in the future,” Brown says.
Antman says she sees hope in successful mergers such as the 1998 partnership of New York Hospital and the Presbyterian Hospital, which created the 2,500-bed New York Presbyterian Hospital. That hospital, which has two distinct medical centers, Columbia University Medical Center and Weill Cornell Medical Center, serves as the primary teaching hospital for Columbia University’s College of Physicians and Surgeons and the Weill Cornell Medical College.
“In these initial discussions we are all looking forward to finding a new way to educate medical students in Massachusetts,” says Antman. “There is no reason we can’t work with our partners to create a better educational experience for our students.”
This BU Today story was written by Art Jahnke.
BUSM graduates MaryAnn Wilbur, MD, MPH (MED ’11, MPH ’11), and James Yeh, MD, MPH (MED ’10), have been chosen for prestigious New England Journal of Medicine (NEJM) editorial fellowships. With more than 600,000 readers in 177 countries, NEJM is the most widely read and cited general medical journal in the world and has a rigorous peer-review and editing process. The yearlong program involves fellows in the day-to-day editorial activities of the journal, work on journal articles and an independent project.
“The fellowships help us inject new ideas into the NEJM,” says Jeffrey Drazen, MD, editor-in-chief of the NEJM. “We are interested to hear each fellow’s fresh perspective, and we hope their relationships with us continue well after their fellowships end.”
Chief resident in obstetrics and gynecology at Johns Hopkins Hospital, Mary Ann Wilbur served as the case manager for the Grow Clinic at Boston Medical Center, BUSM’s primary teaching hospital,
before being accepted to medical school. “For me, medicine is the perfect marriage of science and advocacy, and BUSM was the natural choice for my medical education,” she said. “I had been working on campus at BMC, which cares for the underserved populations of Boston and shares my personal mission.” As a co-founder of the BU Advocacy Training Program, Wilbur also completed a Master’s in Public Health, “because I recognized the importance of understanding the social determinants of health and wanted a framework on which to build when advocating for marginalized populations.”
A co-author of a number of published articles while a medical student, Wilbur learned about the NEJM fellowship from doing a BUSM elective at the journal. “NEJM is a prestigious periodical, and I hope to learn more about how editors review medical literature, a key to successful publishing in the future,” she says. “I also am very interested in the NEJM Perspective articles, which strongly influence the politics of medicine and will help facilitate my career as a physician advocate.” After completing the fellowship, Wilbur plans to stay in Boston to focus on women’s health while caring for the city’s underserved populations.
Yeh practices urgent care medicine at Brigham and Women’s Hospital, Boston, and is a hospitalist on the inpatient medicine service. He completed his internal medicine residency at Cambridge Hospital and is completing a research fellowship in general internal medicine through the Harvard Medical School (HMS) faculty development program. He also is completing a Master’s in Public Health in Clinical Effectiveness at Harvard School of Public Health.
He is the author and co-author of a number of research articles and book chapters, and editor of several books. Yeh serves as deputy editor for the Harvard Public Health Review and as an ad hoc manuscript reviewer for the Journal of General Internal Medicine, contributing editor to the DynaMed EBM Journal, and was an abstract reviewer for the American College of Physicians Annual Meeting 2010-2013.
“I am interested in evidence-based medicine and knowledge translation, and I hope to gain insights in how a medical journal can help communicating medical research into clinical practice,” says Yeh of his participation in the NEJM fellowship. He also is interested in understanding the effectiveness of the communication process about drug effectiveness and safety, and in the FDA’s regulatory policies and drug risk communication. The recipient of HMS awards for excellence in teaching, he plans to continue in academic medicine because of his love of teaching and research along with patient care.
“The New England Journal of Medicine plays a pivotal role in communicating many of the best biomedical research studies as well as framing many medical policy positions,” says BUSM Dean Karen Antman, MD. “Our recent graduates, Drs. Wilbur and Yeh have earned this important opportunity to broaden their perspective on medical communication.”
New online program now open for registration
Many medical students dream of being able to teach one day, but the intensive rigors of their curriculum leave them little time to acquire the skills that would prepare them to do so. The same is often true for doctors and nurses who have developed areas of expertise and are interested in teaching, but lack the requisite teaching background.
Gail March (CFA’73) has witnessed this firsthand as a School of Medicine assistant professor and director of instructional design and faculty development. For the past decade, March has run a faculty development program at MED. But she realized she wasn’t reaching everyone, particularly busy health care providers who have dedicated their professional lives to caring for patients and suddenly find themselves asked to teach. That led March to propose and create a new program, the BUSM+ Medical Education Badge Program through a Digital Learning Initiative (DLI) seed grant for online innovation in higher education.
The program’s first course, Teaching and Learning, will provide health care professionals with a foundation in students’ learning styles, give them tools to design an interactive course, and teach them how to evaluate students. Registration is open now through December 15. Sessions begin January 15 and run through March 30.
“It’s a very new concept,” says March. The program is designed for health care providers of all stripes—including doctors, nurses, chiropractors, and dentists—who are preparing to enter the classroom as instructors. March says the pilot program is also ideal for health care providers already teaching who want to enhance their skills. “We wanted to introduce some new ideas in medical teaching because there have been so many advances in medical technology,” says March.
“There is growing demand for nontraditional professional development programs,” says Chris Dellarocas, director of the DLI. “Such programs are typically short, highly targeted, and do not culminate in traditional degrees, but rather in micro-credentials, such as certificates and badges. Beyond the merits of its excellent content, the MED badge program is especially interesting because it is Boston University’s first experiment with badges.”
Registrants complete up to 10 online sessions to receive the badge level that corresponds with the number of sessions they complete: competent (5 sessions), exemplary (7 sessions), or master (10 sessions). Single sessions are also an option for those not looking to earn a badge.
Each session features a video with tips from MED’s leading faculty—such as Anna Hohler, associate professor of neurology; Robert C. Lowe, associate professor of medicine; and Wayne LaMorte, professor of surgery and School of Public Health professor of epidemiology—on topics such as facilitating small-group learning, developing interactive lectures and presentations, designing multiple-choice assessments, and identifying the neurological basis for the adult learner. Participants will have a week to complete each session, which can be accessed 24/7. Those electing to take all 10 sessions will be given 12 weeks to complete the program.
Registrants receive their digital badges once they’ve completed the requisite number of sessions. March says they can use Mozilla’s Open Badge infrastructure to create a “backpack” to store their new accolades. Or, if they prefer, they can attach them to their electronic portfolio, CV, or social media sites such as LinkedIn and Facebook.
Each badge is embedded with the professional’s name and the sessions he or she completed. “No one else can claim it,” March assures. “It’s your badge.” For those who prefer recognition the old-fashioned way, physical badges and pins can be requested at registration.
March has already heard from health care professionals interested in taking the sessions from as far away as India, Armenia, and Russia. She says the program is designed to be of use to fellows, residents, medical students, physician assistants, nurses, physical therapists, and many other health care professionals—especially considering that the sessions count toward required continuing medical education credits.
Registrants who teach at MED can take the sessions for free, while those affiliated with BU or the Boston Medical Center will receive a 50 percent discount. All other students will pay a fee of anywhere from $60 to $450, depending on whether they are taking a single session or acquiring a master-level badge, or something in between. March says she chose this pay structure because she wants students to be committed to the program and not drop out, which can occur in free massive open online courses. All profits from the program will go toward funding additional courses.
If all goes well, March envisions running the course again in the summer. She also plans to launch three more courses—Curriculum Design, Academic Leadership, and Medical Education Research—covering skills, she says, that medical students and professionals want to learn, but often don’t have time to pursue in traditional classes.
Visit this site for more information about the BUSM+ Medical Education Badge Program.
Institutions and schools outside of Boston University registering more than 10 people can email email@example.com for discounts.
This BU Today story was written by Leslie Friday.
The latest research from the Laboratory of Molecular NeuroTherapeutics of Tsuneya Ikezu, MD, PhD, from the Departments of Pharmacology and Experimental Therapeutics and Neurology, was featured as a “Hot Topic” for press conference at the recent Society for Neuroscience meeting in Washington, DC.
Ikezu’s latest work entitled “Microglia and exosome-mediated spread of pathogenic tau in Alzheimer’s disease (AD) attempts to further the understanding of Alzheimer’s disease and how brain damage caused by AD spreads from one portion of the brain to the next. According to Ikezu it is now thought that by understanding and eventually preventing this progression one may limit the effects and impact of this devastating disease. Ikezu’s team looked at the role of a specific brain cell known as microglia as a possible “shuttle” for one of the presumed culprit molecules in AD’s tau protein.
Comprising more than 40,000 members, the Society for Neuroscience is the world’s largest organization of scientists and physicians dedicated to nervous system research.
Joint pain brings thousands of people to doctors’ offices each year. Surgery is often used as a form a treatment, aimed to fix the underlying cause in hopes to relieve the pain and problem. But what if surgery is instead, predisposing some people to developing osteoarthritis?
Researchers at Boston University School of Medicine (BUSM) investigated the relationship of meniscus surgery and the development of knee osteoarthritis and found patients undergoing this procedure developed osteoarthritis (OA) and were at higher risk for cartilage loss as detected on an MRI compared to knees with prevalent meniscal damage but no surgery.
According to the researchers one can postulate that meniscal surgery has deleterious effects on joint structure in knees at risk of developing OA. “The pros and cons of meniscal surgery need to be carefully considered for every patient in order to avoid accelerated disease onset and progression,” explained corresponding author Frank Roemer, MD, co-director of the Quantitative Imaging Center and associate professor of radiology at BUSM.
These findings were presented at the Radiological Society of North American annual meeting held recently in Chicago.
Boston Magazine has released its annual Top Docs issue.
Sixty-two BUSM faculty and BMC physicians from 29 specialties are listed as “tops” in their respective fields, and Dr. Nahid Bhadelia, assistant professor of medicine and director of infection control at the National Emerging Infectious Diseases Laboratory (NEIDL) at Boston University is featured on the cover with a story about her recent work caring for Ebola patients in Sierra Leone.
In addition, Dr. Thea James, associate professor of emergency medicine and assistant dean for Diversity and Multicultural Affairs at BUSM, was featured in a story titled “A Day in the Medical Life,” which tracked personal health stats of five health care workers in 24 hours.
Domenic Ciraulo, MD
Allergy and Immunology
Helen Hollingsworth, MD
Tania Phillips, MD
Endocrinology, Diabetes and Metabolism
Alan Farwell, MD
Michael Holick, PhD, MD
Stephanie Lee, MD, PhD
James Rosenzweig, MD
Maternal and Fetal Medicine
Robert Blatman, MD
Aviva Lee-Parritz, MD
David Salant, MD
Carlos Kase, MD
Pediatric Infectious Disease
Physical Medicine & Rehabilitation
Susan Bergman, MD
Thoracic & Cardiac Surgery
The lecture, named in honor and memory of prominent cardiologist Howard Kirshenbaum, offered a history of known Ebola outbreaks in central Africa and an overview of the current outbreak in West Africa.
“The current West Africa Ebola outbreak has been more extensive than the cases in Central Africa for a number of reasons,” said Drazen, also a pulmonologist at Brigham and Women’s Hospital, Distinguished Parker B. Francis Professor Medicine at Harvard Medical School, professor of physiology at Harvard School of Public Health and adjunct professor of medicine at BUSM. “With no previous experience with Ebola, the health care systems in Sierra Leone, Guinea and Liberia do not have the knowhow or capacity to effectively deal with and contain the disease.
Drazen, who referenced several recent NEJM articles on the Ebola outbreak, noted the differences between the two regions. The Ebola virus variant or strain evident in West Africa differs from the Central African region. He also said that some of the cultural and behavioral customs in Central African countries with outbreaks, exclusive of burial rites, carry a lower risk of infection. The West African outbreaks occurred in more densely populated areas with a more extensive road network making transmission of the virus more likely. Drazen concluded his remarks encouraging health care workers to volunteer to care for patients in West Africa.
Elaine Kirshenbaum, BU Board of Overseers and BUSM Dean’s Advisory Board member, established the lecture. “My husband was an exceptional physician and it is an honor to support this lecture in his memory,” said Kirshenbaum. “I am honored that Jeff Drazen is this year’s lecturer, and I am grateful to BU who has been here for me.”